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Luksaite-Lukste R, Gecaite I, Marcinkeviciute K, Dumskis E, Samuilis A, Zvirblis T, Jasiunas E, Bausys A, Drungilas M, Luksta M, Kryzauskas M, Petrulionis M, Beisa A, Uselis S, Valeikaite-Taugininene G, Rackauskas R, Strupas K, Poskus T. Observation Safely Reduces the Use of the Computerized Tomography in Medium-to-Low-Risk Patients with Suspected Acute Appendicitis: Results of a Randomized Controlled Trial. J Clin Med 2024; 13:3363. [PMID: 38929896 PMCID: PMC11203661 DOI: 10.3390/jcm13123363] [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: 04/18/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives-The objective was to compare the effectiveness of observation in standard-of-care computed tomography (CT) in adult patients with suspected acute appendicitis (AA). Methods-Patients with clinically suspected AA and inconclusive diagnosis after primary clinical examination, laboratory examination, and transabdominal ultrasound (TUS) were eligible for the study, and they were randomized (1:1) to parallel groups: observation-group patients were observed for 8-12 h and then, repeated clinical and laboratory examinations and TUS were performed; CT group (control group) patients underwent abdominopelvic CT scan. The study utilized Statistical Analysis System 9.2 for data analysis, including tests, logistic regression, ROC analysis, and significance evaluation. Patients were enrolled in the study at Vilnius University Hospital Santaros Klinikos in Lithuania between December 2018 and June 2021. Results-A total of 160 patients (59 men, 101 women), with a mean age of 33.7 ± 14.71, were included, with 80 patients in each group. Observation resulted in a reduced likelihood of a CT scan compared with the CT group (36.3% vs. 100% p < 0.05). One diagnostic laparoscopy was performed in the observation group; there were no cases of negative appendectomy (NA) in the CT group. Both conditional CT and observation pathways resulted in high sensitivity and specificity (97.7% and 94.6% vs. 96.7% and 95.8%). Conclusions-Observation including the repeated evaluation of laboratory results and TUS significantly reduces the number of CT scans without increasing NA numbers or the number of complicated cases.
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Affiliation(s)
- Raminta Luksaite-Lukste
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | - Igne Gecaite
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | | | - Eimantas Dumskis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | - Arturas Samuilis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (I.G.); (E.D.); (A.S.)
| | - Tadas Zvirblis
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (K.M.); (T.Z.); (A.B.)
- Department of Mechanical and Material Engineering, Vilnius Gediminas Technical University, LT-03224 Vilnius, Lithuania
| | - Eugenijus Jasiunas
- Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania; (E.J.); (M.D.)
| | - Augustinas Bausys
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (K.M.); (T.Z.); (A.B.)
| | - Mantas Drungilas
- Vilnius University Hospital Santaros Klinikos, LT-08406 Vilnius, Lithuania; (E.J.); (M.D.)
| | - Martynas Luksta
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Marius Petrulionis
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Augustas Beisa
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Simonas Uselis
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Gintare Valeikaite-Taugininene
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Rokas Rackauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania; (M.L.); (M.K.); (M.P.); (A.B.); (S.U.); (G.V.-T.); (R.R.); (K.S.); (T.P.)
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Scheier E, Taragin B. Resolution of Sonographic Appendicitis in Pediatrics: a Point of Care Ultrasound Case-Series. POCUS JOURNAL 2024; 9:44-50. [PMID: 38681159 PMCID: PMC11044935 DOI: 10.24908/pocus.v9i1.16860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Studies of pediatric appendicitis treated conservatively show a considerable rate of recurrence. Point of care ultrasound (POCUS) imaging at our facility is routinely performed for abdominal pain and may be more likely than radiology-performed ultrasound to encounter cases that then self-resolve. We present a case series collected from a POCUS quality assurance review from 2019 through 2022. Five children were identified with sonographic appendicitis on review of stored POCUS images, and subsequent improvement of pain. A pediatric radiologist reviewed blinded images and agreed with the POCUS interpretation in all five cases. No child in this series received antibiotics. The national patient database was used to ensure that the patients in this series did not present elsewhere with appendicitis. We suggest that these cases represent early appendicitis that self-resolved. Patients should be aware that POCUS showed signs of appendicitis, and should seek medical attention for recurrence of symptoms.
