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Suzuki T, Matsumoto A, Akao T, Matsumoto H. Interval appendectomy as a safe and feasible treatment approach after conservative treatment for appendicitis with abscess: a retrospective, single-center cohort study. Updates Surg 2023; 75:2257-2265. [PMID: 37987979 PMCID: PMC10710379 DOI: 10.1007/s13304-023-01679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
Emergency appendectomy (EA) is the gold standard management for acute appendicitis (AA). However, whether EA or interval appendectomy (IA) after conservative treatment is the optimal approach in AA with abscess remains controversial. This study compared IA and EA in patients presenting with AA accompanied by abscess. This was a retrospective single-center study including 446 consecutive patients undergoing appendectomy between April 2009 and March 2023. AA with abscess was defined as a pericecal abscess observed by computed tomography or abdominal ultrasonography, and patients with signs of peritoneal irritation were excluded. Perioperative outcomes were compared between the patients who directly underwent EA and those who underwent IA after conservative treatment. Among 42 patients (9.4%) with AA and abscess, 34 and 8 patients underwent IA and EA, respectively. The rates of ileocecal resection and postoperative complications were lower in the IA group than in the EA group (3% vs. 50%, P < 0.001 and 9% vs. 75%, P < 0.001, respectively). Colonoscopy before IA was performed in 16 of the 17 patients aged ≥ 40 years in the IA group, and one patient underwent ileocecal resection because of suspicious neoplasm in the root of the appendix. IA after conservative treatment might be considered as the useful therapeutic option for AA with abscess. Colonoscopy during the waiting period between the initial diagnosis and IA should be considered in patients aged ≥ 40 years who may have malignant changes. Implementing IA as a first-line treatment will be beneficial to both patients and healthcare providers.
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Affiliation(s)
- Toshiyuki Suzuki
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, 348-8505, Japan.
| | - Akiyo Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, 348-8505, Japan
| | - Takahiko Akao
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, 348-8505, Japan
| | - Hiroshi Matsumoto
- Department of Surgery, Hanyu General Hospital, Hanyushi Saitama, 348-8505, Japan
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Gil LA, Deans KJ, Minneci PC. Appendicitis in Children. Adv Pediatr 2023; 70:105-122. [PMID: 37422289 DOI: 10.1016/j.yapd.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
The management of pediatric appendicitis continues to advance with the development of evidence-based treatment algorithms and a recent shift toward patient-centered treatment approaches. Further research should focus on development of standardized institution-specific diagnostic algorithms to minimize rates of missed diagnosis and appendiceal perforation and refinement of evidence-based clinical treatment pathways that reduce complication rates and minimize health care resource utilization.
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Affiliation(s)
- Lindsay A Gil
- Pediatric Surgery Research Fellow, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, 700 Children's Drive, Columbus, OH 43206, USA
| | - Katherine J Deans
- Department of Surgery, Nemours Children's Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Peter C Minneci
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, 611 East Livingston Avenue, Columbus, OH 43206, USA.
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3
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Cho SU, Oh SK. Accuracy of ultrasound for the diagnosis of acute appendicitis in the emergency department: A systematic review. Medicine (Baltimore) 2023; 102:e33397. [PMID: 37000097 PMCID: PMC10063291 DOI: 10.1097/md.0000000000033397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Point-of-Care Ultrasound (POCUS) is a quick, useful, noninvasive, and inexpensive diagnostic tool used for the diagnosis of trauma, abdominal pain, dyspnea, and chest pain in the emergency department (ED). However, the diagnostic accuracy of ultrasound in the ED may be different from those reported in previous studies owing to the setting and time constraints in ED. METHODS We conducted our study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A literature search was conducted using databases on US National Library of Medicine's database of biomedical literature, Ovid MEDLINE, online database of biomedical articles, and the collection of databases of systematic reviews and other evidence. The inclusion criteria were the use of bedside ultrasound as a diagnostic tool for acute appendicitis in the ED and the available data on diagnostic parameters such as sensitivity, specificity, and positive and negative predictive values (NPV). We constructed forest plots and summary receiver operating characteristic curves to evaluate the diagnostic accuracy of bedside ultrasound for acute appendicitis in the ED. RESULTS A total of 21 studies that met the inclusion criteria of this study were included for analysis. The overall pooled sensitivity was 0.81 (95% CI, 0.78-0.83), whereas the pooled specificity was 0.87 (95% CI, 0.85-0.88). However, the I2 test showed 91.7% and 90.9% heterogeneity in the sensitivity and specificity values, respectively. The summary receiver operating characteristic curves showed high levels of accuracy, as evidenced by an area under the curve of 0.9249 (standard error: 0.0180). CONCLUSIONS The use of ultrasound for the diagnosis of acute appendicitis in the ED showed that ultrasound has high overall sensitivity and specificity for the diagnosis of acute appendicitis. however, high heterogeneity among the included studies was observed.
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Affiliation(s)
- Sung Uk Cho
- Department of Emergency Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Se Kwang Oh
- Department of Emergency Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
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Wright M, Giddings H, Rahman B, Lord RV. Use of oral contrast for CT scanning and time to diagnosis and treatment of acute appendicitis. ANZ J Surg 2023; 93:115-119. [PMID: 36468833 DOI: 10.1111/ans.18194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether there is a delay in treatment for patients having pre-operative CT imaging with both intravenous and oral contrast (CTIVO) compared to intravenous contrast alone (CTIV). METHODS A retrospective review of patients who underwent emergency appendicectomy at a single hospital during a two-year period (1/1/2019-31/12/2020) was performed. Demographic details, imaging timing/modality; biochemical markers; American Society of Anaesthesiologists (ASA) physical status classification, anaesthetic induction time; operative report findings; histopathology, peri-operative complications, admission/discharge times were recorded. The Sunshine Appendicitis Grading System (SAGS) score was used for severity of appendicitis. RESULTS Pre-operative CT was performed in 294 patients; CTIVO: 159 (54%), CTIV: 135 (46%). Both groups were comparable for age, sex, ASA status and inflammatory markers. The median time from CT request to scanning was longer with CTIVO (CTIVO: 170 min, CTIV: 65 min, P < 0.0001). The median time from CT request to induction of anaesthesia was also longer with CTIVO (CTIVO: 780 minutes, CTIV: 406 min, P < 0.0001). A delay to theatre was not significantly associated with severity of appendicitis (SAGS score). The diagnostic accuracy was not reduced in the CTIV group compared to the CTIVO group. CONCLUSION CTIVO scans significantly delay CT diagnosis and surgical treatment of appendicitis compared to CTIV. Omitting oral contrast does not result in a reduction in diagnostic accuracy for appendicitis.
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Affiliation(s)
- Melissa Wright
- Department of General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.,Department of Surgery, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Hugh Giddings
- Department of General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.,Department of Surgery, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Bayzidur Rahman
- Department of Epidemiology and Biostatistics, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Australian Institute of Health and Innovation, Macquarie University, Sydney, New South Wales, Australia.,The Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Reginald V Lord
- Department of General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.,Department of Surgery, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Daytime versus nighttime laparoscopic appendectomy in term of complications and clinical outcomes: A retrospective study of 1001 appendectomies. Heliyon 2022; 8:e11911. [PMID: 36478845 DOI: 10.1016/j.heliyon.2022.e11911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/25/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
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6
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Smith HF. A review of the function and evolution of the cecal appendix. Anat Rec (Hoboken) 2022; 306:972-982. [PMID: 35363436 DOI: 10.1002/ar.24917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
Abstract
Since its initial discovery in the 1500s, the cecal appendix has been an anatomical structure of great intrigue, notorious for its inconvenient tendency to become inflamed and often require surgical intervention. Appendicitis is one of the most common indications for emergency abdominal surgery, costing healthcare systems billions of dollars globally and causing tens of thousands of deaths annually. Yet, recent studies have indicated that the appendix may serve important protective functions in fortifying the body's immune response against invading pathogens and re-inoculating the gut with commensal bacteria after periods of gastrointestinal illness. While the cecal appendix was once believed to be a synapomorphy of hominoids (humans and other great apes), recent studies suggested that it is a recurrent trait found in several other species of primates, rodents, lagomorphs, marsupials, and monotremes. Mapping appendiceal and other gastrointestinal traits across a mammalian consensus phylogeny revealed that the cecal appendix has evolved independently numerous times throughout mammalian evolution, significantly more than would be expected due to chance alone, suggesting that the appendix is adaptively advantageous. However, attempts to identify an overarching ecological, behavioral, dietary, or environmental factor driving some species to evolve an appendix have been largely unsuccessful, indicating that the cecal appendix has a complex and diverse evolutionary history. This review discusses the current understanding of the pathophysiology, evolution, and possible functions of the appendix, both within humans and broadly across the class Mammalia.
