• Toms Augustin, Siddharth Bhende, Keyur Chavda, Thomas VanderMeer, and Burt Cagir.
• Department of General Surgery Residency, Robert Packer Hospital, One Guthrie Square, Sayre, PA 18840, USA. augustin_toms@guthrie.org
• J. Gastrointest. Surg. 2009 Jul 1;13(7):1306-12.

IntroductionStudies examining the relationship between computed tomography (CT) scans and appendiceal perforation have largely been conducted in urban centers. The present study sought to evaluate this relationship in a rural hospital.Methods And ProceduresThis is a retrospective analysis of 445 patients who underwent appendectomies from January 2000 to June 2005 at a rural teaching hospital.ResultsFour hundred forty-five patients were analyzed in two groups; those who underwent CT scans (N = 245) and those who did not (N = 200). Patients undergoing CT scans were significantly older (median age 38 vs. 22 years, P < 0.0001), were more likely to have perforated appendicitis (P 0.001), were less likely to undergo a negative appendectomy (P = 0.003), and had a significantly longer length of stay than those who did not (P 0.009). Analysis by gender showed that perforation rates continued to be significantly higher in males undergoing CT scans (P 0.004). To examine the possibility that sicker patients were more likely to receive CT scans and also be found to have perforated appendicitis, a sensitivity analysis was performed. Patients showing perforated appendicitis on initial CT scans were excluded and the analysis was repeated. The difference in perforation rates continued to remain significant (P 0.037).ConclusionMales undergoing CT scans are significantly more likely to have perforated appendicitis. A protocol-driven rational approach to CT evaluation of suspected appendicitis may lower perforation rates, especially in males.

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