Bolus Versus Continuous Nasogastric Feeds for Infants With Bronchiolitis: A Randomized Trial

BACKGROUND AND OBJECTIVES: Infants hospitalized with bronchiolitis are commenced on nasogastric feeding to maintain hydration. Feeding strategies vary according to physician or institution preference. The current study hypothesized that continuous nasogastric feeding would prolong length of stay (LOS) when compared to bolus feeding. METHODS: A randomized, parallel-group, superiority clinical trial was performed within an Australian children’s hospital throughout 2 bronchiolitis seasons from May 2018 to October 2019. Infants <12 months hospitalized with bronchiolitis and requiring supplemental nasogastric feeding were randomly assigned to continuous or bolus nasogastric regimens. LOS was the primary outcome. Secondary outcome measures included pulmonary aspirations and admissions to intensive care. RESULTS: The intention-to-treat analysis included 189 patients: 98 in the bolus nasogastric feeding group and 91 in the continuous group. There was no significant difference in LOS (median LOS of the bolus group was 54.25 hours [interquartile range 40.25–82] and 56 hours [interquartile range 38–78.75] in the continuous group). A higher proportion of admissions to intensive care was detected in the continuous group (28.57% [26 of 91] of the continuous group vs 11.22% [11 of 98] of the bolus group [P value 0.004]). There were no clinically significant pulmonary aspirations or statistically significant differences in vital signs between the groups within 6 hours of feed initiation. CONCLUSIONS: No significant difference in LOS was found between bolus and continuous nasogastric feeding strategies for infants hospitalized with bronchiolitis. The continuous feeding group had a higher proportion of intensive care admissions, and there were no aspiration events.

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Abstract P124: Repeat Manual Office Blood Pressure By A Physician Is Lower Than Automated Office Blood Pressure

Hypertension ◽

10.1161/hyp.78.suppl_1.p124 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Bryce Rhodehouse ◽

Courtney Shaver ◽

Jerry Fan ◽

Bright Izekor ◽

Clinton Jones ◽

...

Keyword(s):

Blood Pressure ◽

Vital Signs ◽

Outpatient Setting ◽

Office Blood Pressure ◽

P Value ◽

Signed Rank ◽

Significant Difference ◽

Minute Interval ◽

The Difference ◽

Automated Office Blood Pressure

Introduction: An accurate measurement of blood pressure (BP) is critical to diagnosing and treating hypertension (HTN). Manual office BP (MOBP) often results in higher readings than automated office BP (AOBP). In previous studies, a repeat MOBP by a physician resulted in a lower BP than the initial MOBP by nursing staff. We evaluated our hypothesis that a repeat MOBP by a physician is statistically equivalent to AOBP. Methods: In an ambulatory outpatient setting, patients were roomed and at least a 5-minute interval lapsed before an AOBP was performed using a Welch Allyn Connex Vital Signs Monitor. The physician was blinded to the AOBP. The physician then entered the room and obtained a MOBP with a manual aneroid sphygmomanometer. The difference between the AOBP and the MOBP was calculated. A Wilcoxon signed rank sum test was used to determine if a significant difference between AOBP and MOBP exists. Results: A total of 186 patients (112 females, 74 male) had BP measured with a mean age of 66 years. AOBP resulted in a median systolic BP (SBP) 136 mmHg (IQR 121-150 mmHg) and median diastolic BP (DBP) of 78 mmHg (IQR 72-85 mmHg). MOBP SBP had a median of 132 mmHg (IQR 120-142 mmHg) and DBP had a median of 76 mmHg (IQR 70-81 mmHg). SBP and DBP were significantly lower in the MOBP group with a mean difference between AOBP and MOBP of 4.0 and 2.7 mmHg respectively (p-value of <0.0001). Conclusions: Repeat MOBP performed by the physician resulted in a significantly lower BP compared to AOBP. The lower BP may be due to an overall longer interval between the AOBP measurement and MOBP measurement. MOBP may be a viable option for accurate diagnosis and treatment of HTN clinics without access to a AOBP machine.

