scholarly journals EP.FRI.960 USS appraisal in females of child bearing age presented with possible appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Fady Hatem ◽  
Samir Mostafa ◽  
Basel Chamali ◽  
Andrea Ivanov ◽  
Rebecca Ross ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Published Data ◽  
Negative Appendectomy ◽  
Child Bearing ◽  
Single Centre Study ◽  
Positive Scan ◽  
Negative Appendectomy Rate ◽  
The Mean ◽  
Low Sensitivity ◽  
The Uk

Abstract Aims Appendicitis remains the most common acute surgical condition.  No standard guidelines for the use of imaging studies, and there is a discrepancy between the published data regarding accuracy of these modalities and our practical findings. Yet the growing number of USS reported as “appendix not visualized” has led us to rethink about the value of USS in acute appendicitis.  Methods A retrospective single centre study for all females (15-45 years) underwent emergency appendectomy for suspected acute appendicitis. Analysis of preoperative clinical, radiographic and postoperative histopathological data was done. Results 632 cases analysed over 18months, out of those 238 (37%) were females (15-45 years). USS was done in 129(54%) cases. 25(10.5) cases had both USS and CTAP. 32(13%) cases had only CTAP. The mean rate of appendix visualization in the USS was 30%(71cases) two thirds reported by radiologist versus one third by sonographers. Our negative appendectomy rate dropped from 25 to 15% after a positive scan.  Conclusions Traditional preference for ultrasound in the UK compared to CTAP in young population is mostly due to the potential hazards of irradiation, but USS commonly does not visualise the appendix in our practice (70%), and has low sensitivity and specificity for appendicitis.  However, following a positive USS, NAR dropped to 15%. Radiologists had a higher visualization rate of appendix compared to sonographers. Commitment to improve the performance of ultrasonography by allocating adequately timed sessions to the most experienced radiologists and increasing the use of low dose CT scans are possible solutions.

scholarly journals 651 An Audit of Negative Appendectomy Rate at A District General Hospital in the UK

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Z Al-Hamid ◽  
S Jaskani ◽  
D Chattopadhyay
Keyword(s):  
Acute Appendicitis ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
National Database ◽  
Negative Appendectomy ◽  
Normal Appendix ◽  
Hospital Readmission Rate ◽  
Significant Difference ◽  
Negative Appendectomy Rate ◽  
The Uk

Abstract Aim There is significant variation in management of acute appendicitis across the UK. Despite advancements in imaging modalities, acute appendicitis is still a clinical diagnosis. The primary aim of this study was to determine the negative appendectomy rate (NAR) and secondary aim was to look for the imaging results and hospital readmission rate in case of a normal appendix. Method It is a retrospective analysis of all the patients admitted with a suspicion of acute appendicitis from Jan 2018 to April 2019. For data collection hospital medical record was used. Information about patient demographic details, blood results, outcome, operative findings, and histology of appendix if removed, was collected. For Patients having negative appendectomy, hospital admission rate was calculated. Results Total 517 patients were admitted with suspected acute appendicitis and only 45.6% (n = 236) patients underwent surgery. Females=52.1%, Males 47.9%. Mean age was 31 years. NAR was 10.6% (n = 25). (Females= 9.3%, Males=1.3%), 8.4% female patients were below 35 years of age. Patients were divided into 3 groups (Normal appendix NA, Uncomplicated appendicitis UA, complicated appendicitis CA). There was a statistically significant difference in inflammatory markers between the groups. In NA group 17/25 patients underwent prior imaging and imaging suggested acute appendicitis in 7/17 patients. Post NA hospital readmission rate was 20%, all of them were females, and gynecology opinion was sought in all of them. Conclusions The negative appendectomy rate is at 10.6%, comparable to national database. It is more common in young females due to a range of differential diagnoses.