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Affiliation(s)
- Heather F Smith
- Department of Anatomy, Midwestern University, Glendale, Arizona, USA
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
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7
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Huerta S. Diagnosis and Management of Acute Appendicitis. JAMA 2022; 327:1183-1184. [PMID: 35315897 DOI: 10.1001/jama.2022.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, Dallas
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8
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AL AWAYSHEH MM, ALI SS, AL-AWAYSHEH BM, AL-AWAYSHEH TM. Discovering the true accuracy of ultrasonography in the confirmation of diagnosis of acute appendicitis, a world-wide dilemma. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Morphometric analysis of middle and posterior cranial fossae foramina in 3D reconstructions of CT images: A midline asymmetry evaluation. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1061162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Park JH, Salminen P, Tannaphai P, Lee KH. Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence. Korean J Radiol 2022; 23:517-528. [PMID: 35289145 PMCID: PMC9081692 DOI: 10.3348/kjr.2021.0596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/18/2021] [Accepted: 11/21/2021] [Indexed: 11/15/2022] Open
Abstract
Due to its excellent diagnostic performance, CT is the mainstay of diagnostic test in adults with suspected acute appendicitis in many countries. Although debatable, extensive epidemiological studies have suggested that CT radiation is carcinogenic, at least in children and adolescents. Setting aside the debate over the carcinogenic risk of CT radiation, the value of judicious use of CT radiation cannot be overstated for the diagnosis of appendicitis, considering that appendicitis is a very common disease, and that the vast majority of patients with suspected acute appendicitis are adolescents and young adults with average life expectancies. Given the accumulated evidence justifying the use of low-dose CT (LDCT) of only 2 mSv, there is no reasonable basis to insist on using radiation dose of multi-purpose abdominal CT for the diagnosis of appendicitis, particularly in adolescents and young adults. Published data strongly suggest that LDCT is comparable to conventional dose CT in terms of clinical outcomes and diagnostic performance. In this narrative review, we will discuss such evidence for reducing CT radiation in adolescents and young adults with suspected appendicitis.
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Affiliation(s)
- Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland, Thailand
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland, Thailand
| | - Penampai Tannaphai
- Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Korea
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11
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Busbaih Z, Busbaih J, Odeh A, Albeladi AM, Almohammed Saleh AA. Appendiceal Adhesion to the Gallbladder Detected During Laparoscopic Cholecystectomy: A Case Report. Cureus 2021; 13:e20625. [PMID: 35106195 PMCID: PMC8788890 DOI: 10.7759/cureus.20625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/05/2022] Open
Abstract
Acute cholecystitis is a very common acute abdominal disease that mostly indicates abdominal surgery. Appendiceal adhesion to the gallbladder is a very rare condition detected during laparoscopic surgery. A 54-year-old female patient, with a known case of diabetes and hypertension, presented with right upper quadrant abdominal pain of four months’ duration. The pain was increasing in severity and associated with fatty meals. She was diagnosed with acute cholecystitis and was sent to the operating room for laparoscopic cholecystectomy. Appendiceal adhesion to the gallbladder was found, and laparoscopic cholecystectomy and laparoscopic appendectomy were performed. Adhesion of the appendix to the gallbladder should be considered by general surgeons.
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12
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Abstract
IMPORTANCE Acute appendicitis is the most common abdominal surgical emergency in the world, with an annual incidence of 96.5 to 100 cases per 100 000 adults. OBSERVATIONS The clinical diagnosis of acute appendicitis is based on history and physical, laboratory evaluation, and imaging. Classic symptoms of appendicitis include vague periumbilical pain, anorexia/nausea/intermittent vomiting, migration of pain to the right lower quadrant, and low-grade fever. The diagnosis of acute appendicitis is made in approximately 90% of patients presenting with these symptoms. Laparoscopic appendectomy remains the most common treatment. However, increasing evidence suggests that broad-spectrum antibiotics, such as piperacillin-tazobactam monotherapy or combination therapy with either cephalosporins or fluroquinolones with metronidazole, successfully treats uncomplicated acute appendicitis in approximately 70% of patients. Specific imaging findings on computed tomography (CT), such as appendiceal dilatation (appendiceal diameter ≥7 mm), or presence of appendicoliths, defined as the conglomeration of feces in the appendiceal lumen, identify patients for whom an antibiotics-first management strategy is more likely to fail. CT findings of appendicolith, mass effect, and a dilated appendix greater than 13 mm are associated with higher risk of treatment failure (≈40%) of an antibiotics-first approach. Therefore, surgical management should be recommended in patients with CT findings of appendicolith, mass effect, or a dilated appendix who are fit for surgery, defined as having relatively low risk of adverse outcomes or postoperative mortality and morbidity. In patients without high-risk CT findings, either appendectomy or antibiotics can be considered as first-line therapy. In unfit patients without these high-risk CT findings, the antibiotics-first approach is recommended, and surgery may be considered if antibiotic treatment fails. In unfit patients with high-risk CT findings, perioperative risk assessment as well as patient preferences should be considered. CONCLUSIONS AND RELEVANCE Acute appendicitis affects 96.5 to 100 people per 100 000 adults per year worldwide. Appendectomy remains first-line therapy for acute appendicitis, but treatment with antibiotics rather than surgery is appropriate in selected patients with uncomplicated appendicitis.
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Affiliation(s)
- Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Erik Karl Paulson
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Theodore N Pappas
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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13
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Vaziri M, Nafissi N, Jahangiri F, Nasiri M. Comparison of the appendicitis inflammatory response and Alvarado scoring systems in the diagnosis of acute appendicitis in children. J Med Life 2021; 14:75-80. [PMID: 33767789 PMCID: PMC7982267 DOI: 10.25122/jml-2020-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Our objective was to compare the diagnostic accuracy of Alvarado and appendicitis inflammatory response (AIR) scoring systems among children suspected of acute appendicitis concerning their postoperative outcomes. During a two-year period, a prospective multicentric study was carried in the selected hospitals of Iran. All children who were admitted with the diagnosis of acute appendicitis were enrolled in the study. However, patients suffering from generalized peritonitis or those who had a history of abdominal surgery were excluded. Before decision-making, each patient’s score according to two appendicitis scoring systems was calculated. The clinical outcomes and diagnosis of patients were then compared to the results of each scoring system. For those patients who were a candidate for surgery, the final diagnosis of acute appendicitis was made by histopathology. Patients were divided into a high- and low-risk group according to scoring systems outcomes. Among the patients with a low score for appendicitis, the AIR scoring system had a sensitivity and specificity of 95% and 74%, respectively, which was more promising in comparison to that of the Alvarado system (90% and 70%, respectively). Regarding the patients at higher risk of acute appendicitis, none of the scoring systems provided reliable results since both systems showed sensitivity and specificity of less than 50%, which was not sufficient to distinguish patients who are a candidate for surgery. AIR and Alvarado scoring systems are not accurate models to predict the risk of acute appendicitis among children; however, the AIR system could be used as a reliable material to rule out the acute appendicitis diagnosis.
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Affiliation(s)
- Mohammad Vaziri
- Department of Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Nafissi
- Department of Breast Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Jahangiri
- Department of Pediatric Surgery, Ali-Asghar children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nasiri
- Department of Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Factors Affecting Patient Outcomes in Acute Appendicitis in Rural Areas: An Observational Cohort Study. World J Surg 2021; 45:2337-2346. [PMID: 33813629 DOI: 10.1007/s00268-021-06093-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The most common surgical emergency both in developed and non-developed countries is acute appendicitis and it has a time-dependent clinical course. In this observational cohort study, we aim to investigate the factors affecting patient outcomes in acute appendicitis at a rural hospital. METHODS This observational cohort study was held between November 2012 and May 2014 at a rural hospital. Patients' pre-operative, perioperative, and post-operative data were collected prospectively. Patients were followed-up for 12-months. RESULTS A total of 151 patients were recorded. Factors significantly associated with complicated cases (abscess/perforation) were referral region as remote towns (OR:7.94, 95%CI [3.46-18.23]; p < 0.001), referral season as winter (OR:2.47, %95CI [1.14-5.36]; p = 0.022), pre-operative hospital delay (OR:6.52, 95%CI [3.49-12.20]; p < 0.001), and duration of referral (OR:1.01, 95%CI [1.00-1.01]; p < 0.001). In the multivariate analysis, only pre-operative hospital delay remained as a significant factor (OR:5.87, 95%CI [2.85 - 12.07]; p < 0.001). Factors affecting length of hospital stay (LoHS) were referral region as remote towns (95%CI, β = 3.10 [2.28-3.93], t = 1.91; p < 0.001), abscess/perforation (95%CI, β = 4.70 [4.04-5.36], t = 14.05; p < 0.001), pre-operative hospital delay (95%CI, β = 1.25 [0.87-1.62], t = 6.58; p < 0.001), and duration of referral (95%CI, β = 0.011 [0.01-0.14], t = 7.34; p < 0.001). In the multivariate analysis, all four factors stayed significant. The rate of complicated appendicitis was significantly high in winter than other seasons for patients referring from remote towns (75% vs 33%, p < 0.001). CONCLUSIONS This observational cohort study is the only study specifically focused on the effect of season and region on abscess/perforation rates, LoHS, and accessibility to hospital in patients with acute appendicitis.
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Klein TT, Kohn E, Klin B, Ziv-Baran T, Kozer E, Berkovitch M, Abu Kishk I. sTREM-1 as a diagnostic biomarker for acute appendicitis in children. Asian J Surg 2021; 44:1172-1178. [PMID: 33766532 DOI: 10.1016/j.asjsur.2021.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/13/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The typical history of acute appendicitis is observed in less than 60% of cases. Therefore, searching for a surrogate marker is mandatory. Our goal was to determine whether the soluble triggering receptor expressed on myeloid cells (sTREM-1) is an efficient biomarker for acute appendicitis. METHODS sTREM-1 serum levels were measured in addition to carrying out routine diagnostic tests (urine dipstick, complete blood count and CRP) in children admitted to the Emergency Department with suspected appendicitis. Statistical analysis was performed in order to examine whether sTREM-1 was a significant predictor of appendicitis. RESULTS Fifty three of 134 children enrolled in the study were diagnosed with appendicitis. There was no significant difference in serum sTREM-1 levels (p = 0.111) between children with or without appendicitis (n = 81). Leukocytes, neutrophils and CRP were significantly elevated in the appendicitis group (p < 0.001). The appendix diameter was significantly larger and the Alvarado score significantly higher in the appendicitis group (p < 0.001). CONCLUSION serum sTREM-1 is not a good marker for acute appendicitis. Customary tests in addition to a proper patient history and physical examination are still the most effective methods to diagnose acute appendicitis.
