ACR appropriateness Criteria ® right lower quadrant painsuspected appendicitis

Max P. Rosen, Alexander Ding, Michael A. Blake, Mark E. Baker, Brooks D. Cash, Jeff L. Fidler, Thomas H. Grant, Frederick L. Greene, Bronwyn Jones, Douglas S. Katz, Tasneem Lalani, Frank H. Miller, William C. Small, Stephanie Spottswood, Gary S. Sudakoff, Mark Tulchinsky, David M. Warshauer, Judy Yee, Brian D. Coley

Research output: Contribution to journalReview article

125 Scopus citations

Abstract

The diagnostic imaging of patients presenting with right lower quadrant pain and suspected appendicitis may be organized according to age and gender and to the presence or absence of "classic" signs and symptoms of acute appendicitis. Among adult patients presenting with clinical signs of acute appendicitis, the sensitivity and specificity of CT are greater than those of ultrasound, with improved performance when CT is performed with intravenous contrast. The use of rectal contrast has been associated with decreased time in the emergency department. Computed tomography has also been shown to reduce cost and negative appendectomy rates. Both CT and ultrasound are also effective in the identification of causes of right lower quadrant pain unrelated to appendicitis. Among pediatric patients, the sensitivity and specificity of graded-compression ultrasound can approach those of CT, without the use of ionizing radiation. Performing MRI after inconclusive ultrasound in pregnant patients has been associated with sensitivity and specificity of 80% to 86% and 97% to 99%, respectively. The ACR Appropriateness Criteria ® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Original languageEnglish (US)
Pages (from-to)749-755
Number of pages7
JournalJournal of the American College of Radiology
Volume8
Issue number11
DOIs
StatePublished - Nov 2011

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All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Rosen, M. P., Ding, A., Blake, M. A., Baker, M. E., Cash, B. D., Fidler, J. L., Grant, T. H., Greene, F. L., Jones, B., Katz, D. S., Lalani, T., Miller, F. H., Small, W. C., Spottswood, S., Sudakoff, G. S., Tulchinsky, M., Warshauer, D. M., Yee, J., & Coley, B. D. (2011). ACR appropriateness Criteria ® right lower quadrant painsuspected appendicitis Journal of the American College of Radiology, 8(11), 749-755. https://doi.org/10.1016/j.jacr.2011.07.010