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

scholarly journals Comparison of Clinical Features Between Patients with Positive and Negative Appendectomy

2020 ◽  
Author(s):  
Guner Cakmak ◽  
Baris Mantoglu ◽  
Emre Gonullu ◽  
Kayhan Ozdemir ◽  
Burak Kamburoglu
Keyword(s):  
Acute Appendicitis ◽  
Clinical Features ◽  
Total Bilirubin ◽  
Negative Appendectomy ◽  
C Reactive Protein ◽  
Future Studies ◽  
Female Patients ◽  
Reactive Protein ◽  
Male Patients ◽  
The Mean

Abstract Background: The objective of this study was to retrospectively compare clinical features and prognostic values between the patients who were referred to the general surgery clinic of our hospital with the presumed diagnosis of acute appendicitis and underwent positive or negative appendectomy.Methods: Patients were divided into two groups as positive (PA) (n:362) and negative appendectomy (NA) (n:284) and the data obtained were compared between these two groups.Laboratory investigations were performed in all patients, and white blood cell (WBC), mean platelet volume (MPV), neutrophils count (NEU), neutrophils (%) (NEU%), C-reactive protein (CRP) and total bilirubin (TBIL) values were studied.Results: The mean MPV value was found as 7.88 fl in PA groups and 8.09 fl in NA group, and the mean MPV value was not statistically significantly difference in PA group, compared to NA groups (p=0.012). Laboratory parameters were also compared between genders. Accordingly, the mean MPV value was statistically significantly higher in female patients compared to male patients in PA group (p = 0.04). The mean TBIL value was 0.97 mg/dl in PA group and 0.69 mg/dl in NA group, and the mean TBIL value was statistically significantly higher in PA group (p< 0.001). Finally, TBIL value was statistically significantly lower in female patients compared to male patients in NA and PA group (p < 0.05).Conclusions: According to the results of our study, MPV and T. BIL values differ in PA and NA groups depending on gender. Therefore, these values may not be used as specific biomarkers in predicting positive acute appendicitis. We believe that these results will contribute to the literature and will be guiding for future studies.

Can Computed Tomography Scan be Performed Effectively in the Diagnosis of Acute Appendicitis without the Added Morbidity of Rectal Contrast?

2008 ◽  
Vol 74 (10) ◽  
pp. 917-920 ◽  
Author(s):  
Daniel D. Dearing ◽  
Jamesa Recabaren ◽  
Magdi Alexander
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Ct Scanning ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Suspected Appendicitis ◽  
Ct Examination ◽  
Preoperative Ct ◽  
Negative Appendectomy Rate ◽  
Pathology Reports

The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.

scholarly journals A study to find out correlation between clinical diagnosis and histopathological diagnosis in patients with acute appendicitis undergoing surgical treatment

2019 ◽  
Vol 6 (6) ◽  
pp. 2046
Author(s):  
Mohit Jain ◽  
Yogesh Kumar Sharma
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Scoring System ◽  
Emergency Operation ◽  
Negative Appendectomy ◽  
Histopathological Diagnosis ◽  
Complication Rates ◽  
Diagnostic Modality ◽  
Negative Appendectomy Rate ◽  
A Prospective Study

Background: Acute appendicitis is one of the most frequent abdominal emergencies and appendectomy subsequently the most common emergency operation performed all over the world. The aim of the study is to evaluate the reliability of Clinical Diagnosis for diagnosis of acute appendicitis and correlate it with the gold standard and absolute diagnostic modality, histopathology.Methods: This is a prospective study carried out in 150 patients who were admitted under department of surgery, AFMC Pune, Maharashtra from 1st July 2014 to 31st June 2016 for a clinical diagnosis of acute appendicitis.Results: In our study overall negative appendectomy rate was 18.7% (12.37% in male and 30.19% in female). Hence in the overall females had more negative appendectomy rate compared to males. In our series a score of >7 using Alvarado system had a total sensitivity of 72.95%. While sensitivity increases to 99.18% when score of >5 used as cut-off.Conclusions:Alvarado scoring system is beneficial in decreasing negative appendectomy rate and thus reduces complication rates. It is effective in the diagnosis of acute appendicitis in both men and females but some other diagnostic modality may be necessary to ascertain the diagnosis in females along with the clinical scoring system to rule out other pelvic pathology and to reduce negative appendectomy rate in females. 

scholarly journals EP.FRI.96 Negative appendectomy rate in young females, between theory and practice. Full audit cycle

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Fady Hatem ◽  
Samir Mostafa ◽  
Rebecca Ross ◽  
Basel Chamali ◽  
Andrea Ivanov ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Action Plan ◽  
Theory And Practice ◽  
Negative Appendectomy ◽  
Improvement Project ◽  
Young Females ◽  
Child Bearing ◽  
Audit Period ◽  
Negative Appendectomy Rate ◽  
Audit Cycle

