acute appendicitis
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2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Dai Su ◽  
Qinmengge Li ◽  
Tao Zhang ◽  
Philip Veliz ◽  
Yingchun Chen ◽  
...  

Abstract Background Early screening and accurately identifying Acute Appendicitis (AA) among patients with undifferentiated symptoms associated with appendicitis during their emergency visit will improve patient safety and health care quality. The aim of the study was to compare models that predict AA among patients with undifferentiated symptoms at emergency visits using both structured data and free-text data from a national survey. Methods We performed a secondary data analysis on the 2005-2017 United States National Hospital Ambulatory Medical Care Survey (NHAMCS) data to estimate the association between emergency department (ED) patients with the diagnosis of AA, and the demographic and clinical factors present at ED visits during a patient’s ED stay. We used binary logistic regression (LR) and random forest (RF) models incorporating natural language processing (NLP) to predict AA diagnosis among patients with undifferentiated symptoms. Results Among the 40,441 ED patients with assigned International Classification of Diseases (ICD) codes of AA and appendicitis-related symptoms between 2005 and 2017, 655 adults (2.3%) and 256 children (2.2%) had AA. For the LR model identifying AA diagnosis among adult ED patients, the c-statistic was 0.72 (95% CI: 0.69–0.75) for structured variables only, 0.72 (95% CI: 0.69–0.75) for unstructured variables only, and 0.78 (95% CI: 0.76–0.80) when including both structured and unstructured variables. For the LR model identifying AA diagnosis among pediatric ED patients, the c-statistic was 0.84 (95% CI: 0.79–0.89) for including structured variables only, 0.78 (95% CI: 0.72–0.84) for unstructured variables, and 0.87 (95% CI: 0.83–0.91) when including both structured and unstructured variables. The RF method showed similar c-statistic to the corresponding LR model. Conclusions We developed predictive models that can predict the AA diagnosis for adult and pediatric ED patients, and the predictive accuracy was improved with the inclusion of NLP elements and approaches.


2022 ◽  
pp. 000313482110540
Author(s):  
Jae Hee Cho ◽  
M Jason Akers ◽  
Mehrnaz Siavoshi ◽  
Todd Gress ◽  
Errington C Thompson

Background: The purpose of this study is to investigate the relevant findings in adult patients admitted to Cabell Huntington Hospital who were diagnosed with acute appendicitis. Methods: Patients who had the postoperative diagnosis of acute appendicitis and a preoperative computed tomography (CT) scan from January 2011 through December 2016 were included in this retrospective chart review. Results: There were 592 patients. A thick, edematous appendix was the most common CT finding in acute appendicitis. The average diameter was 12.6 mm. The wall thickness correlated to the diameter of the appendix ( P < 0.001). For comparison, we reviewed the CT scans of 50 trauma patients who had normal abdominal CT scans. The average diameter of a normal appendix was 4.9 mm (SD 1.139) with a range of 4-7 mm. Interestingly, the admission white blood cell count ( P = 0.0372) as well as the thickness of the appendix ( P < 0.0001) were strongly associated with increased length of stay. Conclusions: An appendiceal diameter greater than 9 mm should be considered abnormal and associated with acute appendicitis. Appendiceal size, white blood cell count, and age correlate with length of stay. Early antibiotics and early surgical intervention may decrease length of stay.


2022 ◽  
Author(s):  
Eszter Mán ◽  
Zsolt Simonka ◽  
Ferenc Rárosi ◽  
Zoltán Pető ◽  
András Szilágyi ◽  
...  

