Meaningful standard of reference for appendiceal perforation: pathology, surgery, or both?

Kim, Hyuk Jung; Kim, Mi Sung; Park, Ji Hoon; Ahn, Soyeon; Ko, Yousun; Sang-Hwa, Song; Woo, Ji Young; Lee, Kyung Ho

doi:10.4174/astr.2017.93.2.88

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…The absence of appendicitis was confirmed based on the negative histopathologic findings from the appendectomy specimen (i.e., negative appendectomy), gross surgical findings, or clinical follow-up, including the telephone interview. The presence of appendiceal perforation was based on the spillage of the appendiceal contents, peritonitis, or abscess observed during surgery or pathologically confirmed appendiceal wall defect due to transmural necrosis [ 14 25 ].…”

Section: Methodsmentioning

confidence: 99%

Appendiceal Visualization on 2-mSv CT vs. Conventional-Dose CT in Adolescents and Young Adults with Suspected Appendicitis: An Analysis of Large Pragmatic Randomized Trial Data

et al. 2022

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Objective We compared appendiceal visualization on 2-mSv CT vs. conventional-dose CT (median 7 mSv) in adolescents and young adults and analyzed the undesirable clinical and diagnostic outcomes that followed appendiceal nonvisualization. Materials and Methods A total of 3074 patients aged 15–44 years (mean ± standard deviation, 28 ± 9 years; 1672 female) from 20 hospitals were randomized to the 2-mSv CT or conventional-dose CT group (1535 vs. 1539) from December 2013 through August 2016. A total of 161 radiologists from 20 institutions prospectively rated appendiceal visualization (grade 0, not identified; grade 1, unsure or partly visualized; and grade 2, clearly and entirely visualized) and the presence of appendicitis in these patients. The final diagnosis was based on CT imaging and surgical, pathologic, and clinical findings. We analyzed undesirable clinical or diagnostic outcomes, such as negative appendectomy, perforated appendicitis, more extensive than simple appendectomy, delay in patient management, or incorrect CT diagnosis, which followed appendiceal nonvisualization (defined as grade 0 or 1) and compared the outcomes between the two groups. Results In the 2-mSv CT and conventional-dose CT groups, appendiceal visualization was rated as grade 0 in 41 (2.7%) and 18 (1.2%) patients, respectively; grade 1 in 181 (11.8%) and 81 (5.3%) patients, respectively; and grade 2 in 1304 (85.0%) and 1421 (92.3%) patients, respectively ( p < 0.001). Overall, undesirable outcomes were rare in both groups. Compared to the conventional-dose CT group, the 2-mSv CT group had slightly higher rates of perforated appendicitis (1.1% [17] vs. 0.5% [7], p = 0.06) and false-negative diagnoses (0.4% [6] vs. 0.0% [0], p = 0.01) following appendiceal nonvisualization. Otherwise, these two groups were comparable. Conclusion The use of 2-mSv CT instead of conventional-dose CT impairs appendiceal visualization in more patients. However, appendiceal nonvisualization on 2-mSv CT rarely leads to undesirable clinical or diagnostic outcomes.

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Section: Methodsmentioning

confidence: 99%

Appendiceal Visualization on 2-mSv CT vs. Conventional-Dose CT in Adolescents and Young Adults with Suspected Appendicitis: An Analysis of Large Pragmatic Randomized Trial Data

et al. 2022

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“…Negative appendectomy indicates the clinical consequence of a false-positive diagnosis of appendicitis, whereas appendiceal perforation is associated with a delayed (or false-negative) diagnosis. The two reciprocal endpoints have been commonly used as quality indices in the management of patients with suspected appendicitis [ 63 64 65 ], and in the overall patient access to emergency medical care [ 66 ].…”

Section: Diagnostic Effectiveness and Efficacy: Ldct Vs Cdctmentioning

confidence: 99%

Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence

2022

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Due to its excellent diagnostic performance, CT is the mainstay of diagnostic test in adults with suspected acute appendicitis in many countries. Although debatable, extensive epidemiological studies have suggested that CT radiation is carcinogenic, at least in children and adolescents. Setting aside the debate over the carcinogenic risk of CT radiation, the value of judicious use of CT radiation cannot be overstated for the diagnosis of appendicitis, considering that appendicitis is a very common disease, and that the vast majority of patients with suspected acute appendicitis are adolescents and young adults with average life expectancies. Given the accumulated evidence justifying the use of low-dose CT (LDCT) of only 2 mSv, there is no reasonable basis to insist on using radiation dose of multi-purpose abdominal CT for the diagnosis of appendicitis, particularly in adolescents and young adults. Published data strongly suggest that LDCT is comparable to conventional dose CT in terms of clinical outcomes and diagnostic performance. In this narrative review, we will discuss such evidence for reducing CT radiation in adolescents and young adults with suspected appendicitis.

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Differentiation between complicated and uncomplicated appendicitis: diagnostic model development and validation study

Kim¹,

Park²,

Lee³

et al. 2020

Abdom Radiol

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Meaningful standard of reference for appendiceal perforation: pathology, surgery, or both?

Cited by 7 publications

References 23 publications

Appendiceal Visualization on 2-mSv CT vs. Conventional-Dose CT in Adolescents and Young Adults with Suspected Appendicitis: An Analysis of Large Pragmatic Randomized Trial Data

Appendiceal Visualization on 2-mSv CT vs. Conventional-Dose CT in Adolescents and Young Adults with Suspected Appendicitis: An Analysis of Large Pragmatic Randomized Trial Data

Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence

Differentiation between complicated and uncomplicated appendicitis: diagnostic model development and validation study

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