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Affiliation(s)
- Tal Taraboulos Klein
- Pediatric Division, Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elkana Kohn
- Clinical Pharmacology Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Baruch Klin
- Pediatric Division, Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Affiliated to the Sackler School of Medicine Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Kozer
- Pediatric Division, Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matityahu Berkovitch
- Clinical Pharmacology Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ibrahim Abu Kishk
- Pediatric Division, Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Chiegwu H, Ugwuanyi D, Udoh B, Chianumba F. Evaluation of the diagnostic yield of ultrasound in the management of appendicitis: An experience in a tertiary hospital in South-Eastern Nigeria. WEST AFRICAN JOURNAL OF RADIOLOGY 2021. [DOI: 10.4103/wajr.wajr_17_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Takada T, Inokuchi R, Kim H, Sasaki S, Terada K, Yokota H, Hattori S, Mikami W, Kubota T, Fukuhara S. Is "pain before vomiting" useful?: Diagnostic performance of the classic patient history item in acute appendicitis. Am J Emerg Med 2020; 41:84-89. [PMID: 33401081 DOI: 10.1016/j.ajem.2020.12.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In most surgical textbooks, it has been stated that pain almost always precedes vomiting in patients with appendicitis. However, the usefulness of this classic history item, "pain before vomiting", has been investigated in only one study nearly 50 years ago, in which the cause of abdominal pain could not be identified in more than 40% of patients. Accordingly, our objective was to evaluate the performance of pain before vomiting for the diagnosis of acute appendicitis in patients who presented with both acute abdominal pain and vomiting. METHODS A retrospective chart review of adult outpatients with abdominal pain and vomiting at three acute care hospitals was performed. The reference standard for appendicitis was a CT scan evaluated by two radiologists. Diagnostic performance of pain before vomiting and the value it added to the Alvarado score were evaluated. RESULTS Among 310 patients, 24 patients were diagnosed with appendicitis. Diagnostic performance of pain before vomiting was a sensitivity of 95.8% (95% confidence interval [CI] 79.8-99.3) and a specificity of 16.6% (95% CI 12.6-21.4). When combined with the Alvarado score, it ruled out appendicitis in an additional 12% (increased from 32% to 44%) of patients without any false negatives. CONCLUSIONS "Pain before vomiting" is useful for ruling out appendicitis in patients with abdominal pain and vomiting.
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Affiliation(s)
- Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Ryota Inokuchi
- Department of General and Emergency Medicine, JR Tokyo General Hospital, 2-1-3, Yoyogi, Shibuya-ku, Tokyo 151-8528, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hongja Kim
- Department of General Practice, Kaita Hospital, 1061-1 Kuchinohara, Iizuka, Fukuoka 820-1114, Japan
| | - Sho Sasaki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Department of Nephrology/Clinical Research Support Office, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan
| | - Kazuhiko Terada
- Department of General Medicine, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba 292-0822, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chiba 260-8670, Japan
| | - Shinya Hattori
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chiba 260-8677, Japan
| | - Wakako Mikami
- Department of Radiology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama, Kanagawa 220-8521, Japan
| | - Tadao Kubota
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, 54 Shogo-in Kawaramachi, Sakyo-ku, Kyoto 606-8507, Japan
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18
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Affiliation(s)
- Nicole M Kapral
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Arthur J Pesch
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health system, Charlottesville, VA..
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Trends in Use of Diagnostic Imaging for Abdominal Pain in U.S. Emergency Departments. AJR Am J Roentgenol 2020; 216:200-208. [PMID: 33211574 DOI: 10.2214/ajr.19.22667] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE. CT has excellent accuracy for appendicitis but is associated with risks. Research and educational campaigns have been conducted to implement an ultrasound-first strategy for children but not for adults. The purpose of this study was to measure the use of CT and ultrasound in emergency department (ED) visits for abdominal pain and appendicitis to examine the impact of these efforts. MATERIALS AND METHODS. We analyzed data from the National Hospital Ambulatory Medical Care Survey (1997-2016). Use of CT and ultrasound was measured over time in visits for abdominal pain and visits in which appendicitis was diagnosed. Predictors of CT use were identified by means of regression analysis. RESULTS. For children, CT use increased from 1.2% (95% CI, 0.6-2.5%) in 1997, peaked in 2010 at 16.6% (95% CI, 13.8-19.6%), and decreased slightly in 2016. In adults, CT use increased steadily from 3.9% in 1997 (95% CI, 3.1-4.8%) to 37.8% (95% CI, 35.5-41.0%) in 2016. CT use increased for both pediatric and adult ED visits with a diagnosis of appendicitis, from 5.2% (95% CI, 0.7-29.5%) to 71.0% (95% CI, 43.1-88.8%) for children and 7.2% (95% CI, 2.7-17.6%) to 83.3% (95% CI, 64.1-93.3%) for adults. Children with abdominal pain and a diagnosis of appendicitis evaluated in a pediatric ED were at decreased odds (pain odds ratio, 0.6 [95% CI, 0.3-0.9]; appendicitis odds ratio, 0.2 [95% CI, 0.0-0.7]) of receiving CT than were those evaluated in general EDs. CONCLUSION. CT use has decreased in the evaluation of abdominal pain in children, perhaps because of research findings and efforts to implement an ultrasound-first strategy for suspected appendicitis. In contrast, CT use has continued to increase among adults with abdominal pain in EDs.
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20
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Gray DT, Mizrahi T. Trends in Appendicitis and Perforated Appendicitis Prevalence in Children in the United States, 2001-2015. JAMA Netw Open 2020; 3:e2023484. [PMID: 33125493 PMCID: PMC7599446 DOI: 10.1001/jamanetworkopen.2020.23484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This sequential, cross-sectional study examines the prevalence of perforated appendicitis in children in the United States in relation to access to health care from 2001 to 2015.
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Affiliation(s)
- Darryl T. Gray
- Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Trina Mizrahi
- Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland
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21
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Huckins DS, Copeland K. Diagnostic accuracy of combined WBC, ANC and CRP in adult emergency department patients suspected of acute appendicitis. Am J Emerg Med 2020; 44:401-406. [PMID: 32482481 DOI: 10.1016/j.ajem.2020.04.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/07/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To assess the sensitivity, specificity, and negative predictive value (NPV) of normal total white blood cell count (WBC) and normal absolute neutrophil count (ANC) combined with a normal proprietary C-reactive protein (pCRP) level in adult emergency department (ED) patients with abdominal pain suspected of possible acute appendicitis. METHODS We prospectively enrolled patients ≥18 years of age at seven U.S. emergency departments with ≤72 h of abdominal pain and other signs and symptoms suggesting possible acute appendicitis. Sensitivity, specificity, and NPV for normal WBC and ANC combined with normal pCRP were correlated with the final diagnosis of acute appendicitis. RESULTS We enrolled 422 patients with a prevalence of acute appendicitis of 19.1%. The combination of normal WBC and pCRP exhibited a sensitivity of 97.5% (95% CI, 91.3-99.3%), an NPV of 98.8% (95% CI, 95.9-99.7%) and a specificity of 50.0% (95% CI, 44.7-55.3%) for acute appendicitis. Normal ANC and pCRP resulted in a sensitivity of 100% (95% CI, 95.4-100%), a negative predictive value of 100% (95% CI, 97.5-100%) and a specificity of 44.4% (95% CI, 39.2-49.7%) for acute appendicitis. Normal WBC and pCRP correctly identified 171 of 342 (50.0%) patients who did not have appendicitis with 2 (2.5%) false negatives, while normal ANC and pCRP identified 150 of 338 (44.3%) of patients without appendicitis with no false negatives. CONCLUSION The combination of normal WBC and ANC with normal pCRP levels exhibited high sensitivity and negative predictive value for acute appendicitis in this prospective adult patient cohort. Confirmation and validation of these findings with further study using commercially available CRP assays is needed.