Abstract Aims Females of child bearing age are at higher risk of negative appendectomy rate, the accepted overall NAR is up to (20-25%). Presented is our study to examine the real NAR in the female’s cohort aged (15-45 years) in the form of quality improvement project to improve patient’s outcome. Methodology Retrospective study in the form of Full audit cycle over 18 months, the first cycle was conducted over 12 months period, followed by the action plan and reassessment over 6 months. Preoperative clinical, laboratory, radiographic and histopathological data were collected. Results Over the whole audit period 632 cases were analysed, 238 cases were females in the child bearing age included in our cohort. Over the first phase 419 appendectomy cases were performed, among those 156(37%) were females in child bearing age. Overall NAR was 29% and in our females cohort was 43.5%. Over the second cycle, 213 cases performed, out of which 82(38%) cases included in our cohort. Overall NAR reduced to 25% and in our cohort was 37% Conclusions Despite the advances in diagnostic modalities, Females are at significantly higher risk of NAR 37%. Our overall NAR reduced from 29% to 25% compared to the young females cohort, the rate dropped from 43% to 37%. specific consideration and regular auditing of results regards this cohort are highly recommended. Validation of appendicitis scores for risk stratification, Serial examinations and radiological adjuncts are possible solutions to reduce the NAR among this group.

scholarly journals Negative Appendectomy Rate in Urban Referral Hospitals in Tanzania: A Cross-sectional Analysis of Associated Factors

2021 ◽  
Vol 18 (2) ◽  
pp. 109-114
Author(s):  
Masawa Klint Nyamuryekung’E ◽  
Ali Athar ◽  
Miten Ramesh Patel ◽  
Aidan Njau ◽  
Omar Sherman ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Associated Factors ◽  
Lifetime Risk ◽  
Histological Evaluation ◽  
Negative Appendectomy ◽  
Perforation Rate ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Referral Hospitals ◽  
Negative Appendectomy Rate

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negativeappendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania. Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for  suspected AA with histological evaluation of specimens. The study was powered to detect the NAR at 95% confidence level and 80% power. Results: The histological NAR was 38.5% and the perforation rate was 25.3%. The Alvarado score (AS) was rarely applied (6%), despite ademonstrated ability in this study to decrease the NAR by half. Females were four times more likely to undergo negative appendectomy than males. Conclusion: The NAR is clinically significant as about two out of every five patients undergoing emergency appendectomy for suspected AA do not require the procedure. The AS is underutilized despite a demonstrated ability to decrease the NAR. We recommend that the AS be incorporated in the management of patients with suspected appendicitis. Keywords: Negative appendectomy rate, SubSaharan Africa, Alvarado score, Appendectomy, Suspected acute appendicitis

AIDS defining conditions in Africans resident in the United Kingdom

1996 ◽  
Vol 7 (1) ◽  
pp. 44-47 ◽  
Author(s):  
J. Del Amo ◽  
B. T. Goh ◽  
G. E. Forster
Keyword(s):  
Drug Users ◽  
Opportunistic Infections ◽  
Pneumocystis Carinii ◽  
Published Data ◽  
The United Kingdom ◽  
The Mean ◽  
African Patients ◽  
The Uk ◽  
Time Of Presentation ◽  
Oesophageal Candidiasis

A retrospective study of 55 HIV-1 seropositive African patients living in the UK, seen between January 1986 and November 1993, showed a total of 26 (47%) patients with AIDS. Thirty-one (56%) had symptomatic HIV disease at the time of presentation of whom 19 (34.5%) had an AIDS defining condition. Tuberculosis was the most common AIDS defining illness, accounting for 27% of all initial AIDS diagnoses, followed by Pneumocystis carinii pneumonia and oesophageal candidiasis in 19% each and chronic mucocutaneous genital herpes in 15%. The mean CD4 count at the time of the first AIDS defining event was 91 multiply 10/mm3 (range 4-320 10/ mm3). The profile of AIDS defining illnesses was different to published data of homosexual men and injecting drug users in the UK. This has practical implications when considering differential diagnoses and screening as well as prophylaxis for opportunistic infections in this group of patients.

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