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Medicine Mar 2023Point-of-Care Ultrasound (POCUS) is a quick, useful, noninvasive, and inexpensive diagnostic tool used for the diagnosis of trauma, abdominal pain, dyspnea, and chest...
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.
Topics: Humans; Appendicitis; Sensitivity and Specificity; ROC Curve; Dyspnea; Ultrasonography; Emergency Service, Hospital; Acute Disease
PubMed: 37000097
DOI: 10.1097/MD.0000000000033397 -
World Journal of Emergency Surgery :... Mar 2023Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs.
METHODS
The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.
RESULTS
Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02-6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70-1.48]; I = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18-2.86]; I = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39-1.41]; I = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74-3.93]; I = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48-1.87]; I = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45-2.09], I = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16-6.98], I = 0%) in patients with peritonitis when compared to non-IOPL.
CONCLUSION
IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.
Topics: Humans; Peritoneal Lavage; Abdominal Abscess; Peritonitis; Surgical Wound Infection; Appendicitis; Randomized Controlled Trials as Topic
PubMed: 36991507
DOI: 10.1186/s13017-023-00496-6 -
Journal of Pediatric Surgery Oct 2023Relevant guidelines recommend the use of the Alvarado score (AS) to assist in the diagnosis of acute appendicitis (AA) in children. To provide reference evidence for the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Relevant guidelines recommend the use of the Alvarado score (AS) to assist in the diagnosis of acute appendicitis (AA) in children. To provide reference evidence for the clinical application of AS, we performed a meta-analysis of studies related to the diagnostic accuracy of AS in children with AA.
METHODS
We searched the relevant literature from databases including CNKI, WanFangdata, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science databases from the date of database creation to April 30, 2022, and screened them according to nadir criteria, followed by data extraction and then combined effect sizes to assess the accuracy of AS for diagnosis in children.
RESULTS
Twenty-six studies involving 2579 cases were finally included, including 19 studies with Alvarado score and 8 studies with modified Alvarado Score (1 study included both Alvarado Score and modified Alvarado Score). The combined sensitivity (SE) of AS for diagnosing AA in children was 76.0% (95% CI 74.0-78.0%; I = 95.1%); combined specificity (SP) was 71.0% (95% CI 68.0-74.0%; I = 86.4%); combined positive likelihood ratio (LR+) was 2.43 (95% CI 1.92- 3.07; I = 78.7%); combined negative likelihood ratio (LR-) was 0.28 (95% CI 0.20-0.41; I = 94.2%); combined AUC = 0.8092, Q∗ = 0.7439; combined diagnostic ratio (DOR) was 8.96 (95% CI 5.65 -14.21; I = 76.2%). The combined effect size I was greater than 50% for all children with a modified AS diagnosis of AA, so all analyses used a random-effects model, which showed a combined SE of 87.0% (95% CI 85.0 - 88.0%; I = 85.5%); the combined SP was 47.0% (95% CI 43.0 - 51.0%. I = 88.7%); combined LR+ was 1.68 (95% CI 1.31-2.17; I = 85.9%); combined LR-was 0.28 (95% CI 0.20-0.39; I = 74.3%); combined AUC = 0.8672 and Q∗ = 0.7978. The combined DOR was 6.43 (95% CI 3.38-12.26; I = 80.0%).
CONCLUSION
The results of this meta-analysis suggest that the accuracy of AS in diagnosing AA in children is moderate, and AS can be an auxiliary tool for the diagnosis of AA in children, relying on AS alone for the diagnosis of AA is not recommended; AS can be further improved scientifically to increase its diagnostic value.
Topics: Humans; Child; Appendicitis; Acute Disease; Databases, Factual; Sensitivity and Specificity
PubMed: 36966018
DOI: 10.1016/j.jpedsurg.2023.02.060 -
Future Microbiology Feb 2023To review studies examining the appendiceal microbiota and microbial changes in acute appendicitis. After a systematic literature search, 11 studies examining the... (Review)
Review
To review studies examining the appendiceal microbiota and microbial changes in acute appendicitis. After a systematic literature search, 11 studies examining the appendiceal microbiota (414 samples) using non-culture-based methods were included. The appendiceal microbiota showed decreased α-diversity compared with fecal microbiota. Inflamed and uninflamed appendices showed differences in β-diversity, and there was an increased abundance of oral-associated bacteria in inflamed versus uninflamed appendices. The appendiceal microbiota exhibits lower α-diversity than the fecal microbiota, with an increased abundance of oral-associated bacteria. Compared with uninflamed appendices, the appendix microbiota in acute appendicitis also showed increased abundance of oral-associated bacteria, but no bacterial profile unique to either complicated or uncomplicated appendicitis was found.