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Affiliation(s)
- David S Huckins
- Division of Emergency Medicine, Newton-Wellesley Hospital, Newton, MA, United States of America.
| | - Karen Copeland
- Boulder Statistics, LLC, Boulder, CO, United States of America
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22
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The Accuracy of Low-dose Computed Tomography Protocol in Patients With Suspected Acute Appendicitis: The OPTICAP Study. Ann Surg 2020; 271:332-338. [PMID: 30048324 DOI: 10.1097/sla.0000000000002976] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To compare diagnostic accuracy of contrast enhanced low-dose computed tomography (CT) accomplished in the OPTICAP trial phantom phase to standard CT in patients with suspected acute appendicitis. BACKGROUND Increasing use of CT as the gold standard in diagnosing acute appendicitis has raised concerns regarding radiation exposure. Unenhanced low-dose CT protocols have shown similar diagnostic accuracy with standard CT for diagnosing appendicitis. To our knowledge, there are no other trials in which the same patient with suspected acute appendicitis underwent both standard and low-dose CT allowing interpatient comparison. METHODS OPTICAP is an interpatient protocol sequence randomized noninferiority single-center trial performed at Turku University Hospital between November, 2015 and August, 2016. Sixty patients with suspected acute appendicitis and body mass index <30 kg/m were enrolled to undergo both standard and low-dose contrast enhanced CT scans, which were categorized as normal, uncomplicated or complicated appendicitis by 2 radiologists in blinded manner. All patients with CT confirmed appendicitis underwent appendectomy to obtain histopathology. RESULTS The low-dose protocol was not inferior to standard protocol in terms of diagnostic accuracy; 79% [95% confidence interval (CI) 66%-89%) accurate diagnosis in low-dose and 80% (95% CI 67%-90%) in standard CT by primary radiologist. Accuracy to categorize appendicitis severity was 79% for both protocols. The mean radiation dose of low-dose CT was significantly lower compared with standard CT (3.33 and 4.44 mSv, respectively). CONCLUSION Diagnostic accuracy of contrast enhanced low-dose CT was not inferior to standard CT in diagnosing acute appendicitis or distinguishing between uncomplicated and complicated acute appendicitis in patients with a high likelihood of acute appendicitis. Low-dose CT enabled significant radiation dose reduction.
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Ahmad KA, Ideris N, Aziz SHSA. A Cross-Sectional Study of Neutrophil-to-Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka. Malays J Med Sci 2020; 26:55-66. [PMID: 31908587 PMCID: PMC6939729 DOI: 10.21315/mjms2019.26.6.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/29/2019] [Indexed: 12/29/2022] Open
Abstract
Background Acute appendicitis is one of the most common surgical emergencies. However, its proper diagnosis is complicated. This study aims to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to diagnose acute appendicitis in pre-operative state. Methods Histopathological examination of appendicectomies conducted between 2016 and 2017 in Melaka Hospital, Malaysia were traced and categorised into three groups: i) G1 (normal appendix), ii) G2 (acute appendicitis) and iii) G3 (perforated appendicitis). The reports were randomised and a total of 338 samples were collected. NLR values were compared between the three different groups and analysed. Results The median values of NLR for G1, G2 and G3 were 2.37, 5.25 and 9.27, respectively. We found a statistically significant difference in NLR between G1 and G2 (P < 0.001), and G2 and G3 (P < 0.001). The diagnostic values of NLR for acute appendicitis and perforated appendicitis were 3.11 (sensitivity: 75.23%, specificity: 68.70%) and 6.17 (sensitivity: 76.32%, specificity: 58.72%), respectively. There was a substantial correlation between NLR and disease severity, and a moderate correlation between NLR and duration of admission. Conclusion NLR, with a sensitivity of 75.23% and specificity of 68.70%, is a useful and reliable adjunct in diagnosing acute appendicitis. Hence, it will help in reducing the rate of negative appendicectomies.
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Affiliation(s)
- Khairol Ashraf Ahmad
- Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Noorharisman Ideris
- Department of Surgery, Hospital Melaka, Jalan Mufti Haji Khalil, Melaka, Malaysia
| | - Syed Hassan Syed Abd Aziz
- Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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24
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Montuori M, Famularo S, Santurro L, Lo Bianco G, Giani A, Uggeri F, Gianotti LV. Retroperitoneal abscess from perforated acute appendicitis: a diagnostic challenge. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.18.04939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Rud B, Vejborg TS, Rappeport ED, Reitsma JB, Wille‐Jørgensen P. Computed tomography for diagnosis of acute appendicitis in adults. Cochrane Database Syst Rev 2019; 2019:CD009977. [PMID: 31743429 PMCID: PMC6953397 DOI: 10.1002/14651858.cd009977.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Diagnosing acute appendicitis (appendicitis) based on clinical evaluation, blood testing, and urinalysis can be difficult. Therefore, in persons with suspected appendicitis, abdominopelvic computed tomography (CT) is often used as an add-on test following the initial evaluation to reduce remaining diagnostic uncertainty. The aim of using CT is to assist the clinician in discriminating between persons who need surgery with appendicectomy and persons who do not. OBJECTIVES Primary objective Our primary objective was to evaluate the accuracy of CT for diagnosing appendicitis in adults with suspected appendicitis. Secondary objectives Our secondary objectives were to compare the accuracy of contrast-enhanced versus non-contrast-enhanced CT, to compare the accuracy of low-dose versus standard-dose CT, and to explore the influence of CT-scanner generation, radiologist experience, degree of clinical suspicion of appendicitis, and aspects of methodological quality on diagnostic accuracy. SEARCH METHODS We searched MEDLINE, Embase, and Science Citation Index until 16 June 2017. We also searched references lists. We did not exclude studies on the basis of language or publication status. SELECTION CRITERIA We included prospective studies that compared results of CT versus outcomes of a reference standard in adults (> 14 years of age) with suspected appendicitis. We excluded studies recruiting only pregnant women; studies in persons with abdominal pain at any location and with no particular suspicion of appendicitis; studies in which all participants had undergone ultrasonography (US) before CT and the decision to perform CT depended on the US outcome; studies using a case-control design; studies with fewer than 10 participants; and studies that did not report the numbers of true-positives, false-positives, false-negatives, and true-negatives. Two review authors independently screened and selected studies for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently collected the data from each study and evaluated methodological quality according to the Quality Assessment of Studies of Diagnostic Accuracy - Revised (QUADAS-2) tool. We used the bivariate random-effects model to obtain summary estimates of sensitivity and specificity. MAIN RESULTS We identified 64 studies including 71 separate study populations with a total of 10,280 participants (4583 with and 5697 without acute appendicitis). Estimates of sensitivity ranged from 0.72 to 1.0 and estimates of specificity ranged from 0.5 to 1.0 across the 71 study populations. Summary sensitivity was 0.95 (95% confidence interval (CI) 0.93 to 0.96), and summary specificity was 0.94 (95% CI 0.92 to 0.95). At the median prevalence of appendicitis (0.43), the probability of having appendicitis following a positive CT result was 0.92 (95% CI 0.90 to 0.94), and the probability of having appendicitis following a negative CT result was 0.04 (95% CI 0.03 to 0.05). In subgroup analyses according to contrast enhancement, summary sensitivity was higher for CT with intravenous contrast (0.96, 95% CI 0.92 to 0.98), CT with rectal contrast (0.97, 95% CI 0.93 to 0.99), and CT with intravenous and oral contrast enhancement (0.96, 95% CI 0.93 to 0.98) than for unenhanced CT (0.91, 95% CI 0.87 to 0.93). Summary sensitivity of CT with oral contrast enhancement (0.89, 95% CI 0.81 to 0.94) and unenhanced CT was similar. Results show practically no differences in summary specificity, which varied from 0.93 (95% CI 0.90 to 0.95) to 0.95 (95% CI 0.90 to 0.98) between subgroups. Summary sensitivity for low-dose CT (0.94, 95% 0.90 to 0.97) was similar to summary sensitivity for standard-dose or unspecified-dose CT (0.95, 95% 0.93 to 0.96); summary specificity did not differ between low-dose and standard-dose or unspecified-dose CT. No studies had high methodological quality as evaluated by the QUADAS-2 tool. Major methodological problems were poor reference standards and partial verification primarily due to inadequate and incomplete follow-up in persons who did not have surgery. AUTHORS' CONCLUSIONS The sensitivity and specificity of CT for diagnosing appendicitis in adults are high. Unenhanced standard-dose CT appears to have lower sensitivity than standard-dose CT with intravenous, rectal, or oral and intravenous contrast enhancement. Use of different types of contrast enhancement or no enhancement does not appear to affect specificity. Differences in sensitivity and specificity between low-dose and standard-dose CT appear to be negligible. The results of this review should be interpreted with caution for two reasons. First, these results are based on studies of low methodological quality. Second, the comparisons between types of contrast enhancement and radiation dose may be unreliable because they are based on indirect comparisons that may be confounded by other factors.
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Affiliation(s)
- Bo Rud
- Copenhagen University Hospital HvidovreGastrounit, Surgical DivisionKettegaards Alle 30HvidovreDenmark2650
| | - Thomas S Vejborg
- Bispebjerg Hospital, University of CopenhagenDepartment of Radiology R23 Bispebjerg BakkeCopenhagenDenmarkDK 2400 NV
| | - Eli D Rappeport
- Bispebjerg Hospital, University of CopenhagenDepartment of Radiology R23 Bispebjerg BakkeCopenhagenDenmarkDK 2400 NV
| | - Johannes B Reitsma
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands3508 GA Utrecht
| | - Peer Wille‐Jørgensen
- Bispebjerg HospitalDepartment of Surgical Gastroenterology KBispebjerg Bakke 23Copenhagen NVDenmarkDK‐2400
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Chávez LP, Santos Luna H. Impacto de la Escala de Alvarado para el diagnóstico de apendicitis aguda en Pediatría. REVISTA DE LA FACULTAD DE MEDICINA 2019. [DOI: 10.37345/23045329.v1i26.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introducción: La apendicitis aguda es una condición médica considerada de urgencia, razón por la cual, el diagnóstico certero necesita confirmación con exámenes de laboratorio o de imagen, sin embargo, no todos los centros de asistencia médica cuentan con las facilidades para ello y, una escala de signos y síntomas pueden ser orientadores al diagnóstico. Objetivo: El propósito fundamental de este estudio fue el comparar la sensibilidad y especificidad de la Escala de Alvarado (EA) en el diagnóstico de apendicitis, confirmado por biopsia. Métodos: En forma prospectivo-retrospectivo observacional y transversal abierto, se estudiaron a 219 pacientes con el diagnóstico de abdomen agudo quirúrgico, sugestivo de apendicitis aguda y que se sometieron a apendicetomía abierta o laparoscópica. Se valoraron clínicamente bajo la EA. Se estableció el valor diagnóstico de la aplicación de la Escala por sí sola y se comparó el valor diagnóstico del “gold estándar” que fue el estudio histopatológico o biopsia. Resultados: De los 219 pacientes, 178 fueron diagnosticados con la EA la cual, demostró una especificidad de 53% y sensibilidad del 89%, valor predictivo (VP) positivo de 88%, VP negativo de 53%. Conclusión: La EA continúa siendo una buena guía para el diagnóstico de apendicitis aguda. Palabras clave: apendicitis, manejo quirúrgico, Escala de Alvarado, biopsia o estudio histopatológico.
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Ruiz M, Shahid Z, Renteria O, Huerta S. Current Trends in Training in the Surgical Management of Acute Appendicitis at a Veteran Affairs Hospital. JOURNAL OF SURGICAL EDUCATION 2019; 76:506-511. [PMID: 30249516 DOI: 10.1016/j.jsurg.2018.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/14/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION An open appendectomy used to be one of the most common cases performed by interns and physical exam dictated operative intervention. We hypothesized that the management of acute appendicitis has drastically changed from these previous practices. METHODS A retrospective, single institution study was performed at the VA North Texas Health Care System between July 2005 to June 2017 for all patients who underwent an appendectomy. Using postgraduate year (PGY)-level (PGY 1-3 and PGY 4-5) as a dependent variable, univariate analyses, and multiple logistic regression analyses were performed. All statistical tests were 2-sided, and the statistical significance level was set at a p ≤ 0.05. RESULTS Only patients with acute appendicitis were included (n = 257; male = 90.7%; age = 45.4 ± 15.6 year old; body mass index = 30.3 ± 6.3 Kg/m2). Of these, only 8 were performed by interns, 25 by PGY-2, 147 by PGY-3, 22 by PGY-4, and 55 by PGY-5. On presentation, 92.2% of patients had a computed tomography scan and 90.7% underwent a laparoscopic appendectomy. Conversion rate was 4.7%. There were 20 complications (7.8%) and length of hospital stay was 2.2±3.7 days. Comparing patients operated by senior (PGY-4 and 5) to junior (PGY-1 to -3) residents: patients were of similar age, gender, body mass index, American Society of Anesthesiologists (ASA), and had similar WBC and blood pressure on initial presentation (all p's > 0.05); but were more likely to have diabetes mellitus, hypertension or pulmonary disease. Complication rate was the same (7.8%) for both senior and junior residents. CONCLUSIONS At the VA North Texas Health Care System, most patients presenting with suspected appendicitis undergo a computed tomography scan. Most cases are performed laparoscopically mainly by PGY ≥ 3 residents. The rate of post-operative complications was similar between junior and senior residents.
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Affiliation(s)
- Maria Ruiz
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zain Shahid
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Oswaldo Renteria
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas.
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28
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Gómez López JR, Martín Del Olmo JC, Montenegro Martín MA, Concejo Cutoli P, Martín Esteban ML, Toledano Trincado M, López Mestanza IC, Vaquero Puerta C. Laparoscopic Appendectomy in the Setting of Clinical Prediction Rules. J Laparoendosc Adv Surg Tech A 2018; 29:184-191. [PMID: 30585754 DOI: 10.1089/lap.2018.0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Acute appendicitis (AA) is the most frequent surgical entity in the emergency department, but its correct diagnosis remains challenging. To improve diagnosis, clinical prediction rules (CPRs) have been created to establish objective scores for the probability of suffering AA. In this study, we establish scores indicating whether laparoscopy would be superior to clinical observation or repeat diagnostic test. METHODS A retrospective observational study was conducted with 433 patients submitted to surgery for suspected AA using a laparoscopic approach. The Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, appendicitis inflammatory response, and adult appendicitis score scales were applied in each case to establish a high, medium, or low probability of suffering AA. RESULTS Of the 433 patients analyzed, 381 (88.0%) had AA. Twelve (2.8%) were converted to open surgery, and complications were observed in 54 (12.5%) cases. The CPRs studied showed statistically significant differences between AA and negative appendectomies. However, in patients with intermediate probability scores, the diagnostic accuracy of the CPRs evaluated was not adequate. CONCLUSIONS Laparoscopic surgery can serve as a diagnostic tool for patients with intermediate AA probability scores because of its low associated morbidity and mortality and because it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment.
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29
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Tyler PD, Carey J, Stashko E, Levenson RB, Shapiro NI, Rosen CL. The Potential Role of Ultrasound in the Work-up of Appendicitis in the Emergency Department. J Emerg Med 2018; 56:191-196. [PMID: 30594351 DOI: 10.1016/j.jemermed.2018.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Acute appendicitis is common in the adult emergency department (ED). Computed tomography (CT) scan is frequently used to diagnose this condition, but ultrasound (US)-commonly used in pediatric diagnosis-may also have a role. OBJECTIVES Review the clinical utility and define the frequency and diagnostic accuracy of US to diagnose appendicitis in an adult population in the ED setting. METHODS Retrospective cohort study of patients who underwent appendiceal US in an academic, tertiary ED from July 2013-October 2015. RESULTS There were 174 patients included, of which 39 (22%) had pathology-confirmed appendicitis. There were 25 patients who had an US scan that was positive for appendicitis, 146 (84%) were indeterminate, and 3 (1.7%) were negative. Among patients with a positive US, 25/25 (100%, 95% confidence interval [CI] 84-100%) had appendicitis, 32/146 (22%, 95% CI 16-29%) with an indeterminate US had appendicitis, and 0/3 (0%, 95% CI 0-6.2%) with a negative US had appendicitis. In the 28 definitive cases, US had a sensitivity of 64%, specificity of 2%, positive predictive value of 100%, and negative predictive value of 100%. The likelihood ratio positive and negative were 173 and 0, respectively. CONCLUSION Our initial data suggest that an US that shows appendicitis seems to be reliable; however, a high prevalence of indeterminate studies limits the diagnostic utility as a universal approach in adult patients in the ED setting. Larger studies are needed to identify which patient populations would benefit from US as the initial imaging modality, what factors contribute to the large numbers of indeterminate results, and if any interventions may reduce the number of indeterminate results.
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Affiliation(s)
- Patrick D Tyler
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jeremy Carey
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Eric Stashko
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Robin B Levenson
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Carlo L Rosen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Haijanen J, Sippola S, Grönroos J, Rautio T, Nordström P, Rantanen T, Aarnio M, Ilves I, Hurme S, Marttila H, Virtanen J, Mattila A, Paajanen H, Salminen P. Optimising the antibiotic treatment of uncomplicated acute appendicitis: a protocol for a multicentre randomised clinical trial (APPAC II trial). BMC Surg 2018; 18:117. [PMID: 30558607 PMCID: PMC6296129 DOI: 10.1186/s12893-018-0451-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Based on epidemiological and clinical data acute appendicitis can present either as uncomplicated (70-80%) or complicated (20-30%) disease. Recent studies have shown that antibiotic therapy is both safe and cost-effective for a CT-scan confirmed uncomplicated acute appendicitis. However, based on the study protocols to ensure patient safety, these randomised studies used mainly broad-spectrum intravenous antibiotics requiring additional hospital resources and prolonged hospital stay. As we now know that antibiotic therapy for uncomplicated acute appendicitis is feasible and safe, further studies evaluating optimisation of the antibiotic treatment regarding both antibiotic spectrum and shorter hospital stay are needed to evaluate antibiotics as the first-line treatment for uncomplicated acute appendicitis. METHODS APPAC II trial is a multicentre, open-label, non-inferiority randomised controlled trial comparing per oral (p.o.) antibiotic monotherapy with intravenous (i.v.) antibiotic therapy followed by p.o. antibiotics in the treatment of CT-scan confirmed uncomplicated acute appendicitis. Adult patients with CT-scan diagnosed uncomplicated acute appendicitis will be enrolled in nine Finnish hospitals. The intended sample size is 552 patients. Primary endpoint is the success of the randomised treatment, defined as resolution of acute appendicitis resulting in discharge from the hospital without the need for surgical intervention and no recurrent appendicitis during one-year follow-up. Secondary endpoints include post-intervention complications, late recurrence of acute appendicitis after one year, duration of hospital stay, pain, quality of life, sick leave and treatment costs. Primary endpoint will be evaluated in two stages: point estimates with 95% confidence interval (CI) will be calculated for both groups and proportion difference between groups with 95% CI will be calculated and evaluated based on 6 percentage point non-inferiority margin. DISCUSSION To our knowledge, APPAC II trial is the first randomised controlled trial comparing per oral antibiotic monotherapy with intravenous antibiotic therapy continued by per oral antibiotics in the treatment of uncomplicated acute appendicitis. The APPAC II trial aims to add clinical evidence on the debated role of antibiotics as the first-line treatment for a CT-confirmed uncomplicated acute appendicitis as well as to optimise the non-operative treatment for uncomplicated acute appendicitis. TRIAL REGISTRATION Clinicaltrials.gov , NCT03236961, retrospectively registered on the 2nd of August 2017.
