| 作者 |
Chin-Jui Cheng, Po-Ching Chen, Shoou-Yang Lian, Yung-Li Wang, Shan-Chien Ho, Yu-Fu Chen, Ya-Han Tang, Chen-Guo Ker |
| 摘要 |
Background: Ultrasound and computed tomography (CT) are now preferred for use
in the diagnosis of acute appendicitis (Ap). This was a retrospective study on the use of ultrasound or CT for preoperative diagnosis and hospital expenditure in patients with Ap.
Purpose: We tried to conduct this study to measure the effect of CT on the hospital expenditure of our emergency patients.
Methods: We enrolled 1047 patients with preoperative diagnosis with or without CT or ultrasound and divided them into four groups: Group1, CT and ultrasound; Group 2, CT only; Group 3, ultrasound only; and Group 4, neither CT nor ultrasound. The final operative diagnosis of appendicitis was classified as acute appendicitis (Ap), appendicitis with perforation (Ap-perforation),
and appendicitis with peritonitis (Ap-peritonitis) on the basis of the coding from the results of operative and pathological findings. Clinical profiles of patients included age, sex, Charlson Comorbidity Index, operative procedures, and medical expenditure.
Results: Preoperative diagnosis with ultrasound or CT was found in 139 (13.3%), 180 (17.2%), 383 (36.5%), and 345 (33.0%) patients of Groups 1, 2, 3, and 4, respectively. The use of CT was more common in patients aged ≧65 years (49.1%) than in those <20 years old, with a significant difference. Clinical use of CT was more common in complicated Ap-40.9% for Ap-perforation and 48.0% for Ap-peritonitis. Neverthelesss, the cost of CT accounted for a small fraction (9-11%) of the total hospital expenditure for operative appendicitis under
Taiwan Diseases Related Group reimbursement.
Conclusion: Patients with higher severity and Charlson Comorbidity Index scores are associated with an increased use of CT for the assessment of patient condition in addition to diagnosis. The preoperative use of CT depends mainly on the severity of the disease. Therefore, we do not hesitate to use CT, particularly for elderly patients or patients with high Charlson Comorbidity
Index scores. |
