Dataset Information

Acute appendicitis and the role of pre-operative imaging: A cohort study.

ABSTRACT: Introduction:Acute right iliac fossa (RIF) pain is amongst the most common presentation to the surgical team. Acute appendicitis is the most common cause of this pain and often warrants surgical intervention. In many cases intervention results in a negative appendicectomy with unnecessary complications as a result. The aim of this study was to compare the efficacy of pre-operative imaging in the diagnosis of acute appendicitis to reduce the rate of negative appendicectomy and unnecessary operative intervention. Methods:A retrospective single centre cohort study was undertaken in a district general hospital (DGH) of all laparoscopic appendicectomies over a six-year period. 1344 cases were included and were examined for the use of pre-operative imaging (and type) or none. The sensitivity, specificity, negative and positive predictive value for each type of imaging were analysed for their accuracy in diagnosis appendicitis based on the final histological analysis. Results:The negative appendicectomy rate was found to be greatest in those undergoing ultrasonography (48.21%) as their method of pre-operative imaging whilst those who underwent computed tomography (CTAP 20.26%) had a lower rate equivalent to that of clinical diagnosis alone (20.73%). Conclusion:USS is less sensitive than CT in diagnosing acute appendicitis. There is no statistically significant difference in negative appendicectomy rate between clinical diagnosis and CT diagnosis. Pre-operative imaging has a role in the diagnosis of appendicitis but needs to be utilised appropriately to reduce the strain on the surgical department and prevent the potential of a negative appendicectomy.

SUBMITTER: Rait JS

PROVIDER: S-EPMC7575836 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Acute appendicitis and the role of pre-operative imaging: A cohort study.

Rait Jaideep Singh JS Ajzajian Jirayr J McGillicuddy Joshua J Sharma Amit A Andrews Brian B

Annals of medicine and surgery (2012) 20201009

<h4>Introduction</h4>Acute right iliac fossa (RIF) pain is amongst the most common presentation to the surgical team. Acute appendicitis is the most common cause of this pain and often warrants surgical intervention. In many cases intervention results in a negative appendicectomy with unnecessary complications as a result. The aim of this study was to compare the efficacy of pre-operative imaging in the diagnosis of acute appendicitis to reduce the rate of negative appendicectomy and unnecessary ...[more]

PMID: 33101666

Similar Datasets

Project description:INTRODUCTION:This article presents an overview of a prospective randomised controlled non-inferiority study designed to evaluate the safety and effectiveness of non-operative management (NOM) with operative management in children with acute uncomplicated appendicitis (AUA). Here, we present the study protocol for this APRES study, a multicentre Australian study. The rationale and details of future analysis, in particular, non-inferiority calculations, cost-effectiveness, feasibility and acceptability of each intervention. DESIGN:A multicentre, prospective randomised controlled clinical trial, conducted in 2 Australian tertiary paediatric hospitals. PARTICIPANTS:Children who meet the inclusion criteria of an age between 5 and 15?years and a clinical diagnosis of AUA will be invited to participate, and after consent will be randomised via a computer-based program into treatment groups. The study started in June 2016, and the target recruitment is 220 patients. INTERVENTIONS:Children in the control group will be treated with prophylactic antibiotics and appendicectomy, and those in the intervention group will be treated with antibiotic therapy alone. Primary outcome measures include unplanned or unnecessary operation and complications at 30?days. Secondary outcomes include longer term complications within 1 year, length of stay, time off work and school analgesic requirements and cost. ANALYSIS:Data analyses will be on the intention-to-treat principle using non-inferiority analysis. Analysis will include the Pearson ?2 test for categorical variables and independent sample t-test or Mann-Whitney test for continuous variables. Non-inferiority for NOM will be tested using 1-sided Wald tests with an ? level of 0.05. ETHICS AND DISSEMINATION:The research has been approved by the Human Research Ethics Committee of the Sydney Children's Hospital Network. In addition, results will be reported through academic journals, seminars and conference presentations. TRIAL REGISTRATION NUMBERS:NCT02795793; ACTRN12616000788471.

