Many diagnostic tools for appendicitis: a scoping review

Bahta, Nadir Noureldin Abdella; Rosenberg, Jacob; Fonnes, Siv

doi:10.1007/s00464-023-09890-2

Cited by 4 publications

(16 citation statements)

References 72 publications

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“…Inflammation in the appendix, which is confirmed by histopathology, is the gold standard for presence of appendicitis. World Society of Emergency Surgery's guideline [3] recommends to measure white blood cell count and C-reactive protein in children and these two biomarkers were also included in 66% and 22%, respectively, of all diagnostics tools and scoring systems for appendicitis [35]. Hyperbilirubinemia (blood bilirubin > 20 lmol/L) has been investigated in several studies as a biomarker for perforated appendix [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

“…Hyperbilirubinemia (blood bilirubin > 20 lmol/L) has been investigated in several studies as a biomarker for perforated appendix [36][37][38]. It has not been fully addressed why hyperbilirubinemia is associated with perforated appendix, but it has been proposed that it is due to pathogen invasion of the hepatocytes or pathogen-induced vascular haemolysis [35]. Lastly, sodium has been reported to be decreased in appendicitis, especially with perforated appendix or complicated appendicitis [39].…”

Section: Discussionmentioning

confidence: 99%

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Diarrhoea‐causing microorganisms are rare in adult patients undergoing diagnostic laparoscopy for suspected appendicitis: a prospective observational cohort study

Fonnes

Rasmussen

Holzknecht

et al. 2023

APMIS

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We investigated if diarrhoea‐causing bacteria, including Yersinia species, could mimic the symptoms of appendicitis and lead to surgery. This prospective observational cohort study (NCT03349814) included adult patients undergoing surgery for suspected appendicitis. Rectal swabs were analysed with polymerase chain reaction (PCR) for Yersinia, Campylobacter, Salmonella, Shigella and Aeromonas spp. Blood samples were analysed routinely and with an in‐house ELISA serological test for Yersinia enterocolitica antibodies. We compared patients without appendicitis and patients with appendicitis confirmed by histopathology. The outcomes included PCR‐confirmed infection with Yersinia spp., serologic‐confirmed infection with Y. enterocolitica, PCR‐confirmed infection with other diarrhoea‐causing bacteria and Enterobius vermicularis confirmed by histopathology. A total of 224 patients were included, 51 without and 173 with appendicitis, and followed for 10 days. PCR‐confirmed infection with Yersinia spp. was found in one patient (2%) without appendicitis and no patients (0%) with appendicitis (p = 0.23). Serology was positive for Y. enterocolitica for the same patient without appendicitis and two patients with appendicitis (p = 0.54). Campylobacter spp. were detected in 4% vs 1% (p = 0.13) of patients without and with appendicitis, respectively. Infection with Yersinia spp. and other diarrhoea‐causing microorganisms in adult patients undergoing surgery for suspected appendicitis was rare.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diarrhoea‐causing microorganisms are rare in adult patients undergoing diagnostic laparoscopy for suspected appendicitis: a prospective observational cohort study

Fonnes

Rasmussen

Holzknecht

et al. 2023

APMIS

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“…The predefined answer options in the part about their pre-diagnostic approach were based on the most frequently used variables (symptoms, findings of the physical examination, and biochemical markers) of published CDRs. 4 Three outcomes were investigated in this study. Firstly, to evaluate if appendicitis is regarded as a difficult diagnosis and how surgeons in training overcome their uncertainty when in doubt.…”

Section: Methodsmentioning

confidence: 99%

“…have been developed. 4 Most of these consist of specific symptoms, positive signs in the physical examination, and biochemical markers that in combination have high discriminatory power. 4 Thus, they aid in the diagnostic approach and may reduce…”

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confidence: 99%

“…7 CDR is not a new phenomenon since the first was published in 1986 8 and new research has been published regularly in the past 15 years. 4 However, there is a great difference in the scientific reach of articles developing CDRs, and some studies have never been cited, 9 whereas the Alvarado score 8 has been cited over 1000 times. 9 However, there are no studies that have investigated how familiar surgeons in training are with CDRs and thereby uncovered their reach in clinical practice.…”

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

Bahta,

Gram‐Hanssen,

Jonsson

et al. 2024

World j. surg.

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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.

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The Alvarado Score Is the Most Impactful Diagnostic Tool for Appendicitis: A Bibliometric Analysis

Bahta

Zeinert

Rosenberg

et al. 2023

Journal of Surgical Research

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Many diagnostic tools for appendicitis: a scoping review

Cited by 4 publications

References 72 publications

Diarrhoea‐causing microorganisms are rare in adult patients undergoing diagnostic laparoscopy for suspected appendicitis: a prospective observational cohort study

Diarrhoea‐causing microorganisms are rare in adult patients undergoing diagnostic laparoscopy for suspected appendicitis: a prospective observational cohort study

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

The Alvarado Score Is the Most Impactful Diagnostic Tool for Appendicitis: A Bibliometric Analysis

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