Diagnostic Accuracy of Noncontrast Computed Tomography for Appendicitis in Adults: A Systematic Review
Received 25 March 2009; received in revised form 20 May 2009 and 15 June 2009; accepted 24 June 2009. published online 07 September 2009. Corrected Proof
Study objective
We seek to determine the diagnostic test characteristics of noncontrast computed tomography (CT) for appendicitis in the adult emergency department (ED) population.
Methods
We conducted a search of MEDLINE, EMBASE, the Cochrane Library, and the bibliographies of previous systematic reviews. Included studies assessed the diagnostic accuracy of noncontrast CT for acute appendicitis in adults by using the final diagnosis at surgery or follow-up at a minimum of 2 weeks as the reference standard. Studies were included only if the CT was completed using a multislice helical scanner. Two authors independently conducted the relevance screen of titles and abstracts, selected studies for the final inclusion, extracted data, and assessed study quality. Consensus was reached by conference, and any disagreements were adjudicated by a third reviewer. Unenhanced CT test performance was assessed with summary receiver operating characteristic curve analysis, with independently pooled sensitivity and specificity values across studies.
Results
The search yielded 1,258 publications; 7 studies met the inclusion criteria and provided a sample of 1,060 patients. The included studies were of high methodological quality with respect to appropriate patient spectrum and reference standard. Our pooled estimates for sensitivity and specificity were 92.7% (95% confidence interval 89.5% to 95.0%) and 96.1% (95% confidence interval 94.2% to 97.5%), respectively; the positive likelihood ratio=24 and the negative likelihood ratio=0.08.
Conclusion
We found the diagnostic accuracy of noncontrast CT for the diagnosis of acute appendicitis in the adult population to be adequate for clinical decisionmaking in the ED setting.
⁎the Division of Emergency Medicine, Columbia University Medical Center, New York–Presbyterian Hospital, New York, NY
†Division of Emergency Medicine, Weill Cornell Medical Center, New York–Presbyterian Hospital, New York, NY
‡Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
§Mount Sinai Heart, Mount Sinai Medical Center, New York, NY
∥the Division of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI
Address for correspondence: Veronica Hlibczuk, MD, Division of Emergency Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, 622 West 168th St, PH1-137, New York, NY 10032; 212-305-2995, fax 212-305-6792
Supervising editor: Allan B. Wolfson, MD
Author contributions: VH and JAD conceived the study and reviewed and assessed all relevant studies. VH, JAD, and MDB supervised the conduct of the systematic review and data collection. VH, JAD, and LF conducted the search of all relevant electronic databases, meeting abstracts, and bibliographies. ZJ and MDB provided statistical advice. VH, JAD, ZJ, and MDB analyzed the data. VH and JAD drafted the article, and all authors contributed substantially to its revision. VH takes responsibility for the paper as a whole.
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ABSTRACT