Decision making in patients with acute abdominal pain at a university and at a rural hospital: Does the value of abdominal sonography differ?

Exadaktylos, Aristomenis K.; Sadowski-Cron, Charlotte; Mäder, Paul; Dinkel, Hans Peter; Negri, Marco; Zimmermann, Heinz

doi:10.1186/1749-7922-3-29

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…Our results and other studies as well [ 32 , 36 ], clearly suggested that CRP leads to precise prediction of the severity of acute appendicitis. We think that CRP is not specific test for appendicitis, therefore, before diagnostic decision and indication for treatment, clinicians must depend on structural interpretation of their subjective experience, clinical information and modalities such as laboratory tests, ultrasonography and computed tomography where is available [ 37 , 38 ].…”

Section: Discussionsupporting

confidence: 85%

Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis

Xharra

Gashi-Luci

Xharra³

et al. 2012

World J Emerg Surg

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BackgroundAcute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, laboratory and imaging investigation. The aim of the study is to analyze the role of C-reactive protein (CRP), white blood count (WBC) and Neutrophil percentage (NP) in improving the accuracy of diagnosis of acute appendicitis and to compare it with the intraoperative assessment and histopathology findings.Materials and methodsThis investigation was a prospective double blinded clinical study. The study was done on 173 patients surgically treated for acute appendicitis. The WBC, NP, and measurement of CRP were randomly collected pre-operatively from all involved patients. Macroscopic assessment was made from the operation. Appendectomy and a histopathology examination were performed on all patients. Gross description was compared with histopathology results and then correlated with CRP, WBC, and NP.ResultsThe observational accuracy was 87,3%, as compared to histopathological accuracy which was 85.5% with a total of 173 patients that were operated on. The histopathology showed 25 (14.5%) patients had normal appendices, and 148 (85.5%) patients had acutely inflamed, gangrenous, or perforated appendicitis. 52% were male and 48% were female, with the age ranging from 5 to 59 with a median of 19.7. The gangrenous type was the most frequent (52.6%). The WBC was altered in 77.5% of the cases, NP in 72.3%, and C-reactive protein in 76.9% cases. In those with positive appendicitis, the CRP and WBC values were elevated in 126 patients (72.8%), whereas NP was higher than 75% in 117 patients (67.6%). Out of 106 patients with triple positive tests, 101 (95.2%) had appendicitis. The sensitivity, specificity, and positive predictive values of the 3 tests in combination were 95.3%, 72.2%, and 95.3%, respectively.ConclusionThe raised value of the CRP was directly related to the severity of inflammation (p-value <0.05). CRP monitoring enhances the diagnostic accuracy of acute appendicitis. The diagnostic accuracy of CRP is not significantly greater than WBC and NP. A combination of these three tests significantly increases the accuracy. We found that elevated serum CRP levels support the surgeon's clinical diagnosis.

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Section: Discussionsupporting

confidence: 85%

Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis

Xharra

Gashi-Luci

Xharra³

et al. 2012

World J Emerg Surg

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“…10 Furthermore, numerous international studies illustrate the benefits of PoCUS in rural and remote settings, which could parallel the situation in rural Canada. [11][12][13] Clearly there are multiple advantages to performing PoCUS in the rural ED; moreover, the Canadian Association of Emergency Physicians (CAEP), in their 2012 Position Statement, has encouraged access to PoCUS 24/7/365 in the ED. 14 However, despite the numerous benefits offered by PoCUS in the rural ED setting, several barriers to its use remain.…”

Section: Introductionmentioning

confidence: 99%

Barriers to point-of-care ultrasound use in rural emergency departments

Micks

Sue

Rogers

2016

CJEM

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Over the past few decades, point-of-care ultrasound (PoCUS) has come to play a major role in the practice of emergency medicine. Despite its numerous benefits, there has been a slow uptake of PoCUS use in rural emergency departments. Surveys conducted across Canada and the United States have identified a lack of equipment, training, funding, quality assurance, and an inability to maintain skills as major barriers to PoCUS use. Potential solutions include expanding residency training in ultrasound skills, extending funding for PoCUS training to rural physicians in practice, moving PoCUS training courses to rural sites, and creating telesonography training for rural physicians. With these barriers identified and solutions proposed, corrective measures must be taken so that the benefits of PoCUS are extended to patients in rural Canada where, arguably, it has the greatest potential for benefit when access to advanced imaging is not readily available.

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“…Postoperative complication rates were comparable in both groups. Imaging techniques have been more frequently used in management of patients with abdominal pain, however have brought minor advantages in diagnostic specificity [26,29,30]. Medford-Davis et al presented high incidence of diagnostic errors reaching 35% in high risk patients with abdominal pain, involving most commonly history taking, but also ordering insufficient tests and problems with follow-up of abnormal test results [31].…”

Section: Discussionmentioning

confidence: 99%

“Analysis of readmissions to the emergency department among patients presenting with abdominal pain”

et al. 2020

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Background: Abdominal pain is one of the most common complaints among patients admitted to the Emergency Department (ED). Diagnosis and management of abdominal pain may be a challenge and there are patients who require admission to the ED more than once in a short period of time. Our purpose was to assess the incidence of readmissions among patients treated in the ED due to abdominal pain and to investigate the impact of readmission on the further course of treatment. Methods: We conducted a prospective observational study, which included patients admitted to the ED in one academic, teaching hospital presenting with non-traumatic abdominal pain in a three-month period. Analyzed factors included demographic data, details related to first and subsequent visits in the ED and the course of hospitalization. Results: Overall, 928 patients were included to the study and 101 (10.88%) patients were admitted to the ED more than once during three-month period. Patients visiting ED repeatedly were older (p = 0.03) and more likely to be hospitalized (p < 0.01) compared to single-visit patients. Patients during their subsequent visits spent more time in the ED (p = 0.01), had greater chance to repeat their appointment (p = 0.04), be admitted to the hospital (p < 0.01) and were more likely diagnosed with cholelithiasis (p = 0.03) compared to patients on their initial visit. If admitted to the surgical department they were also more often qualified for surgical procedure than patients on their first visit (p < 0.01). In a group of patients admitted to the surgical department there were no significant differences in rates of conversion, postoperative complications and mortality between subgroups. Conclusions: Readmissions among patients presenting with abdominal pain are a common phenomenon with prevalence of 10.88%. They are most commonly associated with cholelithiasis and occur more frequently among older patients, which suggests, that elderly require more attention during ED managements.

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Decision making in patients with acute abdominal pain at a university and at a rural hospital: Does the value of abdominal sonography differ?

Cited by 7 publications

References 25 publications

Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis

Correlation of serum C-reactive protein, white blood count and neutrophil percentage with histopathology findings in acute appendicitis

Barriers to point-of-care ultrasound use in rural emergency departments

“Analysis of readmissions to the emergency department among patients presenting with abdominal pain”

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