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Predicting complicated appendicitis based on clinical findings: the role of Alvarado and Appendicitis Inflammatory Response scores.
Haak, F; Kollmar, O; Ioannidis, A; Slotta, J E; Ghadimi, M B; Glass, T; von Strauss Und Torney, M.
Affiliation
  • Haak F; Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Spitalstrasse 21, 4031, Clarunis Basel, Switzerland.
  • Kollmar O; Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Spitalstrasse 21, 4031, Clarunis Basel, Switzerland.
  • Ioannidis A; Department of General, Visceral and Pediatric Surgery, University Medical Center, Goettingen, Goettingen, Germany.
  • Slotta JE; Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Spitalstrasse 21, 4031, Clarunis Basel, Switzerland.
  • Ghadimi MB; General, Visceral and Transplantation Surgery, Westpfalz Klinikum, Kaiserslautern, Germany.
  • Glass T; Department of General, Visceral and Pediatric Surgery, University Medical Center, Goettingen, Goettingen, Germany.
  • von Strauss Und Torney M; Department of General, Visceral and Pediatric Surgery, University Medical Center, Goettingen, Goettingen, Germany.
Langenbecks Arch Surg ; 407(5): 2051-2057, 2022 Aug.
Article de En | MEDLINE | ID: mdl-35543821
ABSTRACT

PURPOSE:

The pre-interventional differentiation between complicated and uncomplicated appendicitis is decisive for treatment. In the context of conservative therapy, the definitive diagnosis of uncomplicated appendicitis is mandatory. This study investigates the ability of clinical scoring systems and imaging to differentiate between the two entities.

METHODS:

This is a retrospective analysis of two cohorts from two tertiary referral centers in Switzerland and Germany. All consecutive patients underwent appendectomy between January 2008 and April 2013 (in the first cohort) or between January 2017 and June 2019 (the second cohort). Exclusion criteria did not apply as all patients found by the database search and received an appendectomy were included. Diagnostic testing and calculation of a receiver operating curve were performed to identify a cutoff for clinical scores that resulted in a minimum sensitivity of 90% to detect complicated appendicitis. The cutoff was combined with additional diagnostic imaging criteria to see if diagnostic properties could be improved.

RESULTS:

Nine hundred fifty-six patients were included in the analysis. Two hundred twenty patients (23%) had complicated appendicitis, and 736 patients (77%) had uncomplicated appendicitis or no inflammation. The complicated appendicitis cohort had a mean Alvarado score of 7.03 and a mean AIR of 5.21. This compared to a mean Alvarado of 6.53 and a mean AIR of 4.07 for the uncomplicated appendicitis cohort. The highest Alvarado score with a sensitivity of > 90% to detect complicated appendicitis was ≧ 5 (sensitivity = 95%, specificity 8.99%). The highest AIR score with a sensitivity of > 90% to detect complicated appendicitis was ≧ 3 (sensitivity 91.82%, specificity 18.53). The analysis showed that additional CT information did not improve the sensitivity of the proposed cut-offs.

CONCLUSION:

AIR and Alvarado scores showed limited capability to distinguish between complicated and uncomplicated appendicitis even with additional imaging in this retrospective cohort. As conservative management of appendicitis needs to exclude patients with complicated disease reliably, appendectomy seems until now to remain the safest option to prevent undertreatment of this mostly benign disease.
Sujet(s)
Mots clés

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Appendicite Type d'étude: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limites: Humans Langue: En Journal: Langenbecks Arch Surg Année: 2022 Type de document: Article Pays d'affiliation: Suisse

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Appendicite Type d'étude: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limites: Humans Langue: En Journal: Langenbecks Arch Surg Année: 2022 Type de document: Article Pays d'affiliation: Suisse