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Background: Clinical evaluation alone is still considered adequate by many clinicians who treat patients with appendicitis. The impact of computed tomography (CT) on clinical outcomes remains unclear, and there is no consensus regarding the appropriate use of CT in these patients. We sought to evaluate the impact of abdominal CT on the clinical outcomes of patients presenting with suspected appendicitis. Methods: We conducted a systematic review of the literature to identify studies that examined clinical outcomes related to the use of abdominal CT in the diagnosis of acute appendicitis. Inclusion criteria were studies of adult patients with suspected appendicitis that evaluated the impact of abdominal CT on negative appendectomy rates, perforation rates or time to surgery. Two independent investigators reviewed all titles and abstracts and extracted data from 28 full-text articles. Statistical analysis was conducted using Review Manager 5.0.10 software. Results: The negative appendectomy rate was 8.7% when using CT compared with 16.7% when using clinical evaluation alone (p < 0.001). There was also a significantly lower negative appendectomy rate during the CT era compared with the pre-CT era (10.0% v. 21.5%, p < 0.001). Time to surgery was evaluated in 10 of the 28 studies, 5 of which demonstrated a significant increase in the time to surgery with the use of CT. Appendiceal perforation rates were unchanged by the use of CT (23.4% in the CT group v. 16.7% in the clinical evaluation group, p = 0.15). Similarly, the perforation rate during the CT era was not significantly different than that during the preCT era (20.0% v. 19.6%, p = 0.74). Conclusion: This meta-analysis supports the hypothesis that the use of preoperative abdominal CT is associated with lower negative appendectomy rates. The use of CT in the absence of an expedited imaging protocol may delay surgery, but this delay is not associated with increased appendiceal perforation rates. Routine CT in all patients presenting with suspected appendicitis could reduce the rate of unnecessary surgery without increasing morbidity. Contexte: Beaucoup de cliniciens qui traitent des patients atteints d'appendicite considerent toujours que l'evaluation clinique seule suffit. L'effet de la tomodensitometrie (TDM) sur les resultats cliniques n'est toujours pas clair et il n'y a pas de consensus au sujet de l'utilisation appropriee de la TDM chez ces patients. Nous avons cherche a evaluer l'effet de la TDM abdominale sur les resultats cliniques des patients chez qui l'on soupconne une appendicite. Methodes: Nous avons procede a une synthese systematique des publications pour trouver des etudes ou l'on examinait les resultats cliniques relies a l'utilisation de la TDM abdominale pour diagnostiquer l'appendicite aigue. Les etudes portant sur des patients adultes chez lesquels on soupconnait une appendicite qui ont evalue l'effet de la TDM abdominale sur les taux d'appendicectomie negative, les taux de perforation ou la duree de l'intervention chirurgicale etaient au nombre des criteres d'inclusion. Deux chercheurs independants ont passe en revue tous les titres et les resumes et ont extrait les donnees de 28 articles en version integrale. L'analyse statistique a ete effectuee au moyen du logiciel Review Manager 5.0.10. Resultats: Le taux d'appendicectomie negative s'est etabli a 8,7% lorsqu'on a utilise la TDM comparativement a 16,7% lorsqu'on a utilise l'evaluation clinique seulement (p < 0,001). Il y avait aussi un taux d'appendicectomie negative beaucoup plus faible depuis l'avenement de la TDM qu'avant celle-ci (10,0% c. 21,5%, p < 0,001). Le temps ecoule avant l'intervention chirurgicale a ete evalue dans 10 des 28 etudes, dont 5 ont demontre une augmentation importante du temps ecoule avant l'intervention chirurgicale a la suite de l'utilisation de la TDM. L'utilisation de la TDM n'a pas change les taux de perforation de l'appendice (23,4% chez les participants soumis a une TDM c. 16,7% chez ceux qui ont ete soumis a une evaluation clinique, p = 0,15). De meme, le taux de perforation depuis l'avenement de la TDM n'etait pas tres different de celui qui prevalait avant celle-ci (20,0% c. 19,6%, p = 0,74). Conclusion: Cette meta-analyse appuie l'hypothese selon laquelle il y a un lien entre l'utilisation de la TDM abdominale preoperatoire et des taux moins eleves d'appendicectomie negative. L'utilisation de la TDM en l'absence de protocole d'imagerie acceleree peut retarder l'intervention chirurgicale, mais il n'y a pas de lien entre le retard et des taux accrus de perforation de l'appendice. Une TDM de routine chez tous les patients chez qui l'on soupconne une appendicite pourrait reduire le taux d'interventions chirurgicales inutiles sans accroitre la morbidite., Appendicitis is the most common emergency surgical condition, with more than 250 000 appendectomies performed yearly in the United States. (1) Historically, negative appendectomy rates of 10%-20% have been accepted [...]

Path analyses were applied to test a model that includes internalizing and externalizing behavior problems as predictors of suicidal behaviors in children. Parents of an inpatient sample of boys (N = 87; M age = 9.81 years) rated the frequency of suicidal ideation and completed standardized measures of behavior problems. Blind raters rated the severity of the children's suicidal behaviors. Results revealed a significant direct effect for suicidal ideation on suicide attempt and for depressive symptoms on suicidal ideation. There was also a significant indirect path from impulsivity to suicidal ideation through aggressive and depressive symptoms. Clinical implications are discussed.