Project description:BackgroundPre-operative risk scores are more valuable than post-procedure risk scores because of lacking effective treatment for contrast-induced acute kidney injury (CI-AKI). A number of pre-operative risk scores have been developed, but due to lack of effective external validation, most of them are also difficult to apply accurately in clinical practice. It is necessary to review and validate the published pre-operative risk scores for CI-AKI.Materials and methodsWe systematically searched PubMed and EMBASE databases for studies of CI-AKI pre-operative risk scores and assessed their calibration and discriminatory in a cohort of 2669 patients undergoing coronary angiography or percutaneous coronary intervention (PCI) from September 2007 to July 2017. The definitions of CI-AKI may affect the validation results, so three definition were included in this study, CI-AKI broad1 was defined as an increase in serum creatinine (Scr) of 44.2 μmol/L or 25%; CI-AKI broad2, an increase in Scr of 44.2 μmol/L or 50%; and CI-AKI-narrow, an increase in Scr of 44.2 μmol/L. The calibration of the model was assessed with the Hosmer-Lemeshow test and the discriminatory capacity was identified by C-statistic.ResultsOf the 8 pre-operative risk scores for CI-AKI identified, 7 were single-center study and only 1 was based on multi-center study. In addition, 7 of the scores were just validated internally and only Chen score was externally validated. In the validation cohort of 2669 patients, the incidence of CI-AKI ranged from 3.0%(Liu) to 16.4%(Chen) for these scores. Furthermore, the incidence of CI-AKI was 6.59% (178) for CI-AKI broad1, 1.44% (39) for CI-AKI broad2, and 0.67% (18) for CI-AKI-narrow. For CI-AKI broads, C-statistics varied from 0.44 to 0.57. For CI-AKI-narrow, the Maioli score had the best discrimination and calibration, what's more, the C-statistics of Maioli, Chen, Liu and Ghani was ≥0.7.ConclusionMost pre-operative risk scores were established based on single-center studies and most of them lacked external validation. For CI-AKI broads, the prediction accuracy of all risk scores was low. The Maioli score had the best discrimination and calibration, when using the CI-AKI-narrow definition.

Project description:BackgroundPre-operative kidney function is known to be associated with surgical outcomes. However, in emergency surgery, the pre-operative kidney function may reflect chronic kidney disease (CKD) or acute kidney injury (AKI). We examined the association of pre-operative CKD and/or AKI with in-hospital outcomes of emergency colorectal surgery.MethodsWe conducted a retrospective cohort study including adult patients undergoing emergency colorectal surgery in 38 Japanese hospitals between 2010 and 2017. We classified patients into five groups according to the pre-operative status of CKD (defined as baseline estimated glomerular filtration rate < 60 mL/min/1.73 m2 or recorded diagnosis of CKD), AKI (defined as admission serum creatinine value/baseline serum creatinine value ≥ 1.5), and end-stage renal disease (ESRD): (i) CKD(-)AKI(-), (ii) CKD(-)AKI(+), (iii) CKD(+)AKI(-), (iv) CKD(+)AKI(+), and (v) ESRD groups. The primary outcome was in-hospital mortality, while secondary outcomes included use of vasoactive drugs, mechanical ventilation, blood transfusion, post-operative renal replacement therapy, and length of hospital stay. We compared these outcomes among the five groups, followed by a multivariable logistic regression analysis for in-hospital mortality.ResultsWe identified 3002 patients with emergency colorectal surgery (mean age 70.3 ± 15.4 years, male 54.5%). The in-hospital mortality was 8.6% (169/1963), 23.8% (129/541), 15.3% (52/340), 28.8% (17/59), and 32.3% (32/99) for CKD(-)AKI(-), CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD, respectively. Other outcomes such as blood transfusion and post-operative renal replacement therapy showed similar trends. Compared to the CKD(-)AKI(-) group, the adjusted odds ratio (95% confidence interval) for in-hospital mortality was 2.54 (1.90-3.40), 1.29 (0.90-1.85), 2.86 (1.54-5.32), and 2.76 (1.55-4.93) for CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD groups, respectively. Stratified by baseline eGFR (> 90, 60-89, 30-59, and < 30 mL/min/1.73 m2) and AKI status, the crude in-hospital mortality and adjusted odds ratio increased in patients with baseline eGFR < 30 mL/min/1.73 m2 among patients without AKI, while these were constantly high regardless of baseline eGFR among patients with AKI. Additional analysis restricting to 2162 patients receiving the surgery on the day of hospital admission showed similar results.ConclusionsThe differentiation of pre-operative CKD and AKI, especially the identification of AKI, is useful for risk stratification in patients undergoing emergency colorectal surgery.

Dataset Information

Acute appendicitis and the role of pre-operative imaging: A cohort study.

Publications

Acute appendicitis and the role of pre-operative imaging: A cohort study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets