Oral Contrast

[roja]

After a stunning (and phenom. exhibition of fence sitting), I dug deep to find data to support one of my attendings. I happened across this interesting article about oral contrast and CT for appy.

I know it won't change the 'we need oral and iv and 3 hours for it to transit to appropriately be able to tell you maybe there is appendicitis' in our institution, but I am eternally hopeful.


A systematic review of whether oral contrast is necessary for the
computed tomography diagnosis of appendicitis in adults
Brock A. Anderson, M.D.a, Leon Salem, M.D.a, David R. Flum, M.D., M.P.H.a,b,*
aDepartment of Surgery, University of Washington, BB 431, 1959 N.E. Pacific St., Box 356410, Seattle, WA 98195, USA
bDepartment of Health Services, University of Washington, Seattle, WA, USA
Manuscript received July 22, 2004; revised manuscript March 7, 2005
Abstract
Background: There are several methods of contrast administration when performing computed tomography (CT) scanning for suspected
appendicitis. In this systematic review we evaluated the diagnostic performance of CT with and without contrast material.
Methods: Twenty-three reports were identified using a Medline search.
Results: The aggregated diagnostic performance characteristics of all modes of CT scanning were excellent with a range of sensitivity
(83–97%), specificity (93–98%), positive predictive value (86–98%), negative predictive value (94–99%), and accuracy (92–97%). The
diagnostic performance of CT without oral contrast was similar (sensitivity, 95% vs. 92% [not statistically significant]; negative predictive
value, 96% for both protocols) or surprisingly better (specificity, 97% vs. 94%; positive predictive value, 97% vs. 89%; accuracy, 96% vs.
92%; P
.0001) than with oral contrast.
Conclusions: Noncontrast CT techniques to diagnose appendicitis showed equivalent or better diagnostic performance compared with CT
scanning with oral contrast. A prospective comparative trial of CT with and without oral contrast for appendicitis should be performed to
assess the adequacy of this modality. © 2005 Excerpta Medica Inc. All rights reserved.

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[Sessamoid]

This is going to be pretty hospital specific, depending on whether your radiologists are comfortable and experienced at reading CTs for appy without contrast. I think it's pretty clear that IV contrast is of no proven benefit, but we still do oral/rectal contrast.

 

[roja]

Rectal? I remember reading something about this. This is definately something we try and get, particularly in peds where oral contrast is much more difficult, and we can't get it done, ever.

 

[Sessamoid]

Rectal? I remember reading something about this. This is definately something we try and get, particularly in peds where oral contrast is much more difficult, and we can't get it done, ever.

This is highly dependent on your CT tech and nurse. Very institution dependent and even shift dependent.

 

[USCDiver]

At our institution, the patients get a non-contrasted scan immediately. The film is wet-read and if negative/indeterminant, the patient comes back to the department with a bottle of contrast and waits the 90-120min. Then they go back for another scan.

While we wait for that scan to be read, they go into a special lead-lined room to protect us from their glowing bodies.