Evolution of the Age Distribution and Mortality of Acute Appendicitis

Peltokallio, P

doi:10.1001/archsurg.1981.01380140015003

Cited by 77 publications

(34 citation statements)

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“…It is well known that appendicitis is more difficult to diagnose in older patients and previous studies [17][18][19] have demonstrated that elderly patients sometimes lack not only the typical symptoms of appendicitis, but also some of the clinical data abnormalities. Moreover, according to several studies [20][21][22][23], delayed surgery increases not only the severity of appendicitis, but also postoperative complications and the period of hospitalization. Therefore, it is not surprising that age is closely correlated with the severity of AA.…”

Section: Discussionmentioning

confidence: 99%

A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis

2015

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Section: Discussionmentioning

confidence: 99%

A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis

2015

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“…10,14,19,28 This has been postulated as due to a higher rate of false-negative decisions, 19 higher rate of inhospital delay, 19 and longer duration of symptoms before presentation. 1 Since both extremes of age had increased rates of adverse outcomes, the clinician's suspicions should be increased for these patients, with consideration of observation of these patients at a lower threshold than in the adult patient. In addition, in our study, female patients had a a 2.3 increased odds of unnecessary surgery.…”

Section: Discussionmentioning

confidence: 99%

“…ACA-DEMIC EMERGENCY MEDICINE 2000; 7:1244-1255 A PPENDICITIS is the most common surgical cause of acute abdominal pain, affecting 7% of humans during their lifetimes. 1 More than one hundred years ago, Fitz described the pathophysiology of appendicitis, and McBurney demonstrated how early appendectomy can prevent appendiceal performation. 2,3 The rate of appendiceal perforation is an index of poor outcome, with the patient at increased risk of many complications such as wound infection, abscess formation, sepsis, wound dehiscence, pneumonia, prolonged ileus, heart failure, or renal insufficiency.…”

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confidence: 99%

False‐negative and False‐positive Errors in Abdominal Pain Evaluation Failure to Diagnose Acute Appendicitis and Unnecessary Surgery

Graff

Russell

Seashore

et al. 2000

Academic Emergency Medicine

117

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Abstract. Objectives:To test the hypothesis that physician errors (failure to diagnose appendicitis at initial evaluation) correlate with adverse outcome. The authors also postulated that physician errors would correlate with delays in surgery, delays in surgery would correlate with adverse outcomes, and physician errors would occur on patients with atypical presentations. Methods: This was a retrospective two-arm observational cohort study at 12 acute care hospitals: 1) consecutive patients who had an appendectomy for appendicitis and 2) consecutive emergency department abdominal pain patients. Outcome measures were adverse events (perforation, abscess) and physician diagnostic performance (false-positive decisions, false-negative decisions). Results: The appendectomy arm of the study included 1,026 patients with 110 (10.5%) false-positive decisions (range by hospital 4.7% to 19.5%). Of the 916 patients with appendicitis, 170 (18.6%) false-negative decisions were made (range by hospital 10.6% to 27.8%). Patients who had false-negative decisions had increased risks of perforation (r = 0.59, p = 0.058) and of abscess formation (r = 0.81, p = 0.002). For admitted patients, when the inhospital delay before surgery was >20 hours, the risk of perforation was increased [2.9 odds ratio (OR) 95% CI = 1.8 to 4.8]. The amount of delay from initial physician evaluation until surgery varied with physician diagnostic performance: 7.0 hours (95% CI = 6.7 to 7.4) if the initial physician made the diagnosis, 72.4 hours (95% CI = 51.2 to 93.7) if the initial office physician missed the diagnosis, and 63.1 hours (95% CI = 47.9 to 78.4) if the initial emergency physician missed the diagnosis. Patients whose diagnosis was initially missed by the physician had fewer signs and symptoms of appendicitis than patients whose diagnosis was made initially [appendicitis score 2.0 (95% CI = 1.6 to 2.3) vs 6.5 (95% CI = 6.4 to 6.7)]. Older patients (>41 years old) had more false-negative decisions and a higher risk of perforation or abscess (3.5 OR 95% CI = 2.4 to 5.1). Falsepositive decisions were made for patients who had signs and symptoms similar to those of appendicitis patients [appendicitis score 5.7 (95% CI = 5.2 to 6.1) vs 6.5 (95% CI = 6.4 to 6.7)]. Female patients had an increased risk of false-positive surgery (2.3 OR 95% CI = 1.5 to 3.4). The abdominal pain arm of the study included 1,118 consecutive patients submitted by eight hospitals, with 44 patients having appendicitis. Hospitals with observation units compared with hospitals without observation units had a higher ''rule out appendicitis'' evaluation rate [33.7% (95% CI = 27 to 38) vs 24.7% (95% CI = 23 to 27)] and a similar hospital admission rate (27.6% vs 24.7%, p = NS). There was a lower miss-diagnosis rate (15.1% vs 19.4%, p = NS power 0.02), lower perforation rate (19.0% vs 20.6%, p = NS power 0.05), and lower abscess rate (5.6% vs 6.9%, p = NS power 0.06), but these did not reach statistical significance. Conclusions: Errors in physician diagnostic decisions correlat...

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“…It has been shown that the postoperative complication rate is significantly increased among those with perforated appendicitis [2,15]. Although only 5% to 10% of cases involve the elderly, the incidence of appendicitis among the elderly seems to be increasing with the increase in life expectancy [15,23]. Moreover, the incidence of perforation among the elderly is reported to be as high as 70% [10,27].…”

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confidence: 99%