Topics: Humans; Appendix; Appendicitis; Appendectomy; Microbiota; Bacteria; Acute Disease
PubMed: 36916537
DOI: 10.2217/fmb-2022-0194 -
Annals of Medicine and Surgery (2012) Feb 2023The Alvarado score (AS) has not been widely used for diagnosing acute appendicitis although it has shown to be a good predictor for diagnosing appendicitis. The aim was...
UNLABELLED
The Alvarado score (AS) has not been widely used for diagnosing acute appendicitis although it has shown to be a good predictor for diagnosing appendicitis. The aim was to perform a systematic review of the available literature and synthesize the evidence.
METHODS
A systematic review was performed as per the PRISMA guidelines using search engines like Ovid, PubMed, and Google Scholar with predefined, strict inclusion and exclusion criteria. The quality assessment of included studies was performed using the QUADAS 2 tool. Summary statistics were performed for all variables. A linear regression model was performed between dependent and independent variables using STATA software. Heterogeneity testing showed significant heterogeneity within the included studies; hence, a forest plot with pooled estimates could not be constructed, and therefore a meta-regression was performed.
RESULTS
Seventeen full-text articles met inclusion and exclusion criteria. Ten of which were identified as low-risk studies. Five studies were included in final data pooling with total patients being 2239 and mean age of 31.9 years. (1) Linear regression demonstrated an association between 'histological appendicitis' and 'AS 7-0' with patients receiving intervention, with a significant value of less than 0.005. (2) Meta-regression demonstrated a positive coefficient (0.298), a positive score of 2.20 with a significant value of 0.028 for patients with 'high AS' who received interventions that were significantly proven to be 'histologically appendicitis', indicating a cause-and-effect relationship.
CONCLUSION
High AS (7 and above) is a significant predictor of acute appendicitis. The authors recommend further prospective randomized clinical trials to establish a cause-and-effect relationship.
PubMed: 36845768
DOI: 10.1097/MS9.0000000000000238 -
Surgery May 2023Acute appendicitis is one of many common reasons for acute abdominal pain, and its exact diagnosis is still debatable amongst clinicians. This systematic review and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute appendicitis is one of many common reasons for acute abdominal pain, and its exact diagnosis is still debatable amongst clinicians. This systematic review and meta-analysis of diagnostic test accuracy aim to look at serum pentraxin-3 performance in diagnosing acute appendicitis in patients with acute abdominal pain.
METHODS
This systematic review is registered on the International Prospective Register of Systematic Reviews (CRD42022338296). The primary outcome of this study is to examine the sensitivity, specificity, and post-test probability of serum pentraxin-3 (the index test) in patients with acute appendicitis. We searched various academic databases such as Pubmed, MEDLINE, Cochrane Library, Science Direct, Google Scholar, ScieLO, MedRxiv, BioRxiv, and Research Square. Two independent authors reviewed, selected the articles, and extracted the data. The analysis was done using STATA software using the "midas" and "metandi" commands.
RESULTS
Five articles fulfilled our inclusion criteria with 520 patients, and 27.5% of them were children. The combined sensitivity is 90.3% (95% confidence interval 78.6-95.9), and the combined specificity is 91.2% (95% confidence interval 22.1-99.7). The area under the curve is 0.94 (95% confidence interval 0.92-0.96). Fagan's Nomogram showed that the positive likelihood ratio is 10.38 (95% confidence interval 0.38-284.76) with an 87% post-test probability, while the negative likelihood ratio is 0.11 (95% confidence interval 0.04-0.27) with a 7% post-test probability. The combined negative predictive value is 0.89 (95% confidence interval 0.81-0.98), and the positive predictive value is 0.90 (95% confidence interval 0.81-0.98).
CONCLUSION
Serum pentraxin-3 could only be used as a confirmation test for acute appendicitis but not exclude it.