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Affiliation(s)
- Eric Scheier
- Pediatric Emergency, Kaplan Medical Center and Faculty of Medicine, Hebrew university of JerusalemIsrael
| | - Benjamin Taragin
- Associate Director, Medical School for International Health, Ben Gurion UniversitySherbrooke, QCCanada
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Lastunen KS, Leppäniemi AK, Mentula PJ. Pre-hospital management and patient-related factors affecting access to the surgical care of appendicitis - a survey study. Scand J Prim Health Care 2024:1-9. [PMID: 38497923 DOI: 10.1080/02813432.2024.2329214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND AND AIMS Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay. METHODS A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed. RESULTS The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, p < .001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor's visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40-64 years (OR 1.63 (95% CI 1.06-2.52); compared to age 18-39), age more than 64 years (OR 2.84 (95% CI 1.18-6.80); compared to age 18-39), loss of appetite (OR 2.86 (95% CI 1.64-4.98)), fever (OR 1.66 (95% CI 1.08-2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15-3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32-3.53)). Age 40-64 years (OR 2.41 (95% CI 1.50-3.88)), age more than 64 years (OR 8.79 (95% CI 2.19-35.36)), fever (OR 1.83 (95% CI 1.15-2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14-3.14)) were also risk factors for complicated appendicitis. CONCLUSIONS Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis.
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Affiliation(s)
- Kirsi Serenella Lastunen
- Department of Gastrointestinal Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Ari Kalevi Leppäniemi
- Department of Gastrointestinal Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Panu Juhani Mentula
- Department of Gastrointestinal Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
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Collard MK, Bardin J, Marquet B, Laurin M, Ogier-Denis É. Correlation between the presence of a cecal appendix and reduced diarrhea severity in primates: new insights into the presumed function of the appendix. Sci Rep 2023; 13:15897. [PMID: 37741857 PMCID: PMC10517977 DOI: 10.1038/s41598-023-43070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/19/2023] [Indexed: 09/25/2023] Open
Abstract
Increased severity or recurrence risk of some specific infectious diarrhea, such a salmonellosis or Clostridium difficile colitis, have been reported after an appendectomy in human patients. While several other mammals also possess an appendix, the suspected protective function against diarrhea conferred by this structure is known only in humans. From a retrospective collection of veterinary records of 1251 primates attributed to 45 species, including 13 species with an appendix and 32 without, we identified 2855 episodes of diarrhea, 13% of which were classified as severe diarrhea requiring a therapeutic medication or associated with a fatal issue. We identified a lower risk of severe diarrhea among primate species with an appendix, especially in the early part of life when the risk of diarrhea is maximal. Moreover, we observed a delayed onset of diarrhea and of severe diarrhea in species possessing an appendix. Interestingly, none of the primates with an appendix were diagnosed, treated or died of an acute appendicitis during the 20 years of veterinarian follow-up. These results clarify the function of the appendix among primates, as protection against diarrhea. This supports its presumed function in humans and is congruent with the existence of a selective advantage conferred by this structure.
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Affiliation(s)
- Maxime K Collard
- Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, Team Gut Inflammation, Université de Paris, BP 416, 75018, Paris, France.
