-
European Review For Medical and... Dec 2021We aimed to predict the risk of complicated appendicitis in children, constructing a risk-based prediction tool with the optimal combination of sensitivity and...
OBJECTIVE
We aimed to predict the risk of complicated appendicitis in children, constructing a risk-based prediction tool with the optimal combination of sensitivity and specificity outcomes.
PATIENTS AND METHODS
This is a prospective study on a random sample of children with acute appendicitis who underwent appendectomy. Clinical examination, history, routine laboratory tests, Alvarado and pediatric appendicitis scores, operative and histopathological findings were taken into consideration. The predictive ability of the outcome variables was assessed by the Receiver Operating Characteristics (ROC) analysis. The overall predictive ability and determination of the best cut-off value (the higher sum of sensitivity plus specificity) were calculated. A Classification and Regression Tree (CRT) was used to create a multi-level classification algorithm. The model was set to predict the outcome of complicated appendicitis, considering as potential predictors the demographic characteristics, the clinical findings, and the outcome parameters.
RESULTS
The various combinations of clinical and laboratory parameters did not improve their overall diagnostic ability. However, the CRT analysis resulted in a short classification algorithm based on the Pediatric appendicitis score, neutrophils percentage and the CRP. This model yielded a significantly better predictive ability than all the other combinations of the outcome parameters. The application of the model would predict complicated appendicitis with 90% sensitivity and 78.6% specificity.
CONCLUSIONS
The constructed predictive model may be a useful tool for daily practical use by the clinician, especially in areas where modern diagnostic imaging facilities are absent or not always available. Clinical evaluation and close follow-up remain the more accurate preoperative method to decide the performance and timing of appendectomy.
Topics: Adolescent; Algorithms; Appendectomy; Appendicitis; Child; Female; Humans; Male; Prospective Studies; Risk Assessment; Sensitivity and Specificity
PubMed: 34919234
DOI: 10.26355/eurrev_202112_27428 -
Medical Sciences (Basel, Switzerland) Jul 2022Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of...
Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of hyperbilirubinemia, hyponatremia, and both combined in the preoperative diagnosis of CA. Patients who underwent surgery for acute appendicitis were included in this retrospective review. In total, 247 patients were included in the final analysis. Of these, 36 (14.2%) had early appendicitis, 177 (72.0%) had acute suppurative appendicitis, 32 (13.0%) had necrotizing/gangrenous acute appendicitis, and 2 (0.8%) had other types of appendicitis. The mean total bilirubin (TBIL) level was significantly higher in patients with CA than in those with uncomplicated appendicitis. Conversely, the mean serum sodium level was significantly lower in patients with CA than in those with uncomplicated appendicitis. The levels of TBIL (odds ratio: 1.098, 95% CI: 1.052-1.147) and serum sodium (odds ratio: 0.743, 95% CI: 0.646-0.855) were associated with CA. Hyponatremia combined with hyperbilirubinemia yielded significant discriminatory value for the diagnosis of CA. TBIL and serum sodium levels can be considered as adjuvant parameters in the diagnosis of perforated/necrotizing appendicitis. Although hyperbilirubinemia and hyponatremia together were better able to determine the risk of CA than either marker alone, other markers are required to definitively predict CA. Furthermore, large-scale studies are needed to confirm these findings.
Topics: Acute Disease; Appendicitis; Bilirubin; Biomarkers; Humans; Hyperbilirubinemia; Hyponatremia; Sodium
PubMed: 35893118
DOI: 10.3390/medsci10030036 -
The Western Journal of Emergency... Nov 2014Acute appendicitis is the most common abdominal emergency requiring emergency surgery. However, the diagnosis is often challenging and the decision to operate, observe... (Review)
Review
INTRODUCTION
Acute appendicitis is the most common abdominal emergency requiring emergency surgery. However, the diagnosis is often challenging and the decision to operate, observe or further work-up a patient is often unclear. The utility of clinical scoring systems (namely the Alvarado score), laboratory markers, and the development of novel markers in the diagnosis of appendicitis remains controversial. This article presents an update on the diagnostic approach to appendicitis through an evidence-based review.
METHODS
We performed a broad Medline search of radiological imaging, the Alvarado score, common laboratory markers, and novel markers in patients with suspected appendicitis.
RESULTS
Computed tomography (CT) is the most accurate mode of imaging for suspected cases of appendicitis, but the associated increase in radiation exposure is problematic. The Alvarado score is a clinical scoring system that is used to predict the likelihood of appendicitis based on signs, symptoms and laboratory data. It can help risk stratify patients with suspected appendicitis and potentially decrease the use of CT imaging in patients with certain Alvarado scores. White blood cell (WBC), C-reactive protein (CRP), granulocyte count and proportion of polymorphonuclear (PMN) cells are frequently elevated in patients with appendicitis, but are insufficient on their own as a diagnostic modality. When multiple markers are used in combination their diagnostic utility is greatly increased. Several novel markers have been proposed to aid in the diagnosis of appendicitis; however, while promising, most are only in the preliminary stages of being studied.
