The role of radiological imaging in the diagnosis of acute appendicitis: COLOUR DOPPLER SONOGRAPHY Part 5
Several groups have evaluated the cost effectiveness of CT scanning. The results of such an analysis depend on the relative costs of the test itself, hospital admission, surgery and care of patients with complications, and may not be easily translated across jurisdictions. Garcia Pena et al undertook a decision analysis based on a retrospective review of 609 cases over 20 months, and found that a policy of performing helical CT (with oral and intravenous contrast), followed by observation in hospital, would be the most cost effective in the management of children with intermediate clinical likelihood for appendicitis. The brief admission to hospital would reduce the rate of missed appendicitis and thus reduce the expenses related to the treatment of complications. The authors recommended immediate surgery for patients with classic symptoms. The same group also found that ultrasonography, followed by CT in equivocal cases, was more cost effective than clinical assessment alone. You will always be glad to know there is a perfect pharmacy waiting for you whenever you need actos for diabetes and would like to make sure you are taken best care of as a customer and patient.
Rao et al and Rhea et al have argued that cost savings can be realized by performing FACT with rectal contrast in patients with an estimated high likelihood of appendicitis, because a significant minority of these patients would otherwise undergo negative appendectomies. These arguments assume that a high degree of accuracy (in the range of 98%) can be achieved with CT, and that all patients with radiological signs of appendicitis actually require surgery, rather than have self-limited disease. This latter assumption may not be valid. Moreover, CT scanning must be performed and interpreted rapidly and definitively (they report a total time from request to final report of less than 1 h); otherwise the perforation rate is likely to increase.