Clinical decision rules for appendicitis are not used by surgeons in training: A survey

Abstract

BackgroundsWe aimed to investigate surgeons in training knowledge of clinical decision rules (CDR) for diagnosing appendicitis and their attitudes toward implementing them.MethodsWe included surgeons in training practicing in East Denmark who independently could decide to perform a diagnostic laparoscopy for suspected appendicitis. The survey was developed in Research Electronic Data Capture and face‐validated before use. It consisted of three parts: (1) the characteristics of the surgeons, (2) their diagnostic approach, and (3) their knowledge and attitude toward introducing CDR in the clinic. Data were collected in January 2023.ResultsWe achieved 83 (90%) responses, and 52% of surgeons in training believed that appendicitis was difficult to diagnose. Their diagnostic approach mostly included symptoms and physical examinations for abdominal pain, and C‐reactive protein. A total of 48% knew of at least one clinical decision rule, and 72% had never used a clinical decision rule. Regarding the necessity of CDR in clinical practice, surgeons in training options were divided into thirds: not needed, neither needed nor not needed, and needed. Surgeons in training indicated that CDR needed to be validated and easily applied before they would implement them.ConclusionApproximately 3/4 of surgeons in training had never utilized a clinical decision rule to diagnose appendicitis, and only half knew of their existence. The symptoms and findings incorporated in most CDR aligned with their diagnostic approach. They were conflicted if CDR needed to be implemented in clinical practice.

Invited commentary to “Clinical decision rules for appendicitis are not used by surgeons in training: A survey”

“…From this perspective, the survey of Danish surgeons in training reported in this issue of the World Journal of Surgery gives a depressing impression. 6 About half of the surgeons did not know about the existence of clinical scoring systems, and only 25% had ever used them. Reasons for this was simply unfamiliarity and to a lesser degree lack of trust.…”