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Affiliation(s)
- J. Haijanen
- Division of Digestive Surgery and Urology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - S. Sippola
- Division of Digestive Surgery and Urology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - J. Grönroos
- Division of Digestive Surgery and Urology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - T. Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - P. Nordström
- Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
| | - T. Rantanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - M. Aarnio
- Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - I. Ilves
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - S. Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - H. Marttila
- Department of Hospital Hygiene and Infection Control, Turku University Hospital, Turku, Finland
| | - J. Virtanen
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - A. Mattila
- Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - H. Paajanen
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - P. Salminen
- Division of Digestive Surgery and Urology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
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Sippola S, Grönroos J, Sallinen V, Rautio T, Nordström P, Rantanen T, Hurme S, Leppäniemi A, Meriläinen S, Laukkarinen J, Savolainen H, Virtanen J, Salminen P. A randomised placebo-controlled double-blind multicentre trial comparing antibiotic therapy with placebo in the treatment of uncomplicated acute appendicitis: APPAC III trial study protocol. BMJ Open 2018; 8:e023623. [PMID: 30391919 PMCID: PMC6231590 DOI: 10.1136/bmjopen-2018-023623] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/19/2018] [Accepted: 09/04/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Recent studies show that antibiotic therapy is safe and feasible for CT-confirmed uncomplicated acute appendicitis. Spontaneous resolution of acute appendicitis has already been observed over a hundred years ago. In CT-confirmed uncomplicated acute diverticulitis (left-sided appendicitis), studies have shown no benefit from antibiotics compared with symptomatic treatment, but this shift from antibiotics to symptomatic treatment has not yet been widely implemented in clinical practice. Recently, symptomatic treatment of uncomplicated acute appendicitis has been demonstrated in a Korean open-label study. However, a double-blinded placebo-controlled study to illustrate the role of antibiotics and spontaneous resolution of uncomplicated acute appendicitis is still lacking. METHODS AND ANALYSIS The APPAC III (APPendicitis ACuta III) trial is a multicentre, double-blind, placebo-controlled, superiority randomised study comparing antibiotic therapy with placebo in the treatment CT scan-confirmed uncomplicated acute appendicitis aiming to evaluate the role of antibiotics in the resolution of uncomplicated acute appendicitis. Adult patients (18-60 years) with CT scan-confirmed uncomplicated acute appendicitis (the absence of appendicolith, abscess, perforation and tumour) will be enrolled in five Finnish university hospitals.Primary endpoint is success of the randomised treatment, defined as resolution of acute appendicitis resulting in discharge from the hospital without surgical intervention within 10 days after initiating randomised treatment (treatment efficacy). Secondary endpoints include postintervention complications, recurrent symptoms after treatment up to 1 year, late recurrence of acute appendicitis after 1 year, duration of hospital stay, sick leave, treatment costs and quality of life. A decrease of 15 percentage points in success rate is considered clinically important difference. The superiority of antibiotic treatment compared with placebo will be analysed using Fisher's one-sided test and CI will be calculated for proportion difference. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee of Turku University Hospital and the Finnish Medicines Agency (FIMEA). The findings will be disseminated in peer-reviewed academic journals. TRIAL REGISTRATION NUMBER NCT03234296; Pre-results.
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Affiliation(s)
- Suvi Sippola
- Division of Digestive Surgery and
Urology, Turku University Hospital, Turku, Finland
- Department of Surgery,
University of Turku, Turku, Finland
| | - Juha Grönroos
- Division of Digestive Surgery and
Urology, Turku University Hospital, Turku, Finland
- Department of Surgery,
University of Turku, Turku, Finland
| | - Ville Sallinen
- Department of Surgery,
Helsinki University Central Hospital, Helsinki, Finland
| | - Tero Rautio
- Department of Surgery,
Oulu University Hospital, Oulu, Finland
| | - Pia Nordström
- Division of Surgery, Gastroenterology and
Oncology, Tampere University Hospital, Tampere, Finland
| | - Tuomo Rantanen
- Department of Surgery,
Kuopio University Hospital, Kuopio, Finland
| | - Saija Hurme
- Department of Biostatistics,
University of Turku, Turku, Finland
| | - Ari Leppäniemi
- Department of Surgery,
Helsinki University Central Hospital, Helsinki, Finland
| | | | - Johanna Laukkarinen
- Division of Surgery, Gastroenterology and
Oncology, Tampere University Hospital, Tampere, Finland
| | - Heini Savolainen
- Department of Surgery,
Kuopio University Hospital, Kuopio, Finland
| | - Johanna Virtanen
- Department of Radiology,
Turku University Hospital, Turku, Finland
| | - Paulina Salminen
- Division of Digestive Surgery and
Urology, Turku University Hospital, Turku, Finland
- Department of Surgery,
University of Turku, Turku, Finland
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Kim J, Kim K, Kim J, Yoo J, Jeong W, Cho S, Joo K, Cho Y, Lee J, Ryu S, Yoo Y. The learning curve in diagnosing acute appendicitis with emergency sonography among novice emergency medicine residents. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:305-310. [PMID: 29315613 DOI: 10.1002/jcu.22577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 11/25/2017] [Accepted: 12/21/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Ultrasonography (US) has good accuracy for diagnosing appendicitis when it is performed by emergency physicians. This study aimed to determine the amount of experience that is required to achieve competency in this field. METHODS Three novice emergency medicine residents completed a 1-day training course regarding the US diagnosis of appendicitis. Then, they performed appendix US in the emergency department on patients complaining of right lower quadrant pain. All included patients also underwent computed tomography or US performed by a board-certified radiologist, to confirm the emergency US diagnosis. The agreement between the diagnoses of novices and experts was evaluated. RESULTS A total of 266 patients were included, and the overall Cohen's kappa coefficient was 0.77 (95% confidence interval [CI]: 0.69-0.84). The kappa value of first 20 cases was 0.49 (95% CI: 0.27-0.71). It increased rapidly during evaluation of the first 20 cases. After the first 20 cases, the kappa coefficient was 0.84 (95% CI: 0.77-0.92). The sensitivity and specificity values for the first 20 cases were 64.3% (95% CI: 77.6%-90.7%) and 84.4% (95% CI: 85.4%-95.4%), respectively. After the first 20 cases, the sensitivity and specificity values increased to 90.9% (95% CI: 83.4%-95.8%) and 93.5% (95% CI: 87.0%-97.3%), respectively. CONCLUSIONS A minimum of 20 cases are needed to achieve competency in emergency US diagnosis of acute appendicitis.
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Affiliation(s)
- Jeehyun Kim
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Kipum Kim
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Jungwan Kim
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Jungwoo Yoo
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Wonjoon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sunguk Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Kihyuk Joo
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Yongchul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Jinwoong Lee
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Yeonho Yoo
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, South Korea
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The Alvarado score should be used to reduce emergency department length of stay and radiation exposure in select patients with abdominal pain. J Trauma Acute Care Surg 2018. [PMID: 29521805 DOI: 10.1097/ta.0000000000001885] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kim MS, Kwon HJ, Kang KA, Do IG, Park HJ, Kim EY, Hong HP, Choi YJ, Kim YH. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis. Br J Radiol 2018; 91:20170529. [PMID: 29099612 PMCID: PMC5965797 DOI: 10.1259/bjr.20170529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of ultrasound and to determine which ultrasound findings are useful to differentiate appendicitis from non-appendicitis in patients who underwent ultrasound re-evaluation owing to equivocal CT features of acute appendicitis. METHODS 62 patients who underwent CT examinations for suspected appendicitis followed by ultrasound re-evaluation owing to equivocal CT findings were included. Equivocal CT findings were considered based on the presence of only one or two findings among the CT criteria, and ultrasound re-evaluation was done based on a predefined structured report form. The diagnostic performance of ultrasound and independent variables to discriminate appendicitis from non-appendicitis were assessed. RESULTS There were 27 patients in the appendicitis group. The overall diagnostic performance of ultrasound re-evaluation was sensitivity of 96.3%, specificity of 91.2% and accuracy of 91.9%. In terms of the performance of individual ultrasound findings, probe-induced tenderness showed the highest accuracy (86.7%) with sensitivity of 74% and specificity of 97%, followed by non-compressibility (accuracy 71.7%, sensitivity 85.2% and specificity 60.6%). The independent ultrasound findings for discriminating appendicitis were non-compressibility (p = 0.002) and increased flow on the appendiceal wall (p = 0.001). CONCLUSION Ultrasound re-evaluation can be used to improve diagnostic accuracy in cases with equivocal CT features for diagnosing appendicitis. The presence of non-compressibility and increased vascular flow on the appendix wall are useful ultrasound findings to discriminate appendicitis from non-appendicitis. Advances in knowledge: Ultrasound re-evaluation is useful to discriminate appendicitis from non-appendicitis when CT features are inconclusive.
