Heart size on chest CT and its association with acute heart failure in the emergency department

INTRODUCTION: Acute appendicitis is a common surgical emergency, but accurate diagnosis remains challenging. Despite the 2020 World Society of Emergency Surgery Jerusalem guidelines recommending structured imaging pathways, including ultrasound and selective computed tomography, clinical assessment remains the primary diagnostic tool in Denmark. Contemporary practice emphasises rapid assessment, with imaging reserved for older or borderline cases. We hypothesised that reliance on clinical assessment alone contributes to a high number of negative appendectomies, particularly in young adults. METHODS: We conducted a single-centre retrospective cohort study of adults (> 18 years) undergoing surgery for suspected appendicitis at a tertiary university hospital in Denmark between January 2021 and December 2023. Data were extracted from electronic medical records and analysed in Stata 19.5. RESULTS: Among 613 patients, 522 had histologically confirmed appendicitis, yielding an overall negative appendectomy rate (NAR) of 14.9%. Patients without preoperative imaging (n = 279) had a NAR of 24.4%, compared with 6.9% among those who underwent preoperative imaging (n = 334). CONCLUSIONS: Reliance on clinical assessment alone results in a substantial number of unnecessary operations. Preoperative imaging significantly reduces NAR (p less-than 0.001), supporting broader adoption of guideline-based diagnostic strategies to improve diagnostic accuracy and optimise resource utilisation. FUNDING: None. TRIAL REGISTRATION: Not relevant.