International Journal of Technology Assessment in Health Care



GENERAL ESSAYS

Diagnosis of appendicitis in adults by ultrasonography or computed tomography: A systematic review and meta-analysis


Adèle R. Weston a1, Terri J. Jackson a2 and Stephen Blamey a3
a1 Health Technology Analysts Pty Ltd.
a2 LaTrobe University
a3 Monash Medical Centre

Abstract

Objectives: The use of ultrasonography and computed tomography (CT) in the diagnosis of appendicitis in adult patients was compared.

Methods: Systematic review and meta-analysis of current evidence in two clinical situations: unselected nonpregnant, adult patients with symptoms of appendicitis, and more selective use in only those patients who still have an equivocal diagnosis subsequent to routine clinical investigations.

Results: Meta-analysis of eligible studies shows CT to have better sensitivity and specificity than ultrasound in both clinical situations.

Conclusions: Application of these findings in clinical practice and/or policy would need to evaluate the better diagnostic performance of CT against its cost and availability. In addition, it is imperative that future studies be conducted in patient populations that are well-defined with respect to prior investigations. Sequelae of false-negative and false-positive diagnoses should also be evaluated.


Key Words: Appendicitis; Diagnosis; Spiral computed tomography; Ultrasonography; Academic review.