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Affiliation(s)
- Mi Sung Kim
- 1 Department of Radiology , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea
| | - Heon-Ju Kwon
- 1 Department of Radiology , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea
| | - Kyung A Kang
- 1 Department of Radiology , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea
| | - In-Gu Do
- 2 Department of Pathology , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea
| | - Hee-Jin Park
- 1 Department of Radiology , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea
| | - Eun Young Kim
- 1 Department of Radiology , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea
| | - Hyun Pyo Hong
- 1 Department of Radiology , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea
| | - Yoon Jung Choi
- 1 Department of Radiology , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea
| | - Young Hwan Kim
- 3 Department of Nuclear Medicine , Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine , Seoul, Republic of Korea
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RIPASA versus modified Alvarado scoring system in the diagnosis of acute appendicitis, as a new scoring system of acute appendicitis in ASIA. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ultrasonography in Emergency Department; a Diagnostic Tool for Better Examination and Decision-Making. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2017; 2:e7. [PMID: 31172070 PMCID: PMC6548109 DOI: 10.22114/ajem.v0i0.40] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Context: The aim of this study is to evaluate the applications of ultrasonography (US) as a diagnostic tool in emergency settings. Evidence acquisition: In the present review article, search engines and scientific databases of Google Scholar, Science Direct, PubMed, Medline, Scopus, and Cochrane were searched for the applications of US in emergencies. Finally, related articles which were published between 2000 and 2017, were selected and by reviewing them an attempt was made to evaluate various applications of US for examining and facilitating decision-making in emergency department (ED). Results: As a diagnostic tool, US can be of diagnostic help in emergency settings for the specialists and the treatment team regarding trauma, measuring intracranial pressure (ICP), hemothorax pneumothorax, abscess and its drainage, deep vein thrombosis (DVT), dyspnea, acute abdomen, appendicitis and biliary problems, renal colic and renal stones, shock, foreign object, bone fracture, peripheral nerve block, establishing central and peripheral venous access, lumbar puncture (LP), and confirmation of nasogastric tube (NGT) and endotracheal tube (ETT) placement. Conclusion: The results of this review study showed that US can be of help to EMPs as a diagnostic tool in a wide range of diseases and clinical conditions, which in turn can result in a decrease in the time needed for diagnosis and treatment, and therefore improve both the quality and quantity of the service provided in ED.
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Affiliation(s)
- Rebecca M Rentea
- Deparment of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Shawn D St Peter
- Pediatric Surgical Fellowship and Scholars Programs, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
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Motie MR, Nik MM, Gharaee M. Evaluation of the diagnostic value of serum level of total bilirubin in patients with suspected acute appendicitis. Electron Physician 2017; 9:4048-4054. [PMID: 28607634 PMCID: PMC5459271 DOI: 10.19082/4048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 02/22/2017] [Indexed: 01/19/2023] Open
Abstract
Introduction Clinical diagnosis of acute appendicitis still remains a problem. Delays in diagnosis of acute appendicitis may cause perforation and septic peritonitis which result in increasing morbidity and mortality. The aim of this study was to determine the sensitivity, specificity and the diagnostic value of total serum bilirubin levels as a predictor of acute appendicitis. Methods In this cross-sectional study, patients who underwent appendectomy with the diagnosis of acute appendicitis from April 2012 to March 2013 at Emam Reza Hospital in Mashhad (Iran) were enrolled. Serum bilirubin-Total and Direct-, were measured. Then based on the final pathologic reports, patients were categorized into five groups of normal appendix, chronic inflammatory changes, acute appendicitis, gangrenous and/or necrotic changes, and perforated appendicitis. Independent sample t-test, ANOVA, and Chi-square test were used for data analysis by SPSS version 16. Results There were 174 patients studied, (117 male, 57 female) with a mean age of 27.15±0.7 years. All of the patients had rebound tenderness; 75.3% had nausea, 58.6% had anorexia and 21.3% had fever. The histological reports of all patients showed 76.4% acute appendicitis. Analyzing p-values for SGPT, SGOT, WBC was (p=0.903) and differential count was (p=0.959). The study showed no significant difference between the pathological groups. However, there were no significant differences in serum total bilirubin levels between the pathological groups. Total bilirubin showed sensitivity of 48% and specificity of 61% in the diagnosis of acute appendicitis. Total serum bilirubin more than 0.85 mg/dl was the cut-off value with the best performance for diagnosis of appendicitis. Conclusion Bilirubin levels are reliable, sensitive and specific to diagnosis and a prediction of complicated appendicitis.
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Affiliation(s)
- Mohammad Reza Motie
- M.D, Senior Lecturer, Associate Professor of Surgery, Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Malihe Gharaee
- M.D, Lecturer, Family Doctor, Mashhad University of Medical Sciences, Mashhad, Iran
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40
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Prevalence of Inconsistencies in the Recorded Outcomes of Clinical Evaluations. Pediatr Emerg Care 2017; 33:245-249. [PMID: 26125531 DOI: 10.1097/pec.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to determine the prevalence of variations in the recorded outcomes of clinical evaluations by 2 different physicians during a single patient visit and to comment on observations of physician practices regarding history taking and physical examination. METHODS Structured interviews were conducted with both junior and supervising physicians after they had evaluated patients in a pediatric emergency department who presented with complaints of fever (temperature, >100.4°F) in infants younger than 3 months, fever (temperature, >102.2°F) in infants aged 3 to 12 months, headache in patients older than 5 years, abdominal pain in patients older than 5 years, and head injury in patients younger than 18 years. Data were analyzed with descriptive statistics. RESULTS Most of the data reported by both junior and supervising physicians showed response disagreement. The questions on fever (temperature, >102.2°F) in infants aged 3 to 12 months showed 29% (10/34) disagreement on fever duration and 45% (5/11) on fever height. Questions on abdominal pain in children older than 5 years showed 24% (24/100) disagreement on reporting right lower quadrant pain and 10% (11/106) on right lower quadrant tenderness on examination; however, the discrepancy rates were 56% (56/100) when considering less than complete agreement on all painful sites and 53% (56/106) on all tender sites. Supervising physicians questioned and examined patients presenting with abdominal pain more often than those presenting with other complaints. CONCLUSIONS There are significant variations in the recorded outcome of clinical evaluations by 2 different physicians during a single patient visit. Supervising physicians are more cautious to question and examine patients presenting with abdominal pain compared with other chief complaints.
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Diagnostic Usefulness of Low-Dose Nonenhanced Computed Tomography With Coronal Reformations in Patients With Suspected Acute Appendicitis: A Comparison With Standard-Dose Computed Tomography. J Comput Assist Tomogr 2017; 40:485-92. [PMID: 26938695 DOI: 10.1097/rct.0000000000000381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of the study were to evaluate the usefulness of low-dose (LD) nonenhanced CT (NECT) with coronal reformation in diagnosing acute appendicitis and to compare LD NECT with standard-dose (SD) NECT and SD contrast-enhanced CT (CECT). METHODS A total of 452 patients suspected of having acute appendicitis underwent CT using a scan 1 (SD NECT and SD CECT1, n = 182) or a scan 2 protocol (LD NECT and SD CECT2, n = 270). The diagnostic performance and interobserver agreement for diagnosing acute appendicitis were compared. RESULTS Although the area under the curves of both reviewers of LD NECT were lower than those of SD CECT2, area under the curves of both reviewers for SD NECT were not significantly different for SD CECT1 and LD NECT (all P > 0.05). The interobserver agreements within each scan were excellent (all κ > 0.8). CONCLUSIONS Low-dose NECT with coronal reformation showed high diagnostic performance and can be used as the first-line imaging tool in the work-up of patients with suspected acute appendicitis.
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Abstract
Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes.
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Affiliation(s)
- Jeremiah Smith
- Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA.
| | - Sean M Fox
- Emergency Medicine Residency Program, Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA
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Abstract
Appendicitis is one of the most common surgical pathologies in children. It can present with right lower quadrant pain. Scoring systems in combination with selective imaging and surgical examination will diagnose most children with appendicitis. Clinical pathways should be used. Most surgical interventions for appendicitis are now almost exclusively laparoscopic, with trials demonstrating better outcomes for children who undergo index hospitalization appendectomies when perforated. Nonoperative management has a role in the treatment of both uncomplicated and complicated appendicitis. This article discusses the workup and management, modes of treatment, and continued areas of controversy in pediatric appendicitis.
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Affiliation(s)
- Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Shawn D St Peter
- Pediatric Surgical Fellowship and Scholars Programs, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
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Huckins DS, Copeland K, Self W, Vance C, Hendry P, Borg K, Gogain J. Diagnostic performance of a biomarker panel as a negative predictor for acute appendicitis in adult ED patients with abdominal pain. Am J Emerg Med 2016; 35:418-424. [PMID: 27876541 DOI: 10.1016/j.ajem.2016.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/14/2016] [Accepted: 11/10/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Evaluate the diagnostic accuracy of the APPY1TM biomarker panel, previously described for use in pediatric patients, for identifying adult ED patients with abdominal pain who are at low risk of acute appendicitis. METHODS This study prospectively enrolled subjects >18years of age presenting to seven U.S. emergency departments with <72hours of abdominal pain suggesting possible acute appendicitis. The APPY1 panel was performed on blood samples drawn from each patient at the time of initial evaluation and results were correlated with the final diagnosis either positive or negative for acute appendicitis. RESULTS 431 patients were enrolled with 422 completing all aspects of the study. The APPY1 biomarker panel exhibited a sensitivity of 97.5% (95% CI, 91.3-99.3%), a negative predictive value of 98.4% (95% CI, 94.4-99.6%), a negative likelihood ratio of 0.07 (95% CI, 0.02-0.27), with a specificity of 36.5% (95% CI, 31.6-41.8%) for acute appendicitis. The panel correctly identified 125 of 342 (36.6%) patients who did not have appendicitis with 2 (2.5%) false negatives. The CT utilization rate in this population was 72.7% (307/422). Of 307 CT scans, 232 were done for patients who did not have appendicitis and 79 (34%) of these patients were correctly identified as negative with "low risk" biomarker panel results, representing 26% (79/307) of all CT scans performed. CONCLUSION This biomarker panel exhibited high sensitivity and negative predictive value for acute appendicitis in this prospective adult cohort, thereby potentially reducing the dependence on CT for the evaluation of possible acute appendicitis.