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Abstract 3916: Rapidly Improving Stroke Symptoms: Relation to Stroke Volumes and Discharge Disposition

Stroke ◽

10.1161/str.43.suppl_1.a3916 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Clotilde Balucani ◽

Steven Levine ◽

Jane Khoury Khoury ◽

Pooja Khatri ◽

Jeffrey L Saver ◽

...

Keyword(s):

Nursing Home ◽

Secondary Outcome ◽

P Value ◽

Lesion Volume ◽

P Values ◽

Discharge Disposition ◽

Stroke Study ◽

Significant Difference ◽

Discharge Status ◽

Multiple Logistic Regression Modeling

Background: Rapidly improving stroke symptoms (RISS) is a frequently cited reason for not giving IV rt-PA. However, prior studies have suggested that outcome of acute ischemic stroke patients presenting with RISS is not invariably benign. This raises the possibility that stroke-related disability may be relatively common after RISS. Objective: To explore both discharge disposition and 3-month CT lesion volume in patients with and without RISS based on various pre-specified definitions in The NINDS rt-PA Stroke Study cohort. Methods: The NINDS rt-PA Stroke Study dataset was used to compare baseline to 2-hour NIH Stroke Scale scores (NIHSSS). We calculated baseline NIHSSS - 2hr NIHSSS (positive = improvement [IMP], negative = worsening). Definitions of RISS were raw change in NIHSSS (≥ 4 point IMP) and percent change in NIHSSS (≥ 25% IMP and ≥ 50% IMP). Chi-square and multiple logistic regression modeling were used to assess the association of RISS with outcomes measures. Discharge disposition included: home; relative/friend; rehabilitation; nursing home; death; other. CT lesion volume was based on the 3-month CT scan as previously calculated as a pre-specified secondary outcome of the 2 trials. Results: In the 624 subjects, RISS frequency depended on definition used. Frequencies (all %s) of RISS compared to no-RISS who were discharged Home were 55 vs. 30 for ≥ 4 point IMP, 64 vs. 23 for ≥ 25% IMP, and 78 vs. 30 for ≥ 50% IMP. Frequencies for Discharge to Rehabilitation (RISS vs. no-RISS) were: 1 vs. 36, 14 vs. 41, and 10 vs. 36. Nursing Home discharge frequencies were: 5 vs. 11, 4 vs. 12, and 1 vs. 11. Across all definitions of RISS there was a significant difference in discharge status favoring RISS (all p values < 0.001). Three-month CT lesion volumes (cm3): for RISS ≥ 4 point IMP were: 7.51 [95% Confidence Interval (CI): 1.52, 12.34] vs. no-RISS 19.95 (CI: 2.71, 26.42); for RISS ≥ 25%: 4.64 (CI: 1.07, 7.41) vs. no-RISS 25.96 (CI: 2.99, 33.96); for RISS ≥ 50% IMP: 3.14 (CI: 0.44, 6.36) vs. no-RISS 19.75 (CI: 2.73, 25.50). All p values <0.001.There were no statistically significant rt-PA treatment interactions for CT volume (lowest p-value 0.28) and for discharge status (lowest p-value 0.13). Conclusions: Post hoc exploratory analyses suggest that based on all definitions of RISS used, those patients with RISS were consistently and significantly discharged to a more favorable location than those without RISS. These findings were also consonant with CT lesion volumes at 3 months being significantly smaller for each definition of RISS vs. no RISS. However, while patients with RISS do better in these exploratory outcomes, they still commonly have evidence of cerebral infarction and approximately 2 of 3 with ≥ 4 point IMP and 1 in 5 with at least 50% IMP are not discharged home.

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The influence of intra-aortic balloon counter pulsation on central venous blood oxygen saturation

Perfusion ◽

10.1177/02676591211055968 ◽

2021 ◽

pp. 026765912110559

Author(s):

Ayman Mohamed ◽

Sameh Aboulnaga ◽

Fayez Hamwi ◽

Amr S Omar ◽

Abdulrasheed Pattath ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Oxygen Saturation ◽

