Background: Appendiceal computed tomography (CTA) for the diagnosis of acute appendicitis (AA) has become popular, with a growing body of literature reporting excellent rates of sensitivity, specificity, and accuracy (S/S/A). However, several studies indicate that the true S/S/A of CTA is lower than the best results reported, especially if the white blood count is normal, the reader is inexperienced, or the study is obtained in the absence of surgical consultation. Thus, it is possible that skepticism of the value of CTA to diagnose AA may exist. Our objective was to determine the current knowledge of and attitudes regarding CTA among practicing surgeons.
Methods: Two thousand questionnaires were sent randomly to general surgeon Fellows of the American College of Surgeons. Questions detailed the surgeon's practice, experience, hospital characteristics, and opinion regarding the utility and use of CTA. The existence of a formal CTA protocol, its characteristics, and radiologist availability for CT interpretation were determined. Data were analyzed by x(2) with Fisher exact test, multiple-group x(2), and univariate ANOVA as appropriate. Results are reported as mean +/- SEM with significance accepted at p < 0.05.
Results: The response rate was 27%. Mean age was 51 +/- 1 years, 60% of respondents were general surgeons, and 9% were laparoscopic surgeons. Seventy-four percent of respondents believe the accuracy rate of CTA is less than the originally reported 98%; those who disbelieve are less likely to utilize CTA (p < 0.0001). Sixty-two percent of respondents believe CTA is over-utilized; 43% obtain CTA in </=25% of patients, and 62% obtain CTA in fewer than 50% of patients. Only 36% of respondents had access to CTA by protocol; those surgeons were more likely to know protocol details (p < 0.0001). Emergency medicine physicians order CTA most often (63%), and studies are most often interpreted by an attending radiologist (69%).
Conclusions: Practicing surgeons are skeptical of the role of CTA for diagnosis of AA. Incorporation of CTA into practice is not widespread, perhaps because CTA by protocol is unavailable to most surgeons and because it is often obtained in the absence of surgical consultation.