CONCLUSION
While CT is the most accurate mode of imaging in suspected appendicitis, the accompanying radiation is a concern. Ultrasound may help in the diagnosis while decreasing the need for CT in certain circumstances. The Alvarado Score has good diagnostic utility at specific cutoff points. Laboratory markers have very limited diagnostic utility on their own but show promise when used in combination. Further studies are warranted for laboratory markers in combination and to validate potential novel markers.
Topics: Acute Disease; Appendectomy; Appendicitis; Biomarkers; Decision Support Techniques; Diagnosis, Differential; Evidence-Based Medicine; Humans; Severity of Illness Index; Tomography, X-Ray Computed
PubMed: 25493136
DOI: 10.5811/westjem.2014.9.21568 -
BMC Surgery Sep 2023Acute appendicitis is the leading cause of emergency pediatric surgical admissions in the world. The diagnosis is may be difficult and is often dependent on clinical...
BACKGROUND
Acute appendicitis is the leading cause of emergency pediatric surgical admissions in the world. The diagnosis is may be difficult and is often dependent on clinical parameters. This study was aimed at reviewing the clinical presentations, the management and outcomes in children with inflamed and phlegmonous appendicitis with reference to the operative findings.
METHODS
The records of 211 children 5 to 15 years of age who were operated for acute appendicitis with intra operative findings of inflamed or phlegmonous appendicitis who met inclusion criteria were entered and analyzed using SPSS (IBM) V.26. Descriptive and regression tests were done with p < 0.05 considered statistically significant.
RESULTS
Of 211 children with inflamed and phlegmonous appendicitis, the M: F was 1.48:1 with a median age of 11 years. 58.3% of them presented within 24 h with the commonest symptoms being right lower abdominal pain, anorexia, and vomiting (96.2%,96.2%, 85.3%,) respectively. 96.7% of them had right lower abdominal tenderness. 73% had neutrophils ≥ 75%, and of 171 patients who had abdominal ultrasound scan, 97.7% showed appendiceal diameter ≥ 6 mm. Intraoperatively 56.4% of them were found to have phlegmonous appendicitis. In a retrospective Pediatric Appendiceal Score, only 52.6% of patients fall into the high-risk category, who could be confirmed on preoperative clinical assessment. Postoperatively 90% of them discharged improved with a mean hospital stay of 2.26(SD = 0.9) days. There was no association between the sex of the child and the intraoperative finding of inflamed or phlegmonous appendicitis (p = 0.77).
CONCLUSION
Pediatric appendicitis affects more male children in their second decade of life. Most had phlegmonous appendicitis and presented within 24 h. Duration of illness has little effect on the progress of appendicitis. Surgical management is safe for inflamed and phlegmonous appendicitis with a reasonable hospital stay and a low rate of complications.
Topics: Humans; Child; Male; Appendicitis; Ethiopia; Retrospective Studies; Abdominal Pain; Hospitalization
PubMed: 37710191
DOI: 10.1186/s12893-023-02191-4 -
JAMA Network Open Apr 2022Data are sparse regarding the optimal treatment for complicated appendicitis during pregnancy.
IMPORTANCE
Data are sparse regarding the optimal treatment for complicated appendicitis during pregnancy.
OBJECTIVE
To compare nonoperative and operative management in complicated appendicitis during pregnancy.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was conducted using National Inpatient Sample data from between January 2003 and September 2015. This database approximates a 20% stratified sample of US inpatient hospital discharges. Included individuals were pregnant women discharged with the diagnosis of complicated appendicitis. Data were analyzed from February 2020 through February 2022.
EXPOSURES
Study patients were categorized into 3 groups: those with successful nonoperative management, failed nonoperative management with delayed operation, or immediate operation for complicated appendicitis.
MAIN OUTCOMES AND MEASURES
Clinical outcomes, including maternal infectious complications and perinatal complications, hospital length of stay, and total hospital charges.
