ACR Appropriateness Criteria® Right Lower Quadrant Pain-Suspected Appendicitis
Appendicitis remains the most common surgical pathology responsible for right lower quadrant (RLQ) abdominal pain presenting to emergency departments in the United States, where the incidence continues to increase. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negati...
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| Published in | Journal of the American College of Radiology Vol. 15; no. 11; pp. S373 - S387 |
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| Main Authors | , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.11.2018
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1546-1440 1558-349X 1558-349X |
| DOI | 10.1016/j.jacr.2018.09.033 |
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| Abstract | Appendicitis remains the most common surgical pathology responsible for right lower quadrant (RLQ) abdominal pain presenting to emergency departments in the United States, where the incidence continues to increase. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of experts.
The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. |
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| AbstractList | Appendicitis remains the most common surgical pathology responsible for right lower quadrant (RLQ) abdominal pain presenting to emergency departments in the United States, where the incidence continues to increase. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of experts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.Appendicitis remains the most common surgical pathology responsible for right lower quadrant (RLQ) abdominal pain presenting to emergency departments in the United States, where the incidence continues to increase. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of experts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Appendicitis remains the most common surgical pathology responsible for right lower quadrant (RLQ) abdominal pain presenting to emergency departments in the United States, where the incidence continues to increase. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of experts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Appendicitis remains the most common surgical pathology responsible for right lower quadrant (RLQ) abdominal pain presenting to emergency departments in the United States, where the incidence continues to increase. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of experts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. |
| Author | Garcia, Evelyn M. Levy, Angela D. Smith, Martin P. Karolyi, Daniel R. Camacho, Marc A. Marin, Daniele Scheirey, Christopher D. Moreno, Courtney Lambert, Drew L. Weinstein, Stefanie Fowler, Kathryn J. Kambadakone, Avinash R. Cash, Brooks D. Peterson, Christine M. Chang, Kevin J. Feig, Barry W. Siegel, Alan Carucci, Laura R. Kim, David H. |
| Author_xml | – sequence: 1 givenname: Evelyn M. surname: Garcia fullname: Garcia, Evelyn M. email: emgarcia@carilionclinic.org organization: Virginia Tech Carilion School of Medicine, Roanoke, Virginia – sequence: 2 givenname: Marc A. surname: Camacho fullname: Camacho, Marc A. organization: The University of South Florida Morsani College of Medicine, Tampa, Florida – sequence: 3 givenname: Daniel R. surname: Karolyi fullname: Karolyi, Daniel R. organization: Research Author, Carilion Clinic, Roanoke, Virginia – sequence: 4 givenname: David H. surname: Kim fullname: Kim, David H. organization: Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin – sequence: 5 givenname: Brooks D. surname: Cash fullname: Cash, Brooks D. organization: University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas; American Gastroenterological Association – sequence: 6 givenname: Kevin J. surname: Chang fullname: Chang, Kevin J. organization: Newton-Wellesley Hospital, Newton, Massachusetts – sequence: 7 givenname: Barry W. surname: Feig fullname: Feig, Barry W. organization: The University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons – sequence: 8 givenname: Kathryn J. surname: Fowler fullname: Fowler, Kathryn J. organization: Mallinckrodt Institute of Radiology, Saint Louis, Missouri – sequence: 9 givenname: Avinash R. surname: Kambadakone fullname: Kambadakone, Avinash R. organization: Massachusetts General Hospital, Boston, Massachusetts – sequence: 10 givenname: Drew L. surname: Lambert fullname: Lambert, Drew L. organization: University of Virginia Health System, Charlottesville, Virginia – sequence: 11 givenname: Angela D. surname: Levy fullname: Levy, Angela D. organization: Medstar Georgetown University Hospital, Washington, District of Columbia – sequence: 12 givenname: Daniele surname: Marin fullname: Marin, Daniele organization: Duke University Medical Center, Durham, North Carolina – sequence: 13 givenname: Courtney surname: Moreno fullname: Moreno, Courtney organization: Emory University, Atlanta, Georgia – sequence: 14 givenname: Christine M. surname: Peterson fullname: Peterson, Christine M. organization: Penn State Health, Hershey, Pennsylvania – sequence: 15 givenname: Christopher D. surname: Scheirey fullname: Scheirey, Christopher D. organization: Lahey Hospital and Medical Center, Burlington, Massachusetts – sequence: 16 givenname: Alan surname: Siegel fullname: Siegel, Alan organization: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire – sequence: 17 givenname: Martin P. surname: Smith fullname: Smith, Martin P. organization: Beth Israel Deaconess Medical Center, Boston, Massachusetts – sequence: 18 givenname: Stefanie surname: Weinstein fullname: Weinstein, Stefanie organization: University of California San Francisco, San Francisco, California – sequence: 19 givenname: Laura R. surname: Carucci fullname: Carucci, Laura R. organization: Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30392606$$D View this record in MEDLINE/PubMed |
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| Copyright | 2018 American College of Radiology Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved. |
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| Keywords | CT Pregnant Right lower quadrant Appendicitis MRI Appropriate Use Criteria Atypical Appropriateness Criteria AUC |
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