Venous Blood ◽

Blood Gases ◽

Left Ventricular ◽

Arterial Oxygen ◽

Secondary Outcome ◽

Central Venous ◽

Significant Difference

Objectives We aim at identifying the changes in venous blood saturation values that associates intra-aortic balloon pump (IABP) in cardiac surgery patients with reduced left ventricular function (LVF). Methods A retrospective observational study was conducted in a cardiothoracic intensive care unit (CTICU) in a tertiary cardiac center over 5 years in Qatar. A total of 114 patients with at least moderate impairment of LVF with ejection fraction (EF) less than 40% were enrolled. According to the association of IABP, patients were segregated into two groups with and without IABP (groups 1, 40 patients and group 2, 74 patients). Sequential arterial and venous blood gases were analyzed. The primary outcome was to analyze the changes in the central venous saturation (ScvO2) in both groups and the secondary outcome was to analyze whether these changes affect the overall outcome in terms of intensive care unit (ICU) length of stay. Results There was no significant difference between both groups with regard to age, preoperative EF, hemoglobin, and arterial oxygen saturation (SaO2) in blood gases. Patients with IABP have a higher cScvO2 when compared to the other group (71.5 ± 12.5 vs 63.5 ± 9.3, 68.3 ± 12.6 vs 60.1 ± 9.5, 62.7 ± 10.8 vs 55.63 ± 8.1, and 60.6 ± 7.6 vs 54.9 ± 8.1; p = 0.04, 0.05, 0.03, and 0.5, respectively). However, generalized estimating equations (GEE) analysis showed that compared with the participants showing that there is a decreasing trend in mean levels within the groups during follow-ups, overall difference between both groups’ mean levels was not statistically significant. Conclusions In this study, we observed that after cardiac surgeries, patients with IABP had non-significant higher ScvO2 when compared with a corresponding group with moderate impairment of LVF. Further prospective studies are required to validate these findings.

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Impact of blood group on survival following critical illness: a single-centre retrospective observational study

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000426 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000426

Author(s):

Robert Slade ◽

Raza Alikhan ◽

Matt P Wise ◽

Lam Germain ◽

Simon Stanworth ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Blood Group ◽

Outcome Measure ◽

Tertiary Hospital ◽

Current Data ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Transfusion Requirements ◽

Significant Difference

BackgroundPredicting patient outcomes following critical illness is challenging. Recent evidence has suggested that patients with blood group AB are more likely to survive following major cardiac surgery, and this is associated with a reduced number of blood transfusions. However, there are no current data to indicate whether a patient’s blood group affects general intensive care outcomes.ObjectiveThe objective of this study was to determine if ABO blood group affects survival in intensive care. The primary outcome measure was 90-day mortality with a secondary outcome measure of the percentage of patients receiving a blood transfusion.DesignRetrospective analysis of electronically collected intensive care data, blood group and transfusion data.SettingGeneral intensive care unit (ICU) of a major tertiary hospital with both medical and surgical patients.PatientsAll patients admitted to ICU between 2006 and 2016 who had blood group data available.InterventionNone.Measurements and main results7340 patients were included in the study, blood group AB accounted for 3% (221), A 41% (3008), B 10.6% (775) and O 45.4% (3336). These values are similar to UK averages. Baseline characteristics between the groups were similar. Blood group AB had the greatest survival benefit (blood group AB 90-day survival estimate 76.75, 95% CI 72.89 to 80.61 with the overall estimate 72.07, 95% CI 71.31 to 72.82) (log-rank χ2 16.128, p=0.001). Transfusion requirements were similar in all groups with no significant difference between the percentages of patients transfused (AB 23.1%, A 21.5%, B 18.7%, O 19.9%, Pearson χ2 5.060 p=0.167).ConclusionAlthough this is primarily a hypothesis generating study, intensive care patients with blood group AB appeared to have a higher 90-day survival compared with other blood groups. There was no correlation between blood group and percentage of patients receiving transfusion.