- Department of Colorectal Surgery, Saint-Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | - Jérémie Bardin
- CR2P (Centre de Recherche en Paléontologie - Paris; UMR 7207), CNRS/MNHN/Sorbonne Université, Muséum National d'Histoire Naturelle, Paris, France
| | | | - Michel Laurin
- CR2P (Centre de Recherche en Paléontologie - Paris; UMR 7207), CNRS/MNHN/Sorbonne Université, Muséum National d'Histoire Naturelle, Paris, France
| | - Éric Ogier-Denis
- Centre de Recherche sur l'Inflammation, INSERM, U1149, CNRS, ERL8252, Team Gut Inflammation, Université de Paris, BP 416, 75018, Paris, France
- INSERM U1242, Centre Eugène Marquis, Université de Rennes 1, Rennes, France
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Malik AK, Innes AH, Reddy L, Munro C, Phillips AW. Appendicectomy remains treatment of choice for patients with acute appendicitis. BMJ 2023; 382:e074652. [PMID: 37604515 DOI: 10.1136/bmj-2022-074652] [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: 08/23/2023]
Affiliation(s)
- Abdullah K Malik
- Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
- Liver Unit, Freeman Hospital, Newcastle upon Tyne
| | - Ailsa H Innes
- Department of Surgery, Queen Elizabeth Hospital, Gateshead, UK
| | - Lomalan Reddy
- Saltaire and Windhill Medical Partnership, Bradford, UK
| | - Clara Munro
- Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Alexander W Phillips
- Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- School of Medical Education, Newcastle University, Newcastle upon Tyne
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Javanmard-Emamghissi H, Lund JN, Tierney GM. Comment on: DIAgnostic iMaging or Observation in early equivocal appeNDicitis (DIAMOND): open-label, randomized clinical trial. Br J Surg 2023; 110:279. [PMID: 36394897 DOI: 10.1093/bjs/znac365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Hannah Javanmard-Emamghissi
- Department of Medicine and Health Science, University of Nottingham at Derby, Royal Derby Hospital, Derby, UK
| | - Jonathan N Lund
- Department of Medicine and Health Science, University of Nottingham at Derby, Royal Derby Hospital, Derby, UK
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Lastunen KS, Leppäniemi AK, Mentula PJ. Author response to: Comment on: DIAgnostic iMaging or Observation in early equivocal appeNDicitis (DIAMOND): open-label, randomized clinical trial. Br J Surg 2023; 110:280. [PMID: 36285889 PMCID: PMC10364514 DOI: 10.1093/bjs/znac367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Kirsi S Lastunen
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ari K Leppäniemi
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Panu J Mentula
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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The role of imaging in the diagnosis of acute appendicitis during the COVID-19 pandemic: a retrospective cohort study. Updates Surg 2023; 75:205-208. [PMID: 36422811 PMCID: PMC9686250 DOI: 10.1007/s13304-022-01426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
Acute appendicitis is one of the most common general surgical emergencies worldwide; however, its diagnosis remains challenging, with a high proportion of negative appendicectomies. The purpose of this study was to investigate the benefit of routine use of pre-operative imaging for the evaluation of suspected appendicitis. This retrospective cohort study included all cases of appendicectomies performed for suspected acute appendicitis during the first and second peaks of the COVID-19 pandemic, between March 2020 and February 2021. The control group included all cases of appendicectomies performed for suspected acute appendicitis in the previous 12 months (March 2019-February 2020). One hundred and four patients underwent appendicectomy in the study group, compared to 209 in the control group, with similar gender distribution but a significantly higher median age in the study group (33 vs. 28, p = 0.001). The two groups had similar rates of perforation and similar median white cell count (WCC) and CRP. Imaging was used in 80.77% of the patients in the study group, compared to 61.72% in the control group (p = 0.001), with 55.77% of patients in the study group undergoing CT scans. Despite this, the negative appendicectomy rate (NAR) in the two groups did not differ significantly (11.54% vs. 15.79%, p = 0.320). The increase in the use of imaging for the diagnosis of acute appendicitis during the COVID-19 pandemic did not lead to a significantly lower negative appendicectomy rate. Registration: The study was pre-registered at ClinicalTrials.gov (NCT05205681).
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