Predictive factors of negative appendectomy in children

Zouari, Mohamed; Abid, Imen; Dhaou, Mahdi Ben; Louati, Hamdi; Jallouli, Mohamed; Mhiri, Riadh

doi:10.1016/j.ajem.2017.07.075

Cited by 7 publications

(5 citation statements)

References 5 publications

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“…Children with PCA more frequently had a peripheral WBC count >10 × 10 3 /μL and left shift than children with NA. This is consistent with prior studies that demonstrated that an absence of an elevated WBC count is a risk factor for NA in both children and adults 38–40 . At our institution, US reports for suspected appendicitis are standardized to be reported as high probability, low probability, or equivocal for appendicitis.…”

Section: Discussionsupporting

confidence: 89%

“…This is consistent with prior studies that demonstrated that an absence of an elevated WBC count is a risk factor for NA in both children and adults. [38][39][40] At our institution, US reports for suspected appendicitis are standardized to be reported as high probability, low probability, or equivocal for appendicitis. Secondary signs (eg, presence of pelvic free fluid, fat stranding, hyperemia) are also reported if present.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Accuracy of Suspected Appendicitis

et al. 2020

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Objective: When evaluating suspected appendicitis, limited data support quality benchmarks for negative appendectomy (NA); none exist for delayed diagnosis of appendicitis (DDA). The objectives of this study are the following: (1) to provide preliminary evidence supporting a quality benchmark for DDA and 2) to compare presenting features and diagnostic evaluations of children with NA and DDA with those with pathologyconfirmed appendicitis (PCA) diagnosed during initial emergency department (ED) encounter.Methods: Secondary analysis of data from a QI project designed to reduce the use computed tomography when evaluating suspected appendicitis using a case-control design. Patients undergoing appendectomy in an academic tertiary care children's hospital system between January 1, 2015, and December 31, 2016 (n = 1,189) were eligible for inclusion in this case-control study. Negative appendectomy was defined as no pathologic change or findings consistent with a different diagnosis. Delayed diagnosis of appendicitis was defined as patients undergoing appendectomy within 7 days of a prior ED visit for a related complaint. Controls of PCA (n = 150) were randomly selected from all cases undergoing appendectomy.Results: There were 42 NA (3.5%) and 31 DDA (2.6%). Cases of PCA and NA exhibited similar histories, examination findings, and underwent comparable diagnostic evaluations. Cases of PCA more frequently demonstrated a white blood cell count greater than 10 Â 10 3 /μL (85% vs 67%; P = 0.01), a left-shift (77% vs 45%; P < 0.001), and an ultrasound interpretation with high probability for appendicitis (73% vs 54%; P = 0.03). Numerous significant differences in history, examination findings, and diagnostic tests performed existed between cases of PCA and DDA. Conclusions:Children with PCA and NA present similarly and undergo comparable evaluations resulting in appendectomy. A 3% to 4% NA rate may be unavoidable given these similarities. Presenting features in DDA significantly differ from those of PCA. An irreducible proportion of appendicitis diagnoses may be delayed.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Suspected Appendicitis

et al. 2020

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“…The diameter of the appendix ranged from 6 mm to 13 mm with a mean of 7.6 mm on ultrasound (n=101) and 9 mm 8–13 on CT scan (n=3). A periappendiceal fat infiltration was described in 88% of cases, and minimal periappendiceal effusion in 22% of cases.…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3][4][5] After retrieval of the anatomopathological results from the removed appendix, the mean rate of so-called 'negative' appendidectomy, that is, removal of healthy appendices, is 1%-40%. [6][7][8][9][10] These observations have led surgeons to rethink their approach. Historically, medical treatment was first attempted when surgery proved impossible-in pregnant women, soldiers or submariners.…”

Section: Introductionmentioning

confidence: 99%

Non-operative treatment of acute appendicitis in children: clinical efficacy of amoxicillin-clavulanic acid in a retrospective single-centre study

