Imaging Possible Appendicitis With CT

Study Overview
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Brief Summary
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Pain in the right lower abdomen is one of the commonest reasons patients present to general surgeons as an emergency. Whether or not such patients have appendicitis is crucial to their assessment. In UK practice, when the diagnosis is unclear, ultrasound scanning (US) is commonly used to investigate the problem. US is very safe but it will only visualise the appendix in the minority of cases. As a result, the sensitivity for diagnosing appendicitis in this setting is probably only 5-30%. Alternatively, computed tomography (CT) is an accurate way of diagnosing appendicitis in over 90% of cases. CT scans are readily available and with modern scanners, high quality images can be achieved with lower radiation doses. Unenhanced scanning avoids the use of contrast media and permits further reductions in ionising radiation exposure.

Detailed Description
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Pain in the right lower abdomen is one of the commonest reasons patients present to general surgeons as an emergency. Whether or not such patients have appendicitis is crucial to their assessment. In UK practice, when the diagnosis is unclear, ultrasound scanning (US) is commonly used to investigate the problem. US is very safe but it will only visualise the appendix in the minority of cases. As a result, the sensitivity for diagnosing appendicitis in this setting is probably only 5-30%. Alternatively, computed tomography (CT) is an accurate way of diagnosing appendicitis in over 90% of cases. CT scans are readily available and with modern scanners, high quality images can be achieved with lower radiation doses. Unenhanced scanning avoids the use of contrast media and permits further reductions in ionising radiation exposure.

Official Title
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A Feasibility Randomised Control Trial to Evaluate the Role of Computed Tomography in Patients With Indeterminate Right Iliac Fossa Pain

Conditions
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Abdominal Pain

Intervention / Treatment
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* Other: unenhanced abdomino-pelvic CT scan
* Other: abdominal ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Acute presentation with abdominal pain and/or tenderness which is most marked in the right lower abdomen Exclusion Criteria: Age<18 Age>60 Pregnancy Patients with a firm clinical diagnosis of appendicitis where surgical management is indicated at presentation Patients who have undergone CT scanning within the past two months Patients with cognitive impairment who would lack capacity to give consent Inability to understand written or spoken English Patients who have previously undergone appendicectomy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Abdominal CT<br> | Other: unenhanced abdomino-pelvic CT scan<br>* unenhanced abdomino-pelvic CT scan<br>|
| Other: Abdominal Ultrasound<br> | Other: abdominal ultrasound<br>* abdominal ultrasound<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility | As assessed by the rate of refusal to participate amongst eligible patients | 2 years |