Topics: Child; Humans; Appendicitis; Abdominal Pain; Abdomen, Acute; Acute Disease; Diagnostic Tests, Routine; Sensitivity and Specificity
PubMed: 36828742
DOI: 10.1016/j.surg.2023.01.007 -
European Journal of Medical Research Feb 2023Acute appendicitis is one of the most frequent intra-abdominal diseases requiring emergency surgical consult and treatment. The diagnosis of this condition is based on... (Review)
Review
INTRODUCTION
Acute appendicitis is one of the most frequent intra-abdominal diseases requiring emergency surgical consult and treatment. The diagnosis of this condition is based on clinical features and radiologic findings. One-third of patients with acute appendicitis present unusual symptoms. There are several circumstances that may cause misdiagnosis and unclear prognostic prediction. Among these, situs viscerum inversus totalis and midgut malrotation can be challenging scenarios, leading to a delay in treatment, especially when these conditions are unknown. We decided to carry on a systematic review of published cases of acute appendicitis in the context of anatomical anomalies.
METHODS
We used the MESH terms "appendicitis" AND "situs inversus" AND/OR "gut malrotation" to search for titles and abstracts. Inclusion criteria were patients with clinical and/or radiological diagnosis of acute appendicitis, with conservative or surgical management and with preoperative/intraoperative findings of situs viscerum inversus or gut malrotation. Additionally, previous reviews were examined. Exclusion criteria of the studies were insufficient patient clinical and demographic data.
RESULTS
We included in this review 70 articles concerning 73 cases of acute appendicitis with anatomical anomaly. Patients were aged from 8 to 86 years (median: 27.0 years). 50 were male and 23 were female. 46 patients (63%) had situs viscerum inversus, 24 (33%) had midgut malrotation, 2 (2.7%) had Kartagener's syndrome, one of them (1.4%) had an undetermined anomaly In 61 patients the anatomical anomaly was unknown previously (83.6%), while 16,4% already were aware of their condition.
CONCLUSION
Acute appendicitis can occur in association of rare anatomical anomalies and in these cases diagnosis can be challenging. Situs viscerum inversus and midgut malrotation should always be considered in the differential diagnosis of a patient with left lower quadrant pain, especially in younger population. Besides clinical features, it is fundamental to implement the diagnostic progress with radiological examination. Laparoscopic approach is useful to identify and treat acute surgical emergency and it is also a diagnostic tool and can be tailored in order to offer the best exposition of the operatory field for each single case.
Topics: Humans; Female; Male; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Radiography; Acute Disease; Diagnosis, Differential
PubMed: 36805741
DOI: 10.1186/s40001-023-01059-w -
Minerva Surgery Aug 2023The significance of laparoscopy after appendectomy is still unclear, despite the fact that it is thought to be an appropriate technique for the detection and management...
INTRODUCTION
The significance of laparoscopy after appendectomy is still unclear, despite the fact that it is thought to be an appropriate technique for the detection and management of postoperative complications. We aimed to determine the incidence, risk factors, diagnosis, and laparoscopic approach for the treatment of acute complications after appendectomy performing a systematic review of the literature.
EVIDENCE ACQUISITION
We performed systematic review of the PubMed/MEDLINE, Embase and GoogleScholar bibliographic databases between 1995 and 2022 regarding laparoscopic resolution of early postoperative complications after appendectomy. Demographics, peri-operative variables, and postoperative outcomes were analyzed.
EVIDENCE SYNTHESIS
A total of 9 studies comprising 116 cases of laparoscopic resolution of early complications after appendectomy were included. The primary surgery showed a 60% of perforated or gangrenous appendicitis. Time elapse between the appendectomy and the diagnosis of the postoperative complication was from 2 to 15 days (median 5.8 days). The procedures performed at laparoscopy were as follows: laparoscopic washout and drainage of generalized peritonitis and intra-abdominal abscesses (95.6%), laparoscopic lysis of adhesions due to small bowel obstruction (1.7%), running suturing for unnoticed small bowel lesion (1.7%) and one patient required a right colectomy due to stump leakage (0.8%). Conversion to an open approach was necessary in 9 patients (7.8%). Postoperative complications after early re-laparoscopy washout were reported in 4 publications (15.5%). Finally, 15 (12.9%) patients required an additional intervention. The mean LOS was of 5 days.