RESULTS
Among 8087 pregnant women with complicated appendicitis (median [IQR] age, 27 [22-32] years), nonoperative management of complicated appendicitis was successful among 954 patients (11.8%) and failed among 2646 patients (32.7%), who underwent delayed operation; 4487 patients (55.5%) underwent immediate operation. In multivariate analysis, successful nonoperative management was associated with higher odds of amniotic infection (odds ratio [OR], 4.35; 95% CI, 2.22-8.53; P < .001) and sepsis (OR, 1.52; 95% CI, 1.10-2.11; P = .01) compared with immediate operation, while there was no significant difference in preterm delivery, preterm labor, or abortion. However, failed nonoperative management that required delayed operation was associated with higher odds of preterm delivery, preterm labor, or abortion compared with immediate operation (OR, 1.45; 95% CI, 1.24-1.68; P < .001). Immediate operation was associated with decreased hospital charges compared with nonoperative management that was successful (regression coefficient [RC], 0.09; 95% CI, 0.07-0.11; P < .001) and that failed (RC, 0.12; 95% CI: 0.11-0.14; P < .001). In subgroup multivariate logistic regression analysis, each day in delay to surgery was associated with an increase in odds of preterm delivery, preterm labor, or abortion by 23% (OR, 1.23; 95% CI, 1.18-1.29; P < .001).
CONCLUSIONS AND RELEVANCE
This study found that immediate operation for complicated appendicitis in pregnant women was associated with lower odds of maternal infectious complications without higher odds of perinatal or other maternal complications compared with successful nonoperative management. Failed nonoperative management was associated with worse clinical outcomes.
Topics: Adult; Appendicitis; Cohort Studies; Female; Humans; Infant, Newborn; Pregnancy; Premature Birth; Retrospective Studies; Treatment Outcome
PubMed: 35426921
DOI: 10.1001/jamanetworkopen.2022.7555 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2022This study aims to determine whether refugee patients are more likely to present with complicated appendicitis.
BACKGROUND
This study aims to determine whether refugee patients are more likely to present with complicated appendicitis.
METHODS
Patients who were hospitalized and treated with the diagnosis of acute appendicitis in a single center between 2018 and 2020 were evaluated within the scope of this study, and the included patients were divided into two groups as refugees (n=140) and local patients (n=386). The primary outcome was complicated appendicitis rate, and the duration of symptoms, time to appendectomy, operation time, diagnostic modality, and length of hospital stay were also analyzed. According to operational diagnosis and pathology reports, cases were categorized as either non-complicated or complicated.
RESULTS
The complicated appendicitis rate, and the number of patients with symptoms lasting longer than 72 h were statistically more significant in refugee patients (p=0.009 and n: 186, p=0.000, respectively). The refugee patients had a younger mean age and a higher male patient rate which was statistically significant (p=0.000 for both). There was no significant difference between the groups concerning time to appendectomy, operation time, type of surgery, hospital length of stay, and diagnostic modality (p>0.05).
CONCLUSION
The findings of this study demonstrated that refugee patients have a higher complicated appendicitis rate and late admission rate, even though refugee patients have equal access to healthcare in our country. Future research is needed to identify factors affecting outcomes of refugee patients.
Topics: Appendectomy; Appendicitis; Humans; Laparoscopy; Length of Stay; Male; Postoperative Complications; Refugees; Retrospective Studies; Treatment Outcome
PubMed: 34967436
DOI: 10.14744/tjtes.2020.70025 -
Journal of Medical Case Reports Feb 2022Chronic appendicitis is a condition unfamiliar to many physicians and is often referred to as a controversial diagnosis. This can give rise to diagnostic delay.
BACKGROUND
Chronic appendicitis is a condition unfamiliar to many physicians and is often referred to as a controversial diagnosis. This can give rise to diagnostic delay.
CASE PRESENTATION
We present two cases of chronic appendicitis: a Caucasian female aged 21 years and a Caucasian male aged 34 years. The patients had different clinical presentations, which led the initial investigations in very different directions-tropical infectious disease and possible malignancy, respectively. In both cases, radiological imaging was the key investigation leading to the final surprising diagnosis.
CONCLUSION
With these two case stories, we wish to draw attention to chronic appendicitis as a possible differential diagnosis in younger patients with chronic or recurrent abdominal pain, particularly if the pain is located in the lower abdomen and is accompanied by fever.
Topics: Abdomen; Abdominal Pain; Adult; Appendicitis; Chronic Disease; Delayed Diagnosis; Diagnosis, Differential; Female; Humans; Male; Young Adult
PubMed: 35135615
DOI: 10.1186/s13256-022-03273-2 -
Journal of Infection in Developing... Mar 2023Appendicitis is a global abdominal disease and is often treated by appendectomy. Surgical site infection (SSI) is a common complication after an appendectomy that causes...
INTRODUCTION
Appendicitis is a global abdominal disease and is often treated by appendectomy. Surgical site infection (SSI) is a common complication after an appendectomy that causes a significant burden on health systems. This study aimed to evaluate the trends and variations in the burden of appendicitis by year, region, socioeconomic status, and health expenditure and to assess associated SSI by appendicitis burden, surgical approach, and type of appendicitis.
