Incidence, demographics, and outcomes of nonoperative management of appendicitis in the United States.

BACKGROUND: Appendicitis is the most common intraabdominal surgical emergency in the United States, with over 250,000 cases each year. Several recent studies have evaluated the efficacy of nonoperative management of appendicitis. We measured changes in the treatment of appendicitis in the United States from 1998 to 2014 and evaluated outcomes in the contemporary cohort of appendicitis cases from 2010 to 2014. METHODS: The National Inpatient Sample was queried for cases with a principal diagnosis of appendicitis. Cases with peritoneal abscesses were excluded. We determined trends in management and then compared cases managed nonoperatively versus those managed with early operation for demographics and outcomes including mortality, total charges, and length of stay using univariate analysis, binary logistic regression analysis, and case-control matching. RESULTS: Although early operation remains the dominant treatment for acute appendicitis in the United States, there is an accelerating trend in nonoperative management. Nonoperative management is associated with increased age, number of comorbidities, and inpatient diagnoses. In univariate, multiple regression, and case-control analysis, nonoperative management is associated with decreased total charges but significantly increased risk of mortality. CONCLUSIONS: Elderly patients and patients with medical comorbidities are more likely to be treated nonoperatively for appendicitis than younger patients. Although previously published data support nonoperative management of appendicitis in low-risk surgical patients, we suggest that elderly or medically complex patients may benefit from early operative treatment of appendicitis and are potentially at risk of poor outcomes from nonoperative management.

Surgeon-performed focused assessment with sonography for trauma as an early screening tool for pregnancy after trauma.

BACKGROUND: Incidental pregnancy in trauma patients is associated with a high fetal mortality. Because of quality assurance reasons, many trauma centers have eliminated the rapid urine pregnancy screen. We sought to determine the utility and impact of the initial ultrasound examination in the diagnosis of pregnancy in female trauma patients. METHODS: Data were analyzed for all female trauma patients in whom pregnancy was diagnosed during a 5-year period. RESULTS: One hundred one (70%) of 144 pregnant women had an initial ultrasound examination. Eighteen patents had newly diagnosed pregnancies, of whom 8 of 9 patients (89%) at > or = 8 weeks' gestation were diagnosed by the initial ultrasound. This directly contributed to a significant decrease in the amount of radiation exposure (p < 0.001) compared with patients diagnosed by serum beta-human chorionic gonadotropin. CONCLUSION: An initial ultrasound examination should be considered in all female trauma patients of reproductive age. This may help to promote a reduction in fetal radiation exposure.