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Nurses and guideline for interrupting or not initiating CPR: An exploratory survey

Clinical Nursing Studies ◽

10.5430/cns.v7n4p13 ◽

2019 ◽

Vol 7 (4) ◽

pp. 13

Author(s):

Claudia Agnoletto ◽

Fancesco Gastaldo ◽

Simonetta Padrin

Keyword(s):

Intensive Care ◽

Work Experience ◽

Healthcare Providers ◽

P Value ◽

Anonymous Questionnaire ◽

Work Area ◽

Significant Difference ◽

Exploratory Survey ◽

And Behaviors ◽

Lack Of Knowledge

Objective: An area that still causes difficulties and a sense of inadequacy in healthcare providers is related to Do Not Attempt Resuscitation decision (DNAR). The aim of the study is to investigate knowledge, opinions and behaviors of nurses about DNAR in order to plan appropriate improvement interventions.Methods: An anonymous questionnaire was administered to 207 nurses belonging to four Medicine Departments and to four Intensive Care areas. The questionnaire, which consists of 29 items, collects some information related to work experience and investigates opinions and behaviors of nurses about DNAR decision.Results: 55% of the nurses in the sample say they do not know the meaning of the acronym DNAR. It was noted a statistically significant association both between training and knowledge of DNAR (p-value = .038) and between years of work and knowledge of the acronym (p-value = .004). There was also a statistically significant difference between knowledge of the acronym and some opinions and behaviors of nurses, including the importance of informing the patient about DNAR decision (p-value = .028).Conclusions: The study shows that the sample investigated, regardless of the work area of afference, does not know DNAR decision adequately. The lack of knowledge influences opinions and attitudes of nurses in relation to DNAR decision, constituting a barrier for an appropriate management of the patient. The need for more training on the topic and the formulation of clear protocols on DNAR decision emerges.

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Introduction of the identification, situation, background, assessment, recommendations tool to improve the quality of information transfer during medical handover in intensive care

Journal of the Intensive Care Society ◽

10.1177/1751143716660982 ◽

2016 ◽

Vol 18 (1) ◽

pp. 17-23 ◽

Cited By ~ 4

Author(s):

Benjamin Ramasubbu ◽

Emma Stewart ◽

Rosalba Spiritoso

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Patient Information ◽

Information Transfer ◽

Relevant Information ◽

Interquartile Range ◽

Quality And Safety ◽

Significant Difference ◽

Handover Process

Objective To audit the quality and safety of the current doctor-to-doctor handover of patient information in our Cardiothoracic Intensive Care Unit. If deficient, to implement a validated handover tool to improve the quality of the handover process. Methods In Cycle 1 we observed the verbal handover and reviewed the written handover information transferred for 50 consecutive patients in St George’s Hospital Cardiothoracic Intensive Care Unit. For each patient’s handover, we assessed whether each section of the Identification, Situation, Background, Assessment, Recommendations tool was used on a scale of 0–2. Zero if no information in that category was transferred, one if the information was partially transferred and two if all relevant information was transferred. Each patient’s handover received a score from 0 to 10 and thus, each cycle a total score of 0–500. Following the implementation of the Identification, Situation, Background, Assessment, Recommendations handover tool in our Intensive Care Unit in Cycle 2, we re-observed the handover process for another 50 consecutive patients hence, completing the audit cycle. Results There was a significant difference between the total scores from Cycle 1 and 2 (263/500 versus 457/500, p < 0.001). The median handover score for Cycle 1 was 5/10 (interquartile range 4–6). The median handover score for Cycle 2 was 9/10 (interquartile range 9–10). Patient handover scores increased significantly between Cycle 1 and 2, U = 13.5, p < 0.001. Conclusions The introduction of a standardised handover template (Identification, Situation, Background, Assessment, Recommendations tool) has improved the quality and safety of the doctor-to-doctor handover of patient information in our Intensive Care Unit.

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C-reactive protein/albumin ratio as a predictor of 28 day mortality in patients with sepsis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200225 ◽

2020 ◽

Vol 8 (2) ◽

pp. 503

Author(s):

Hamsa B. T. ◽

Srinivasa S. V. ◽

Raveesha A.

