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When Diagnosing Appendicitis, Skip the Enteral Contrast

Summary and Comment |
August 8, 2014

When Diagnosing Appendicitis, Skip the Enteral Contrast

  1. Cheryl Lynn Horton, MD

Diagnostic efficacy of CT imaging with intravenous contrast was equivalent with and without enteral contrast in patients with suspected appendicitis.

  1. Cheryl Lynn Horton, MD

To determine if the addition of enteral contrast improves sensitivity of computed tomography (CT) imaging with intravenous (IV) contrast for diagnosing acute appendicitis, researchers evaluated medical records for 9047 patients who underwent nonelective appendectomies at 56 hospitals in Washington State during 2010 and 2011. Most patients (89%) received CT imaging, and, of these, 54% received IV contrast alone and 29% received IV plus enteral contrast (oral, rectal, or both).

Concordance between final radiology and pathology reports was 90.0% for patients receiving IV plus enteral contrast and 90.4% for those receiving only IV contrast; concordance was significantly lower for those who did not receive contrast (85.7%). Predictors of concordant CT imaging were older age and increasing weight; predictors of discordant CT imaging were lack of contrast and presence of three or more comorbid conditions. Mean time from emergency department (ED) admission to operation initiation was 48 minutes longer for patients receiving enteral contrast than for those receiving IV contrast only.

Comment

Many medical centers are moving toward eliminating enteral contrast for most abdominal CT imaging, as it adds no benefit and lengthens ED stay. When evaluating young and thin patients with suspected appendicitis, ultrasound imaging may be a reasonable place to start. For patients requiring CT imaging, IV contrast alone is sufficient, as enteral contrast offers no diagnostic benefit and should be avoided.

  • Disclosures for Cheryl Lynn Horton, MD at time of publication Nothing to disclose

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