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February 26, 1997

Does This Patient Have Appendicitis?

Author Affiliations

Beth Israel Deaconess Medical Center Boston, Mass

JAMA. 1997;277(8):626. doi:10.1001/jama.1997.03540320028020

To the Editor.  —It is unfortunate that an article entitled "does this patient have appendicitis?" dismisses computed tomography (CT) with a single sentence stating that "the accuracy of computed tomography in diagnosing appendicitis has been inconsistent."1Wagner et al1 base this statement on references from an older literature, prior to the general availability of such improvements as spiral CT and thin section scanning. More recent studies demonstrate a 96% to 100% sensitivity and an 89% to 95% specificity of CT in the diagnosis of appendicitis.2-4 Rao et al4 identified the normal or abnormal appendix in all of their 100 cases. More importantly, CT can frequently diagnose or exclude other conditions that simulate appendicitis.2,3The article by Wagner et al1 specifically emphasizes the clinical examination. As a radiologist who has spent much of his career writing about the overutilization of imaging examinations, I heartily concur with this approach. However,