Keyword(s):

Inotropic Support ◽

Secondary Outcome ◽

P Value ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein ◽

Significant Difference ◽

Life Threatening ◽

Sepsis And Septic Shock ◽

A Prospective Study

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis remains a major cause of morbidity and mortality worldwide. Important biomarkers that can be used as prognostic markers in sepsis are C Reactive Protein (CRP) and serum Albumin levels. CRP levels markedly elevate in response to infection whereas albumin levels decrease in response to acute phase infection. We want to ascertain the value of CRP/albumin ratio as an independent predictor of 28-day mortality in sepsis patients.Methods: A prospective study was conducted including 150 patients satisfying the criteria for sepsis according to SOFA score of more than 2. Initial CRP/Albumin ratio was assessed to determine its significance in assessing the 28-day mortality, primary end point of our study. Secondary end points assessed were length of ICU stay, need for inotropic support, need for ventilator support and renal replacement therapy.Results: In the analysis of CRP/Albumin ratio as a predictor of 28-day mortality, patients were followed up from day of admission till 28 days to assess primary outcome. Among study subjects survivors were 92 in whom mean CRP/ALB ratio was 0.1197 and non survivors were 58 patients with mean CRP/ALB ratio was 0.0426. p-value <0.001, there was statistically significant difference found between survivor and Non-Survivor with respect to CRP/Albumin ratio. In assessing secondary outcome statistically significant association was found for need for ventilator and inotropic support, whereas it was insignificant in assessing need for dialysis and length of ICU stay.Conclusions: CRP/albumin ratio, which indicates the extent of residual inflammation, could be used as a prognostic marker in predicting mortality in patients with sepsis and septic shock.

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MRI Assessment of Global and Regional Diaphragmatic Motion in Critically Ill Patients Following Prolonged Ventilator Weaning

Medical Sciences ◽

10.3390/medsci7050066 ◽

2019 ◽

Vol 7 (5) ◽

pp. 66

Author(s):

Khurram Saleem Khan ◽

James Meaney ◽

Ignacio Martin-Loeches ◽

Daniel V. Collins

Keyword(s):

Intensive Care ◽

Vertical Displacement ◽

Interquartile Range ◽

Control Group ◽

P Value ◽

Diaphragmatic Dysfunction ◽

Intensive Care Patients ◽

The Right ◽

Ventilated Patients ◽

Left Hemi

Introduction: diaphragmatic dysfunction is a common cause of slow weaning in mechanically ventilated patients. Diaphragmatic dysfunction in ventilated patients can be global or regional. The aim of our study was to evaluate the motion of the entire diaphragm in patients who were ventilated for a protracted period in comparison with healthy controls by using Magnetic Resonance Imaging (MRI). Methods: Intensive care patients who had a prolonged ventilator wean and required tracheostomies were enrolled based on extensive exclusion criteria. MRI dynamic sequence and subtraction images were used to measure vertical displacement at five different points on each hemi-diaphragm during normal tidal breathing. Tidal displacement of each point on the right and left hemi-diaphragms of the patients were compared to the precise respective points on the right and left hemi-diaphragms of enrolled controls. Results: Eight intensive care patients and eight controls were enrolled. There were observed significant differences in the displacements of the left hemi-diaphragm between the two groups (median 6.4 mm [Interquartile range (IQR), 4.6–12.5]) vs. 11.6 mm [IQR, 9.5–14.5], p = 0.02). There were also observed significant differences in the displacements at five evaluated study points on the left hemi-diaphragms of the patients when compared to the precise respective points in controls, especially at the dome (median 6.7 mm [IQR, 5.0–11.4] vs. 13.5 mm [IQR 11.5-18], p value = 0.005) and the anterior zone of apposition (median 5.0 mm [IQR, 3.3–7.1] vs. 7.8mm [IQR, 7.1–10.5], p value = 0.01). The intensive care patients showed lower minimal and maximal values of displacement of right hemi-diaphragms compared to the controls, suggesting that the differences in the displacement of right hemi-diaphragm are possible; however, the differences in the mean values of displacement of right hemi-diaphragm between the intensive care patient group and the control group (median 9.8 mm [IQR (Interquartile range), 5.0–12.3] vs. 10.1 mm [IQR 8.3–18.5], p = 0.12) did not reach the level of significance. Conclusion: Although frequently global, diaphragm dysfunction in ventilated patients after prolonged ventilation can also be regional or focal when assessed by MRI dynamic sequence. The vertical displacement of both right and left hemi-diaphragms at various anatomical locations had different values in both controls, and patients. There were significant focal variations in the movement of diaphragm in patients with ventilator-induced diaphragmatic dysfunction.

