Use of sonography in diagnosing acute appendicitis: Comparison of a teaching hospital and a community hospital

Abstract Introduction The Coronavirus-19 (COVID-19) pandemic has led to a 50–70% reduction in acute non-COVID-19 presentations to emergency departments globally. Aim To determine the impact of COVID-19 on incidence, severity, and outcomes of acute surgical admissions in an Irish University teaching hospital. Methods Descriptive data concerning patients presenting with acute appendicitis, diverticulitis, and cholecystitis were analysed and compared from March–May 2020 to March–May 2019. Results Acute surgical admissions decreased in March from 191 (2020) to 55 (2019) (55%), before increasing by 28% in April (2019: 119, 2020: 153). Admissions due to acute cholecystitis reduced by 33% (2019: 33, 2020: 22), with increased severity at presentation (P = 0.079) and higher 30-day readmission rates (P = 0.056) reported. Acute appendicitis presentations decreased by 44% (2019: 78, 2020: 43, P = 0.019), with an increase in severity (P < 0.001), conservative management (P < 0.001), and post-operative complications (P = 0.029) in 2020 compared to the same period in 2019. Conclusion COVID-19 has potentiated a significant reduction in acute surgical presentations to our hospital. Patients presenting with acute appendicitis during the pandemic had more severe disease, were more likely to have complications, and were significantly more likely to be managed conservatively when compared to historical data.

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Causes of acute peritonitis in 1188 consecutive adult patients in Ghana

Tropical Doctor ◽

10.1258/0049475054036788 ◽

2005 ◽

Vol 35 (2) ◽

pp. 84-85 ◽

Cited By ~ 7

Author(s):

Michael Ohene-Yeboah

Keyword(s):

Acute Appendicitis ◽

Prospective Study ◽

Teaching Hospital ◽

Communicable Diseases ◽

Adult Patients ◽

Emergency Unit ◽

Ileal Perforation ◽

Acute Peritonitis ◽

Generalized Peritonitis ◽

Previous Series

In a five-year prospective study,1188 consecutive adult patients were admitted and treated for acute generalized peritonitis at the Surgical Emergency Unit of the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Appendicitis and typhoid ileal perforation were the commonest causes, occurring in 43.1% and 35.1% of patients, respectively. Other conditions (gastroduodenal perforations, ruptured abscesses, traumatic bowel perforations and amoebic colonic perforations) accounted for fewer than 25% of cases. This paper notes that acute appendicitis and typhoid perforation remain the leading causes of peritonitis in Ghana. Compared with previous series, the importance of appendicitis in acute peritonitis has diminished. The complications of communicable diseases now cause peritonitis more commonly than 35 years ago. This may reflect deteriorating conditions of sanitation and housing during the intervening period.

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Rheumatic Pneumonia: The Need for a New Approach

PEDIATRICS ◽

10.1542/peds.56.6.1075 ◽

1975 ◽

Vol 56 (6) ◽

pp. 1075-1078

Author(s):

Steven P. Serlin ◽

Mary Ellen Rimsza ◽

John H. Gay

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Acute Appendicitis ◽

Mexican American ◽

Community Hospital ◽

Good Health ◽

Low Grade ◽

New Approach ◽

Rare Manifestation ◽

Comprehensive Discussion

Rheumatic pneumonia is a well-described, poorly understood, rare manifestation of rheumatic fever that is generally fatal. Until 1958, when Brown and his colleagues presented their comprehensive discussion, pediatric journals provided only five references. Since then, only one article has appeared in the pediatric literature. As illustrated by the following case report, pediatricians need to be aware of rheumatic pnuemonia in order to determine optimal therapy and management. CASE REPORT A.M., a 13-year-old Mexican-American boy, was in apparent good health until he developed fleeting arthralgia, abdominal pain, and low-grade fever. The day following the onset of symptoms acute appendicitis was suspected, and a laparotomy was performed at a community hospital.

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Non-Operative Management of Acute Appendicitis in Al-Hilla Teaching Hospital

Indian Journal of Public Health Research & Development ◽

10.37506/ijphrd.v11i4.9141 ◽

2020 ◽

Keyword(s):

Acute Appendicitis ◽

Teaching Hospital ◽

Operative Management ◽

Non Operative Management

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Computed tomographic studies of the head in a teaching hospital and a community hospital: a comparison.

