Computed Tomography in Diagnosing Suspected Appendicitis

To the Editor. In the September 1999 issue of Pediatrics, Garcia Pena et al1 review their experience in using computed tomography (CT) to aid in the diagnosis of suspected cases of appendicitis. They conclude that any of a variety of strategies employed using CT scans resulted in reduced costs and improved diagnosis, management, and outcome for children with appendicitis. The authors should be complimented for a rigorous examination of data from a large series of patients. The study has generated considerable attention in the lay press, with Time magazine among others reporting on the diagnostic value of CT scanning in possible cases of appendicitis in children. As a pediatric surgeon, I have had several families inquire since the publication of this article about whether I would be ordering a CT scan on their child who was being evaluated for appendicitis. The diagnosis of appendicitis in childhood can be an extremely difficult one to make, and the ability to use CT scanning to assist in making that diagnosis is apparent from the data in the article. I feel less certain, however, that the article justifies the routine use …