METHODOLOGY
Data on Disability-Adjusted Life Years (DALYs) and the human development index were collected from the Global Burden of Disease (GBD) Study and the United Nations Development Programme, respectively. Studies on SSI after appendectomy using the uniform definition and published in 1990-2021 were retrieved.
RESULTS
Between 1990 and 2019, the global age-standardized DALY rate of appendicitis decreased by 53.14%, with the highest burdens in Latin America and Africa. The burden of appendicitis was significantly negatively correlated with HDI (r = -0.743, p<0.001) and health expenditure (r = -0.287, p<0.001). Among 320 published studies on SSI after an appendectomy, 78.44% of studies did not report criteria for SSI diagnosis or adopt a uniform definition. In total, 69 studies with uniform SSI definitions were included. Studies with uniform SSI definitions were recorded poorly in regions with a heavy burden of appendicitis. The SSI of appendectomy was positively correlated with open appendectomy and complicated appendicitis.
CONCLUSIONS
Uniform SSI definition, promotion of laparoscopic technology, and establishment of SSI special management are needed to decrease the burden of SSI after an appendectomy, especially in developing countries.
Topics: Humans; Surgical Wound Infection; Appendectomy; Appendicitis; Risk Factors; Laparoscopy; Retrospective Studies
PubMed: 37023429
DOI: 10.3855/jidc.17145 -
Cirugia Pediatrica : Organo Oficial de... Jul 2022The impact of the SARS-CoV-2 pandemic on healthcare has already been described, since it has caused an increase in diagnostic delay and morbidity. Our objective was to...
INTRODUCTION
The impact of the SARS-CoV-2 pandemic on healthcare has already been described, since it has caused an increase in diagnostic delay and morbidity. Our objective was to assess its influence on the development of complications in children with acute appendicitis.
MATERIALS AND METHODS
A retrospective cohort study was carried out. It included acute appendicitis patients under 15 years of age treated from January 1, 2019 to December 31, 2020. They were classified according to diagnosis date as before the pandemic (B) (January 2019-February 2020) and during the pandemic (D) (March 2020-December 2020). According to operative findings, they were classified as complicated appendicitis (perforated/abscess/plastron/peritonitis) and non-complicated appendicitis (catarrhal/phlegmonous/gangrenous). Demographic data, progression time, and postoperative complications were analyzed.
RESULTS
A total of 309 patients were included, 193 (62.5%) in Group B, and 116 (37.5%) in Group D, with an age of 9.2 ± 0.4 and 9.4 ± 0.6 years, respectively (CI = 95%). Diagnostic time was 1.35 and 1.43 days (p>0.05) in Groups B and D, respectively, with ≥ 3 days representing 15.5% of cases in Group B, and 16.4% of cases in Group D (p = 0.84). The proportion of complicated appendicitis was 23.3% in Group B vs. 21.6% in Group D (p>0.05). Postoperative complications were observed in 11.4% of patients in Group B, and in 13.8% of patients in Group D (p>0.05), with intra-abdominal abscess being the most frequent complication in both groups (54.5% of the total complications in Group B vs. 65.5% in Group D; p>0.05).
CONCLUSIONS
The management of acute appendicitis and its complications in pediatric patients has not been impacted by the SARS-CoV-2 pandemic or the safety measures enforced.
Topics: Acute Disease; Appendectomy; Appendicitis; COVID-19; Child; Delayed Diagnosis; Humans; Laparoscopy; Postoperative Complications; Retrospective Studies; SARS-CoV-2
PubMed: 35796085
DOI: 10.54847/cp.2022.03.16 -
Rhode Island Medical Journal (2013) Apr 2022Acute appendicitis is the most common abdominal surgical emergency, with an average of 7-9% of individuals developing the condition within their lifetime.1 While cases... (Review)
Review
Acute appendicitis is the most common abdominal surgical emergency, with an average of 7-9% of individuals developing the condition within their lifetime.1 While cases of acute traumatic appendicitis are rare, medical literature supports their plausibility with the most famous case stretching back to the controversial 1926 death of stunt performer, Harry Houdini. Several mechanisms have been proposed by which blunt abdominal trauma results in acute appendicitis. In this review, we describe a young, otherwise healthy male, who developed epigastric abdominal pain after being struck in the abdomen while wrestling with his cousin of similar age. The patient was found to have peri-appendiceal inflammatory change, appendiceal mural thickening and edema consistent with acute uncomplicated appendicitis.
Topics: Abdominal Injuries; Abdominal Pain; Acute Disease; Appendicitis; Humans; Male; Wounds, Nonpenetrating
PubMed: 35349619
DOI: No ID Found