Enteral Contrast in the Computed Tomography Diagnosis of Appendicitis: Comparative Effectiveness in a Prospective Surgical Cohort : Annals of Surgery

Journal Logo

Original Articles

Enteral Contrast in the Computed Tomography Diagnosis of Appendicitis

Comparative Effectiveness in a Prospective Surgical Cohort

Drake, Frederick Thurston MD, MPH*,‡; Alfonso, Rafael MD*,‡; Bhargava, Puneet MD; Cuevas, Carlos MD; Dighe, Manjiri K. MD; Florence, Michael G. MD§; Johnson, Morris G. MD**; Jurkovich, Gregory J. MD††; Steele, Scott R. MD‡‡; Symons, Rebecca Gaston MPH; Thirlby, Richard C. MD; Flum, David R. MD, MPH*,‡ The Writing Group for SCOAP-CERTAIN

Author Information
Annals of Surgery 260(2):p 311-316, August 2014. | DOI: 10.1097/SLA.0000000000000272


Our goal was to perform a comparative effectiveness study of intravenous (IV)-only versus IV + enteral contrast in computed tomographic (CT) scans performed for patients undergoing appendectomy across a diverse group of hospitals.


Small randomized trials from tertiary centers suggest that enteral contrast does not improve diagnostic performance of CT for suspected appendicitis, but generalizability has not been demonstrated. Eliminating enteral contrast may improve efficiency, patient comfort, and safety.


We analyzed data for adult patients who underwent nonelective appendectomy at 56 hospitals over a 2-year period. Data were obtained directly from patient charts by trained abstractors. Multivariate logistic regression was utilized to adjust for potential confounding. The main outcome measure was concordance between final radiology interpretation and final pathology report.


A total of 9047 adults underwent appendectomy and 8089 (89.4%) underwent CT, 54.1% of these with IV contrast only and 28.5% with IV + enteral contrast. Pathology findings correlated with radiographic findings in 90.0% of patients who received IV + enteral contrast and 90.4% of patients scanned with IV contrast alone. Hospitals were categorized as rural or urban and by their teaching status. Regardless of hospital type, there was no difference in concordance between IV-only and IV + enteral contrast. After adjusting for age, sex, comorbid conditions, weight, hospital type, and perforation, odds ratio of concordance for IV + enteral contrast versus IV contrast alone was 0.95 (95% CI: 0.72–1.25).


Enteral contrast does not improve CT evaluation of appendicitis in patients undergoing appendectomy. These broadly generalizable results from a diverse group of hospitals suggest that enteral contrast can be eliminated in CT scans for suspected appendicitis.

© 2014 by Lippincott Williams & Wilkins.

You can read the full text of this article if you:

Access through Ovid