Radiology ◽

10.1148/radiology.145.2.7134438 ◽

1982 ◽

Vol 145 (2) ◽

pp. 367-370 ◽

Cited By ~ 1

Author(s):

B J McNeil ◽

J R Kirkwood ◽

J A Hanley ◽

J Polak ◽

R Wilkinson ◽

...

Keyword(s):

Teaching Hospital ◽

Community Hospital ◽

Computed Tomographic

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Trends in Route of Hysterectomy after the Implementation of a Comprehensive Robotic Training Program

Minimally Invasive Surgery ◽

10.1155/2018/7362489 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Eleni Papalekas ◽

Jay Fisher

Keyword(s):

Robotic Surgery ◽

Training Program ◽

Teaching Hospital ◽

Community Hospital ◽

Tertiary Care ◽

Monitoring Program ◽

Teaching Hospitals ◽

Robotic Training ◽

Abdominal Approach ◽

National Trends

Objective. To evaluate trends in surgical approach for hysterectomy following the introduction and implementation of a comprehensive robotic surgery program. Methods. A retrospective review of all hysterectomies done at two institutions, a community hospital and a suburban, tertiary-care teaching hospital, in the same health system over a five-year period, January 2010 through December 2014. A robotic surgery training program was implemented during the first year of the study and trends in route of hysterectomy were evaluated in the subsequent years. Results. A total of 5175 patients undergoing hysterectomy, for both benign and malignant indications, were included in the study. There was a significant decrease in the percent of cases performed through an abdominal approach at both the community and teaching hospitals (19.3% decline at each institution). There was an inversely related significant increase in the percent of robotic procedures at both the community and teaching hospitals (44.5% and 17%, respectively). A decrease in number of cases performed vaginally over this period was only noted in the community hospital site (25.2% decrease), and there was a slightly higher rate of vaginal hysterectomies at the teaching hospital over this study period (21.9% in 2010, 24.1% in 2014). Conclusion. The decrease in number of abdominal and laparoscopic hysterectomies and increase in number of robotic hysterectomies that was seen are consistent with national trends. The initiation of a robotic training program did not prevent the proliferation of use of the robot but did aim to ensure proficiency on the robot prior to gaining privileges for patient use. This type of comprehensive training and monitoring program could be applied to future technologic advances to ensure a standard level of surgical proficiency. Trends in route of hysterectomy are clearly multifactorial and involve patient, provider, and location-specific factors that are likely to continue to change.

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Pilot Study: Outcomes of the Full Abdominopelvic Ultrasound Protocol for Diagnosis of Acute Appendicitis in Children: A Retrospective Chart Review

Journal of Diagnostic Medical Sonography ◽

10.1177/8756479320917402 ◽

2020 ◽

Vol 36 (6) ◽

pp. 530-534

Author(s):

Robert Dima ◽

Yongdong Wang ◽

Sarah Zuccolo ◽

Michelle Palmer ◽

Kerry Cheong

Keyword(s):

Pilot Study ◽

Acute Appendicitis ◽

Emergency Room ◽

Teaching Hospital ◽

Patient Management ◽

Chart Review ◽

Retrospective Chart Review ◽

Sonographic Evaluation ◽

Suspected Acute Appendicitis ◽

Rule Out

Objective: Sonographic evaluation for acute appendicitis in children often involves an exhaustive protocol, for which the therapeutic yield has not been formally evaluated. The purpose of the study was to pilot a retrospective chart review of children receiving an abdominopelvic sonogram upon presenting with suspected acute appendicitis. Methods: An annual retrospective chart review was designed to review abdominopelvic sonograms to rule out appendicitis and specifically performed at a Canadian children’s teaching hospital. Studies were excluded if the requisition stated multiple clinical concerns or if the patient was >18 years at the time of the sonogram. Results: Based on 230 patient cases reviewed, alternative diagnostic sonographic findings were found in 141 (61%) charts. Only 18 patient cases (8%) demonstrated both alternative sonographic findings as well as a change in management by the emergency room physician. Conclusion: Alternative diagnostic findings, based on a complete abdominopelvic sonogram, were common (61%) in this chart review but rarely changed patient management.

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