• N. Engl. J. Med. · Apr 2012

    Randomized Controlled Trial Comparative Study

    Low-dose abdominal CT for evaluating suspected appendicitis.

    • Kyuseok Kim, Young Hoon Kim, So Yeon Kim, Suyoung Kim, Yoon Jin Lee, Kwang Pyo Kim, Hye Seung Lee, Soyeon Ahn, Taeyun Kim, Seung-sik Hwang, Ki Jun Song, Sung-Bum Kang, Duck-Woo Kim, Seong Ho Park, and Kyoung Ho Lee.
    • Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
    • N. Engl. J. Med. 2012 Apr 26;366(17):1596-605.

    BackgroundComputed tomography (CT) has become the predominant test for diagnosing acute appendicitis in adults. In children and young adults, exposure to CT radiation is of particular concern. We evaluated the rate of negative (unnecessary) appendectomy after low-dose versus standard-dose abdominal CT in young adults with suspected appendicitis.MethodsIn this single-institution, single-blind, noninferiority trial, we randomly assigned 891 patients with suspected appendicitis to either low-dose CT (444 patients) or standard-dose CT (447 patients). The median radiation dose in terms of dose-length product was 116 mGy·cm in the low-dose group and 521 mGy·cm in the standard-dose group. The primary end point was the percentage of negative appendectomies among all nonincidental appendectomies, with a noninferiority margin of 5.5 percentage points. Secondary end points included the appendiceal perforation rate and the proportion of patients with suspected appendicitis who required additional imaging.ResultsThe negative appendectomy rate was 3.5% (6 of 172 patients) in the low-dose CT group and 3.2% (6 of 186 patients) in the standard-dose CT group (difference, 0.3 percentage points; 95% confidence interval, -3.8 to 4.6). The two groups did not differ significantly in terms of the appendiceal perforation rate (26.5% with low-dose CT and 23.3% with standard-dose CT, P=0.46) or the proportion of patients who needed additional imaging tests (3.2% and 1.6%, respectively; P=0.09).ConclusionsLow-dose CT was noninferior to standard-dose CT with respect to negative appendectomy rates in young adults with suspected appendicitis. (Funded by GE Healthcare Medical Diagnostics and others; ClinicalTrials.gov number, NCT00913380.).

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