CT based Acute Appendicitis Severity Index for acute appendicitis and validate its effectiveness in predicting complicated appendicitis

Mahankali, Shravan Kumar; Ahamed, Shefeek Abubacker; Gupta, Gaurav Som Prakash; Razek, Ahmed Abdel Khalek Abdel

doi:10.1007/s10140-021-01950-1

Cited by 11 publications

(9 citation statements)

References 29 publications

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“…Recently, a CT-based acute appendicitis severity index has been found to be a reliable parameter predicting complicated appendicitis. 25 Furthermore, using imaging analysis together with the clinical scoring systems may enable better differentiation in cases of complicated and uncomplicated appendicitis. 26 According to our study results, CT-assessed sarcopenia might predict complicated appendicitis in geriatric patients with a moderate degree of sensitivity and specificity and be used separately or in combination with diagnostic scoring systems.…”

Section: Discussionmentioning

confidence: 99%

The predictive value of computerized tomography‐assessed sarcopenia for complicated appendicitis in geriatric patients

Demiray¹,

Atlanoğlu²,

GEDİK³

et al. 2023

Aging Medicine

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ObjectiveGeriatric patients have more complicated appendicitis, which leads to higher morbidity and mortality rates. Sarcopenia has been shown to have a negative impact on patients undergoing surgery. This study aims to reveal the predictive value of computerized tomography‐assessed (CT‐assessed) sarcopenia for complicated appendicitis in geriatric patients.MethodsOne‐hundred fifty‐four patients’ with acute appendicitis age, gender, co‐morbidities, appendicitis status, and body mass index (BMI) values were analyzed. The skeletal muscle index (SMI) and related measurements were evaluated.ResultsFifty‐two percent of the patients had complicated, and 48% had uncomplicated appendicitis. There was a statistically significant difference between uncomplicated and complicated cases regarding BMI, SMI, and muscle area values (P < 0.05). The cutoff point by Receiver Operating Characteristic Curve analysis was conducted for SMI and showed 71% sensitivity and 52% specificity (P = 0.042). Multivariate analysis has shown that comorbidities are significantly more associated with complicated appendicitis than sarcopenia.ConclusionGeriatric patients with lower BMI, decreased muscle area, and CT‐detected sarcopenia have an increased risk of complicated appendicitis. Comorbidities are also important risk factors. Surgeons should be aware of factors leading to complicated appendicitis, which may cause higher morbidity and mortality rates in elderly patients.

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Section: Discussionmentioning

confidence: 99%

The predictive value of computerized tomography‐assessed sarcopenia for complicated appendicitis in geriatric patients

Demiray¹,

Atlanoğlu²,

GEDİK³

et al. 2023

Aging Medicine

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“…These results do not indicate that all cases of appendicitis do not require surgery. Hence, distinguishing patients with appendicitis who require surgical treatment from those who can recover with NOM is necessary [17]. Patients who require surgical treatment have a poor prognosis and develop complications if surgery is delayed.…”

Section: Discussionmentioning

confidence: 99%

“…Gangneung Asan Medical Center is the only tertiary hospital in the region, and the proportion of patients who require surgical treatment is high and the proportion of patients who self-recover is low. The progression of appendicitis might be closely related to the natural course of appendicitis and the underlying systemic disease in patients [17]. The incidence of complications was high in patients with a high ASA class and complicated appendicitis at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

To Reduce the Incidence of Postoperative Intraabdominal Abscess, the Application of Nonoperative Management Should be Circumspect Considering Patient Factors and the Nature of Acute Appendicitis

