Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis

Andersson, Manne; Kołodziej, Blanka; Andersson, Roland

doi:10.1002/bjs.10637

Cited by 75 publications

(76 citation statements)

References 34 publications

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“…Identification of the optimal cut‐off scores for use in the UK population will increase the likelihood of risk prediction models being disseminated widely and implemented safely in the UK National Health Service. Routine risk scoring has been found in prospective studies to be associated with reduced need for imaging and hospital admission, and to reduce the NAR.…”

Section: Discussionmentioning

confidence: 99%

“…The UK has one of the world's highest NARs, so the predefined aim for this study was to evaluate the potential for routine risk scoring to identify low‐risk UK patients who are unlikely to have appendicitis. It was predicted that the NAR would be lower in the other participating countries and there would be no need for appendicitis risk scoring.…”

Section: Discussionmentioning

confidence: 99%

“…National differences in clinical pathways mean that analyses must be stratified by country. At the time of planning the analysis, the NAR was anticipated to be around 20 per cent in the UK, but under 5 per cent in other European countries. Given the low baseline NAR, there is little clinical need for risk scoring in European populations, so validation of risk scores in those patients would be unlikely to change clinical practice.…”

Section: Methodsmentioning

confidence: 99%

“…Robustly validated risk prediction models that identify groups at low risk of appendicitis could help to standardize clinical assessment and inform patient and doctor decision‐making. In turn, this may reduce hospital admissions, overtreatment and healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Bhangu

2019

Br J Surg

118

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Background: Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis.Methods: A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16-45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis).Results: Some 5345 patients across 154 UK hospitals were identified, of which two-thirds (3613 of 5345, 67⋅6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28⋅2 per cent) than men (120 of 993, 12⋅1 per cent) (relative risk 2⋅33, 95 per cent c.i. 1⋅92 to 2⋅84; P < 0⋅001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut-off score 8 or less, specificity 63⋅1 per cent, failure rate 3⋅7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut-off score 2 or less, specificity 24⋅7 per cent, failure rate 2⋅4 per cent).Conclusion: Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision-making by identifying adults in the UK at low risk of appendicitis were identified. * Co-authors of this study are listed in Appendix S1 (supporting information).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Bhangu

2019

Br J Surg

118

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“…Nevertheless, given the large number of clinical scores, any hospital should have its own protocol for the AA as the SIS (Surgical Infection Society) suggests. 9,10 From the other side the surgery is superior, obviously, in avoiding the relapse of the disease but exposes to the risk of surgery with a mortality and morbidity ranging from 0.07 to 0.7%, 0.5 to 2.4%, respectively. [11][12][13] Moreover, due to the lack in diagnostic accuracy, the appendix removal exposes to an unuseful and harmful surgery; late occlusion from post-operative adhesion is widely described…”

Section: Introductionmentioning

confidence: 99%

Acute appendicitis: not just a therapeutic puzzle to solve

et al. 2017

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Over the last 5 years, acute appendicitis (AA) is definitely drawing the scientific attention. As the timing in efficiently and promptly treating patients with AA is essential, any potential blind spot in understanding the disease should be clarified. Consequently, physicians will be able to address the patient towards the more appropriate therapeutic pathway (antibiotic or surgery) and avoid any harmful delay. Currently, neither surgery nor antibiotic seem offer a remarkable advantage to the patients therefore surgery remains the gold-standard in treating AA in accordance to the historical dogma.

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Computed tomography for diagnosis of acute appendicitis in adults

Rud

Vejborg

Rappeport

et al. 2019

Cochrane Database of Systematic Reviews

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Cochrane Database of Systematic Reviews Data collection and analysisTwo review authors independently collected the data from each study and evaluated methodological quality according to the Quality Assessment of Studies of Diagnostic Accuracy -Revised (QUADAS-2) tool. We used the bivariate random-e ects model to obtain summary estimates of sensitivity and specificity. Main resultsWe identified 64 studies including 71 separate study populations with a total of 10,280 participants (4583 with and 5697 without acute appendicitis). Estimates of sensitivity ranged from 0.72 to 1.0 and estimates of specificity ranged from 0.5 to 1.0 across the 71 study populations. Summary sensitivity was 0.95 (95% confidence interval (CI) 0.93 to 0.96), and summary specificity was 0.94 (95% CI 0.92 to 0.95). At the median prevalence of appendicitis (0.43), the probability of having appendicitis following a positive CT result was 0.92 (95% CI 0.90 to 0.94), and the probability of having appendicitis following a negative CT result was 0.04 (95% CI 0.03 to 0.05). In subgroup analyses according to contrast enhancement, summary sensitivity was higher for CT with intravenous contrast (0.96, 95% CI 0.92 to 0.98), CT with rectal contrast (0.97, 95% CI 0.93 to 0.99), and CT with intravenous and oral contrast enhancement (0.96, 95% CI 0.93 to 0.98) than for unenhanced CT (0.91, 95% CI 0.87 to 0.93). Summary sensitivity of CT with oral contrast enhancement (0.89, 95% CI 0.81 to 0.94) and unenhanced CT was similar. Results show practically no di erences in summary specificity, which varied from 0.93 (95% CI 0.90 to 0.95) to 0.95 (95% CI 0.90 to 0.98) between subgroups. Summary sensitivity for low-dose CT (0.94, 95% 0.90 to 0.97) was similar to summary sensitivity for standard-dose or unspecified-dose CT (0.95, 95% 0.93 to 0.96); summary specificity did not di er between lowdose and standard-dose or unspecified-dose CT. No studies had high methodological quality as evaluated by the QUADAS-2 tool. Major methodological problems were poor reference standards and partial verification primarily due to inadequate and incomplete follow-up in persons who did not have surgery. Authors' conclusionsThe sensitivity and specificity of CT for diagnosing appendicitis in adults are high. Unenhanced standard-dose CT appears to have lower sensitivity than standard-dose CT with intravenous, rectal, or oral and intravenous contrast enhancement. Use of di erent types of contrast enhancement or no enhancement does not appear to a ect specificity. Di erences in sensitivity and specificity between low-dose and standard-dose CT appear to be negligible. The results of this review should be interpreted with caution for two reasons. First, these results are based on studies of low methodological quality. Second, the comparisons between types of contrast enhancement and radiation dose may be unreliable because they are based on indirect comparisons that may be confounded by other factors.How reliable are the results of the studies in this review? Among the included studies, th...

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Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis

Abstract: AIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 ( http://www.clinicaltrials.gov).

Cited by 75 publications

References 34 publications

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Acute appendicitis: not just a therapeutic puzzle to solve

Computed tomography for diagnosis of acute appendicitis in adults

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