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Affiliation(s)
- David S Huckins
- Division of Emergency Medicine, Newton-Wellesley Hospital, Newton, MA, United States.
| | | | - Wesley Self
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Cheryl Vance
- University of California Davis, Sacramento, CA, United States
| | - Phyllis Hendry
- University of Florida College of Medicine, Jacksonville, FL, United States
| | - Keith Borg
- Medical University of South Carolina, Charleston, SC, United States
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Ferrara F, Bollo J, Vanni LV, Targarona EM. Diagnosis and management of right colonic diverticular disease: A review. Cir Esp 2016; 94:553-559. [PMID: 27823760 DOI: 10.1016/j.ciresp.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 02/07/2023]
Abstract
The aim of this narrative review is to define the clinical-pathological characteristics and to clarify the management of right colonic diverticular disease. It is rare in Europe, USA and Australia and more common in Asia. In the recent years its incidence has increased in the West, with various distributions among populations. Many studies have reported that it is difficult to differentiate the presenting symptoms of this disease from those of appendicitis before surgery, because the signs and symptoms are similar, so misdiagnosis is not infrequent. With accurate imaging studies it is possible to reach a precise preoperative diagnosis, in order to assess an accurate treatment strategy. Currently the management of this disease is not well defined, no clear guidelines have been proposed and it is not known whether the guidelines for left colonic diverticular disease can also be applied for it. Several authors have stated that conservative management is the best approach, even in case of recurrence, and surgery should be indicated in selected cases.
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Affiliation(s)
- Francesco Ferrara
- Departamento de Medicina, Cirugía y Neurociencias, Universidad de Siena, Siena, Italia; Departamento de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Jesús Bollo
- Departamento de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Letizia V Vanni
- Departamento de Medicina, Cirugía y Neurociencias, Universidad de Siena, Siena, Italia
| | - Eduardo M Targarona
- Departamento de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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46
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Abstract
Appendicitis represents the most common abdominal surgical emergency in the pediatric age group. Despite being a relatively common condition, the diagnosis of appendicitis in children can prove to be challenging in many cases. The goal of this article is to review the predictive utility for presenting signs and symptoms, laboratory tests, and imaging studies in the diagnostic work-up of appendicitis. Furthermore, we sought to explore the predictive utility of composite measures based on multiple sources of diagnostic information, as well as the utility of clinical pathways as a means to streamline the diagnostic process.
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Affiliation(s)
- Charity C Glass
- Department of Surgery, Children׳s Hospital Boston, Harvard Medical School, 300 Longwood Ave. Fegan-3, Boston, MA 02115
| | - Shawn J Rangel
- Department of Surgery, Children׳s Hospital Boston, Harvard Medical School, 300 Longwood Ave. Fegan-3, Boston, MA 02115.
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47
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Agbor VN, Njim T, Aminde LN. Pyosalpinx causing acute appendicitis in a 32-year-old Cameroonian female: a case report. BMC Res Notes 2016; 9:368. [PMID: 27461228 PMCID: PMC4962464 DOI: 10.1186/s13104-016-2175-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/21/2016] [Indexed: 12/17/2022] Open
Abstract
Background Pyosalpinx as a cause of acute appendicitis is very rare. We report the first case of a right pyosalpinx causing an extrinsic compression of the appendiceal lumen and consequently an acute appendicitis following an obstruction. Case presentation A 32 year old female from the North west region of Cameroon, presented with an acute exacerbation of a mild chronic right iliac fossa pain over a 2 day duration. She underwent exploratory laparotomy and intraoperative findings were a bilateral pyosalpinx, with the right fallopian tube adhering to the caecum and the terminal ileum, and obstructing the lumen of an inflammed appendix. A classical appendectomy and a right salpingectomy were done. The post-operative period was uneventful and she returned after 2 weeks for a follow-up visit with no further complaints. Conclusion We describe to the best of our knowledge, the first case of an acute appendicitis caused by an extrinsic obstruction of the appendiceal lumen by a pyosalpinx. The close proximity of the caecum to the right fallopian tube most likely accounted for this occurrence. Although a rare entity, physicians should always keep in mind very rare causes of an acute appendicitis to guide management. This case highlights the shortcomings of pelvic ultrasonography in the diagnosis this condition. A pelvic computed tomography scanning should therefore be sought in case of a doubtful pelvic ultrasonography result. Finally, there is an urgent need to improve the awareness on sexually transmitted infections in our setting.
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Affiliation(s)
| | - Tsi Njim
- Nuffield Department of Medicine, University of Oxford, Oxfordshire, United Kingdom. .,Health and Human Development (2HD) Research Group, Douala, Cameroon.
| | - Leopold Ndemnge Aminde
- Clinical Research Education, Networking and Consultancy (CRENC), Douala, Littoral, Cameroon.,School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia
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48
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Ferrarese A, Falcone A, Solej M, Bono D, Moretto P, Dervishi N, Andrea V, Enrico S, Nano M, Martino V. Surgeon's clinical valuation and accuracy of ultrasound in the diagnosis of acute appendicitis: A comparison with intraoperative evaluation. Five years experience. Int J Surg 2016; 33 Suppl 1:S45-50. [PMID: 27255128 DOI: 10.1016/j.ijsu.2016.05.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Acute appendicitis is the most common cause of acute abdomen in adolescents, with an overall incidence of 7%. Two such tools are used to diagnose acute appendicitis: ultrasound and Computer Tomography imaging. End point of this study was to verify the accuracy of ultrasound imaging in the diagnosis of acute appendicitis with respect to intraoperative observations and the respective clinical and laboratory findings in young and in the elderly. METHODS We considered all the appendectomies for acute appendicitis performed between 1 January 2010 and 1 January 2015. We evaluated clinical symptoms, laboratory findings, ultrasound findings, intraoperative signs, and anatomical and pathological findings. In the study we compared the ultrasound and intraoperative findings and then compared these with the respective clinical and laboratory data. RESULTS In a comparison of diagnostic accuracy, the difference between clinical and ultrasound examinations was not significant. The differences between the diagnostic accuracy of clinical and laboratory findings and between ultrasound and laboratory investigations were statistically significant. CONCLUSION We defined white blood cells and C protein levels as non-diagnostic of the type of acute inflammation but rather as indicators of the severity of the inflammatory process. We also agree with the authors who proposed the incorporation of ultrasonography into routine practice in the diagnosis of acute appendicitis, but only and exclusively to support other diagnostic procedures and preferably within emergency departments. A thorough clinical examination of patients with suspected acute appendicitis is still the best diagnostic procedure available to us.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Alessandro Falcone
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Dario Bono
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Paolo Moretto
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of Radiology, Orbassano, Turin, Italy.
| | - Najada Dervishi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of Radiology, Orbassano, Turin, Italy.
| | - Veltri Andrea
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of Radiology, Orbassano, Turin, Italy.
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Mario Nano
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
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49
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Yang HK, Ko Y, Lee MH, Woo H, Ahn S, Kim B, Pickhardt PJ, Kim MS, Park SB, Lee KH. Initial Performance of Radiologists and Radiology Residents in Interpreting Low-Dose (2-mSv) Appendiceal CT. AJR Am J Roentgenol 2015; 205:W594-W611. [PMID: 26587949 DOI: 10.2214/ajr.15.14513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE The objective of our study was to prospectively evaluate the initial diagnostic performance and learning curve of a community of radiologists and residents in interpreting 2-mSv appendiceal CT. SUBJECTS AND METHODS We included 46 attending radiologists and 153 radiology residents from 22 hospitals who completed an online training course of 30 2-mSv CT cases. Appendicitis was confirmed in 14 cases. Most of the readers had limited (≤ 10 cases, n = 32) or no (n = 118) prior experience with low-dose appendiceal CT. The order of cases was randomized for each reader. A multireader multicase ROC analysis was performed. Generalized estimating equations were used to model the learning curves in diagnostic performance. RESULTS Diagnostic performance gradually improved with years of training. The average AUC was 0.94 (95% CI, 0.90-0.98), 0.92 (0.88-0.96), 0.90 (0.85-0.96), and 0.86 (0.80-0.92) for the attending radiologists, senior residents, 2nd-year residents, and 1st-year residents, respectively. We did not observe any notable intrareader learning curves over the training course of the 30 cases except a decrease in reading time. Diagnostic accuracy and sensitivity were significantly affected by the reader training level and prior overall experience with appendiceal CT but not by the prior specific experience with low-dose appendiceal CT. CONCLUSION The learning curve is likely prolonged and forms gradually over years by overall radiology training and clinical experience in general rather than by experience with low-dose appendiceal CT specifically.
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Affiliation(s)
- Hyun Kyung Yang
- 1 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Yousun Ko
- 1 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Min Hee Lee
- 2 Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do, 420-767, Korea
| | - Hyunsik Woo
- 3 Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Soyeon Ahn
- 4 Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Bohyoung Kim
- 1 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Perry J Pickhardt
- 5 Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mi Sung Kim
- 6 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Bin Park
- 7 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyoung Ho Lee
- 1 Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- 8 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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50
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Low-Dose (2-mSv) CT in Adolescents and Young Adults With Suspected Appendicitis: Advantages of Additional Review of Thin Sections Using Multiplanar Sliding-Slab Averaging Technique. AJR Am J Roentgenol 2015; 205:W485-91. [DOI: 10.2214/ajr.14.13994] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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