Lee

Yoon

2022

J Acute Care Surg

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Purpose: Surgery and nonoperative management (NOM) are the treatment modalities for acute appendicitis (AA). There is little evidence to indicate which treatment method should be performed according to the patient's condition or disease severity, surgical extension, and timing after an appendectomy. This study aimed to evaluate postoperative intra-abdominal abscess (PIAA) associated with these factors.Methods: The medical records of 839 patients who underwent appendectomy after a diagnosis of AA between 2019 and 2020 at Gangneung Asan Medical Centre were reviewed retrospectively. The factors associated with PIAA were evaluated.Results: Postoperative complications occurred in 92 patients. Following appendectomy, 16 (1.9%), 83 (9.9%), and three (0.4%) patients developed PIAA, surgical site infection, and incisional hernia, respectively. The American Society of Anesthesiologists class, complicated appendicitis on preoperative abdominal computed tomography, failure of NOM, and extensive surgery above appendectomy were associated with the development of PIAA. However, a laparoscopic approach, irrigation, indwelling drain, ultrasonic dissection, and use of sterile bags were not associated with the development of PIAA.Conclusion: NOM for some patients with complicated AA is an attractive treatment modality. However, to reduce the incidence of PIAA, the application of NOM should be circumspect considering patient factors and the nature of acute appendicitis. Furthermore, appendectomy should be performed as early as possible for patients not indicated for NOM.

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“…In a meta-analysis by Kim et al, the relatively increasing appendiceal contrast-enhancement had a pooled sensitivity of 74.94% and a pooled specificity of 9.25% (11). Mahankali et al used MHE in their CT-based severity assessment of acute appendicitis, while Iamwat et al used MHE as one of the criteria for differentiating between complicated and uncomplicated appendicitis (15,27). In the present study, MHE was another finding that was more common in complicated appendicitis (65.3%).…”

Section: Discussionmentioning

confidence: 99%

“…According to studies discussing the role of CT in the diagnosis of complicated appendicitis in the literature, there is no specific CT finding used to predict the presence of complicated appendicitis (11)(12)(13)(14). Some studies investigate the role of various scoring systems used for establishing appendicitis intensity in the diagnosis of acute appendicitis (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Is acute appendicitis complicated or uncomplicated? Approaching the question via computed tomography

2022

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Background The distinction between complicated and uncomplicated appendicitis is very important for the selection of the treatment method. Purpose To investigate the sensitivity and specificity of computed tomography (CT) in differentiating between complicated and uncomplicated appendicitis to demonstrate that false negativity in differentiating these cases can be reduced when CT findings are incorporated into the clinical evaluation of patients. Material and Methods All patients aged ≥18 years who underwent appendectomy at Malatya Training and Research Hospital in 2020 and 2021 were retrospectively screened. Of them, 283 patients were included in the study who had undergone CT before the operation. Patients with appendicitis were divided into two groups: complicated and uncomplicated, according to the results of their pathology tests. Demographic data, laboratory results, and CT images of the patients were evaluated. Results The patients with complicated appendicitis had a significantly higher mean age ( P<0.001). The most common CT findings in patients with complicated appendicitis were moderate or severe peri-appendiceal fat stranding (PFS) and appendix wall enhancement defect (AWD). The findings with the highest sensitivity were PFS (77.9%) and AWD (69.4%). Although abscess, phlegmon, and peri-appendiceal air had the highest specificity (100%), these findings were the ones with the lowest sensitivity. According to the scoring system was developed for the differential diagnosis, CT had a sensitivity of 83.3% and a specificity of 79.2%. Conclusion Based on the sensitivity and specificity values measured for CT according to the findings of our study, the scoring system may be useful for the differential diagnosis of complicated appendicitis.

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CT based Acute Appendicitis Severity Index for acute appendicitis and validate its effectiveness in predicting complicated appendicitis

Cited by 11 publications

References 29 publications

The predictive value of computerized tomography‐assessed sarcopenia for complicated appendicitis in geriatric patients

The predictive value of computerized tomography‐assessed sarcopenia for complicated appendicitis in geriatric patients

To Reduce the Incidence of Postoperative Intraabdominal Abscess, the Application of Nonoperative Management Should be Circumspect Considering Patient Factors and the Nature of Acute Appendicitis

Is acute appendicitis complicated or uncomplicated? Approaching the question via computed tomography

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