Abstract BackgroundThe aim of our prospective study was to confirm the validity, diagnostic accuracy of the modified Alvarado score developed in the Department of Surgery, University of Szeged.Methods138 patients were enrolled in our study between 01 January 2019 and 01 January 2020. The patient’s modified Alvarado score was calculated in the Emergency Department before surgical consultation and decision of further therapy. The score was validated based on the final histology finding of the removed appendix. Additionally, potential correlation was examined between the frequency of drain usage, hospital stay, antibiotic use and the severity of the inflammation. ResultsComparing the scores with the histological findings, specificity of the modified Alvarado score was 84.78%, its sensitivity was 97.83% (with cutoff value of 5.5). Spearman's rank correlation (0.796) and ROC analysis (area under the curve 0.968) confirmed that the modified Alvarado score has an excellent predictive value in the diagnosis of acute appendicitis. Based on the result of the Fisher's exact test, cross tabulation and Spearman’s rank correlation correlation was found between the severity of the inflammation determined by the histology finding, the selected antibiotic and the duration of the antibiotic therapy, the average duration of hospitalization and drain insertion. ConclusionsBased on the results of our study, predictive value of the new, modified score system is excellent, using this score system is safe in the differential diagnosis of acute appendicitis as an aid for non-surgical consultants in emergency care. This new score system may decrease the number of unnecessary surgical consultations, decrease waiting time of the patients and some unnecessary examinations can be avoided. Trial RegistrationValidation of the modified Alvarado score in patients presenting in the Emergency Department with right lower abdominal complaints, ethical license number: 248/2018/SZTE, date of registration: 2018.11.04., name of ethics committee: SZTE SZAKK Regionális és Intézményi Humán Orvosbiológiai Kutatásetikai Bizottság- Clinical Research Coordination Office of the University of Szeged


Endoscopy ◽  
2022 ◽  
Author(s):  
Baohong Yang ◽  
Lingjian Kong ◽  
Ullah Saif ◽  
Lixia Zhao ◽  
Dan Liu ◽  
...  

Background and study aims: To assess the efficacy and clinical outcomes of endoscopic retrograde appendicitis therapy (ERAT) versus laparoscopic appendectomy (LA) for patients with uncomplicated acute appendicitis (AA). Patients and methods: We adopted propensity score matching (1:1) to compare ERAT and LA patients with uncomplicated AA from April 2017 to March 2020. We reviewed a total of 2880 patients with suspected acute appendicitis, of whom 422 patients with uncomplicated AA met the matching criteria (ERAT, 79; LA, 343), yielding 78 pairs of patients. Results: The rate of curative treatment within one year after ERAT was 92.1%; 95% CI, [83.8% - 96.3%]. The percentage of Visual Analog Scale (VAS) ≤ 3 at six hours after treatment was 94.7%; 95% CI [87.2% - 97.9%] in the ERAT group, and significantly higher than that in the LA group 83.3%; 95% CI [73.5% - 90.0%]. Median operative/procedure time and median hospital length of stay in the ERAT group were significantly lower compared to the LA group. At one year, the median recurrence time was 50 days (IQRs, 25-127) in the ERAT group. The overall adverse event rate was 24.3%; 95% CI [14.8% - 33.9%] in the LA group and 18.4%; 95% CI [9.7% - 27.1%] in the ERAT group, with no significant difference between the two groups. Conclusions: ERAT is a technically feasible method to treat uncomplicated AA compared to LA.


2022 ◽  
Author(s):  
Vishal P. Bhabhor

Appendicitis is one of the most common causes of acute abdomen with life time risk between 6 and 8% and it’s a most common non obstetric surgical emergency during pregnancy. Appendicitis is claimed to be unknown in the villages of India and China in paper by A. M. Spencer. The reason is simply due to the fact that diagnostic facilities do not exist and cases are not recognized. So diagnosing acute appendicitis accurately and efficiently can reduce morbidity and mortality from perforation and other complications. Surgical intervention is the first choice for appendicitis with medical management being reserved for special situations.


Author(s):  
Tahereh Bakhshandeh ◽  
Abdulbaset Maleknejad ◽  
Narges Sargolzaie ◽  
Amin Mashhadi ◽  
Mohadeseh Zadehmir

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