Picard,

Abbo,

Munzer

et al. 2023

bmjpo

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BackgroundThe success rate of non-operative treatment (NOT) of acute uncomplicated appendicitis (AUA) in children varies from 65% to 95%. There are no recommendations on the appropriate antibiotic therapy.ObjectiveTo determine the clinical efficacy of amoxicillin-clavulanic acid for NOT of AUA in children.MethodsDesign: Cross-sectional study in a single medical centre. Settings: Emergency department and Paediatric Visceral Surgery department of the Children Hospital in Toulouse, France. Patients: Patients 5–15 years old who were diagnosed with appendicitis, (1) With abdominal pain and a first episode of acute appendicitis, (2) With no radiological or ultrasound evidence of appendicolith, appendiceal perforation, pelvic abscess nor peritonitis, and (3) With non-septic general aspect, were included. Interventions: NOT consisted of hospital admission. The antibiotic treatment was a combination of amoxicillin and clavulanic acid (80 mg/kg/day of amoxicillin): intravenous regimen during 48 hours followed by oral route during 7 days. Main outcome measure: Success rate of amoxicillin-clavulanic acid NOT in children with AUA at 2 years.ResultsThe initial success rate of amoxicillin-clavulanic acid NOT in children with AUA was 100% (104/104 patients). The success rate at 2 years was 85.6% (89/104) at discharge. None of the 15 patients who underwent surgery after recurrence of appendicitis presented with peritonitis, appendiceal perforation nor pelvic abscess.ConclusionNarrowed antibiotic therapy with amoxicillin and clavulanic acid seems to be an alternative to surgery in children with AUA. It is necessary to wait for the results of ongoing studies to confirm these results.

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“…The acceptable rate has been even higher in children [34]. However, the reported in pediatric literature rate of negative appendectomy has continued to vary widely from 1% to 40% [35][36][37][38][39][40][41][42][43][44]. In large populations of children with appendectomies, the reported negative appendectomy rate varied from 4.3% to 6.7% [35,45,46].…”

Section: Acute Appendicitis In Childrenmentioning

confidence: 99%

Application of Heisenberg’s Uncertainty Principle in the Diag-Nostic Dilemma of Children With Acute Appendicitis: Negative Appendectomy Versus Complicated Appendicitis Rates

Roupakias¹,

Fouzas²,

Kostopoulou³

et al. 2023

Preprint

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Abstract Background. There is an inherent limit in the accuracy of our measurements, set by nature itself and predicted by Heisenberg's uncertainty principle, which defines the properties of nature in the microcosmos. There is a fundamental limit to the accuracy with which complementary phys-ical quantities of a particle can be predicted from their initial conditions. As classical physics is essentially considered at borderline of quantum mechanics, so the power of uncertainty princi-ple is limited in describing everyday life perceived or managed phenomena. Method. In this study, we apply Heisenberg's uncertainty principle to children under diagnostic uncertainty re-garding appendicitis. We analyze this phenomenon in clinical practice. Results. Medical practice is full of uncertainty. False negative decisions correlate with delays in treatment and adverse outcomes in children with atypical appendicitis. On the other hand, false-positive surgery deci-sions result in negative appendectomies. With improvement of technology, the incidence of complicated appendicitis or negative appendectomies due to diagnostic uncertainty has de-creased but cannot be ignored or eliminated. Conclusion. According to the principle, there is a fundamental limit to the accuracy with which the complementary variables of negative appen-dectomy and complicated appendicitis can be observed or measured simultaneously. What does all this mean for the physician?

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Predictive factors of negative appendectomy in children

Cited by 7 publications

References 5 publications

Diagnostic Accuracy of Suspected Appendicitis

Diagnostic Accuracy of Suspected Appendicitis

Non-operative treatment of acute appendicitis in children: clinical efficacy of amoxicillin-clavulanic acid in a retrospective single-centre study

Application of Heisenberg’s Uncertainty Principle in the Diag-Nostic Dilemma of Children With Acute Appendicitis: Negative Appendectomy Versus Complicated Appendicitis Rates

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