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Association between Prehospital Arterial Hypercapnia in Acute Heart Failure and Admission to Acute Care Units : A Retrospective Cohort Study

10.21203/rs.3.rs-28775/v1 ◽

2020 ◽

Author(s):

Mathias Fabre ◽

Christophe A. Fehlmann ◽

Birgit Gartner ◽

Catherine G. Zimmermann-Ivoll ◽

Florian Rey ◽

...

Keyword(s):

Heart Failure ◽

Intensive Care ◽

Acute Heart Failure ◽

Acute Care ◽

Vital Signs ◽

Admission Rate ◽

Ethics Committee ◽

High Dependency ◽

Significant Difference ◽

Acute Care Unit

Abstract Background: Acute Heart Failure (AHF) is a common condition that often manifests by acute respiratory distress and requires urgent medical evaluation and treatment. Arterial hypercapnia is common in AHF. It has been associated with a higher rate of intubation and non-invasive ventilation in the Emergency Room (ER), but its prognostic value has never been studied in the prehospital setting. Methods: A retrospective study was performed on the charts of all patients taken care of by a physician-staffed prehospital mobile unit between June 2016 and September 2019 in Geneva. After approval by the ethics committee, charts were screened to identify all adult patients with a diagnosis of AHF. The main predictor was prehospital hypercapnia. The primary outcome was admission rate in an acute care unit (ACU, composite of intensive care or high-dependency units). Secondary outcomes were ER length of stay (LOS), orientation from ER (intensive care unit, high-dependency unit, general ward, discharge home), intubation rate at 24 hours, hospital LOS and hospital mortality. Results: A total of 104 patients with a diagnosis of AHF were included. Hypercapnia was found in 59 (57%) patients and vital signs were more severely altered in this group. The overall ACU admission rate was 47%, with a statistically significant difference between hypercapnic and non-hypercapnic patients (58% vs 33% respectively, p=0.014). ER LOS was shorter in hypercapnic patients (5.5 hours vs 8.9 hours, p=0.008). Conclusions: There is a significant association between prehospital arterial hypercapnia and acute care unit admission in AHF patients. Trial Registration:This study was approved on 20.08.2019 by the institutional ethics committee of Geneva, Switzerland (Project ID 2019-01559)

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816 Managing Acute Appendicitis During the First Wave of the COVID-19 Pandemic: A Single-Centre Retrospective Study

British Journal of Surgery ◽

10.1093/bjs/znab259.478 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Lotfallah ◽

A Aamery ◽

G Moussa

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Statistical Significance ◽

Length Of Hospital Stay ◽

Interquartile Range ◽

Secondary Outcome ◽

Complication Rates ◽

Alvarado Score ◽

Significant Difference

Abstract Introduction The COVID-19 pandemic provoked a change to normal surgical practice and led to a higher proportion of acute appendicitis (AA) patients being treated conservatively with antibiotics. We aim to analyse patients presenting with AA during the first wave of the pandemic, comparing surgically and conservatively managed patients. Method All patients presenting to our centre with AA between March and July 2020 were included. Six-month follow-up data was collected retrospectively using electronic records. Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcome was length of hospital stay. Results Fifty-seven patients (n = 57) were admitted with AA, 45.6% (n = 26) managed conservatively compared to 54.4% (n = 31) treated surgically. Higher complication rates were observed amongst the conservatively managed group, although not statistically significant (16% vs 35%; p = 0.131). There was no significant difference in length of hospital stay observed between the two groups (surgical: median, 2; interquartile range, 2-3 vs conservative: median, 3; interquartile range, 2-4). White cell count (WCC) and Alvarado score were higher on admission in the surgical group with statistical significance (p = 0.012 and p = 0.028 respectively). Conclusions Stratification criteria, such as Alvarado score and WCC may identify patients more suitable for conservative management. Longer term follow-up will be carried out, which may alter complication rates in either group. We suggest all patients treated conservatively should undergo computerised tomography (CT) to exclude complicated appendicitis. Further UK-based studies will add to the evidence-base surrounding management of AA during the COVID-19 pandemic.

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