Low vs. Standard Dose CT for Appendicitis Trial

A Multi-institutional Trial Comparing Clinical Outcomes Following Low- vs. Standard-dose Abdominal CT as the First-line Imaging Test in Adolescents and Young Adults With Suspected Acute Appendicitis

To determine whether low-dose (LD) CT is noninferior to standard-dose (SD) computed tomography (CT) as the first-line imaging test in adolescents and young adults in regard to negative appendectomy rate (NAR).

• Acute appendicitis is a very common disease. Many patients are adolescents or young adults.
• CT is the current standard imaging test for the diagnosis of appendicitis.
• In recent years, the awareness of carcinogenic risk associated with CT radiation has increased.
• According to a recent single-institutional randomized controlled trial, LD CT (employing a quarter of standard radiation dose) was found to be noninferior to SD CT with respect to NARs in adolescents and young adults with suspected appendicitis.
• However, LD CT is not yet widely accepted.
• To establish LD CT as the first-line imaging test, a multi-institutional study is needed to confirm the generalizability of the prior single-institutional study.

Inclusion Criteria:

• Emergency department visit with suspected symptoms and signs of acute appendicitis
• Intravenous contrast-enhanced computed tomography examination requested due to suspicion of appendicitis
• Willing to provide telephone or cell phone numbers for follow-up
• Signed informed consent provided prior to study entry

Exclusion Criteria:

• Prior cross-sectional imaging tests to evaluate the presenting symptoms and signs
• Prior history of surgical removal of the appendix