CONCLUSIONS
Infectious complications are not uncommon after appendectomy, but their incidence increases significantly in complicated appendicitis, with IAA being the most feared complication. When re-exploration is mandatory, the laparoscopic approach is a safe and highly effective tool for the diagnosis and treatment of these complications, adding the benefits of minimally invasive surgery.
Topics: Humans; Appendectomy; Appendicitis; Retrospective Studies; Postoperative Complications; Laparoscopy
PubMed: 36789906
DOI: 10.23736/S2724-5691.22.09835-5 -
Diagnostics (Basel, Switzerland) Jan 2023Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37-2.7 cases per 100,000 person-years, which can... (Review)
Review
Pylephlebitis, defined as infective thrombophlebitis of the portal vein, is a rare condition with an incidence of 0.37-2.7 cases per 100,000 person-years, which can virtually complicate any intra-abdominal or pelvic infections that develop within areas drained by the portal venous circulation. The current systematic review aimed to investigate the etiology behind pylephlebitis in terms of pathogens involved and causative infective processes, and to report the most common symptoms at clinical presentation. We included 220 individuals derived from published cases between 1971 and 2022. Of these, 155 (70.5%) were male with a median age of 50 years. There were 27 (12.3%) patients under 18 years of age, 6 (2.7%) individuals younger than one year, and the youngest reported case was only 20 days old. The most frequently reported symptoms on admission were fever (75.5%) and abdominal pain (66.4%), with diverticulitis (26.5%) and acute appendicitis (22%) being the two most common causes. Pylephlebitis was caused by a single pathogen in 94 (42.8%) cases and polymicrobial in 60 (27.2%) cases. However, the responsible pathogen was not identified or not reported in 30% of the included patients. The most frequently isolated bacteria were (25%), spp. (17%), and spp. (15%). The treatment of pylephlebitis consists initially of broad-spectrum antibiotics that should be tailored upon bacterial identification and continued for at least four to six weeks after symptom presentation. There is no recommendation for prescribing anticoagulants to all patients with pylephlebitis. However, they should be administered in patients with thrombosis progression on repeat imaging or persistent fever despite proper antibiotic therapy to increase the rates of thrombus resolution or decrease the overall mortality, which is approximately 14%.
PubMed: 36766534
DOI: 10.3390/diagnostics13030429 -
Clinics and Research in Hepatology and... Mar 2023The appendix has an important immune function in both health and disease, and appendectomy may influence microbial ecology and immune function. This meta-analysis aims... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
The appendix has an important immune function in both health and disease, and appendectomy may influence microbial ecology and immune function. This meta-analysis aims to assess the association between appendectomy and the risk and course of Crohn's disease (CD).
METHODS
PubMed, EMBASE, and the Cochrane Library were used to identify all studies published until June 2022. Data from studies evaluating the association between appendectomy and CD were reviewed.
RESULTS
A total of 28 studies were included in the final analysis, comprising 22 case-control and 6 cohort studies. A positive relationship between prior appendectomy and the risk of developing CD was observed in both case-control studies (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.22-2.08) and cohort studies (relative risk [RR]: 2.28, 95% CI: 1.66-3.14). The elevated risk of CD persisted 5 years post-appendectomy (RR = 1.24, 95% CI: 1.12-1.36). The risk of developing CD was similarly elevated regardless of the presence (RR = 1.64, 95% CI: 1.17-2.31) or absence (RR = 2.77, 95% CI: 1.84-4.16) of appendicitis in patients. Moreover, significant differences were found in the proportion of terminal ileum lesions (OR = 1.63; 95% CI: 1.38-1.93) and colon lesions (OR = 0.70; 95% CI: 0.5-0.84) between CD patients with appendectomy and those without appendectomy.
CONCLUSIONS
The risk of developing CD following an appendectomy is significant and persists 5 years postoperatively. Moreover, the elevated risk of CD may mainly occur in the terminal ileum.
Topics: Humans; Crohn Disease; Appendectomy; Cohort Studies; Appendix; Case-Control Studies
PubMed: 36746236
DOI: 10.1016/j.clinre.2023.102090