Latest & greatest articles for appendicitis

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Appendicitis

Appendicitis is an inflammation of the appendix. Both children and adults can suffer from appendicitis. If untreated the appendix can perforate, causing the release of infectious material in the body, which can be life threatening.

Symptoms and causes of appendicitis

Common symptoms of appendicitis include sharp pain in the abdomen, loss of appetite, fever, severe cramps, diarrhoea and nausea.

It is believed that the main cause of appendicitis is an obstruction of the appendix. The blockage can eventually lead to necrosis giving bacteria and opportunity to cause infection. The blockages is typically calcified faecal deposits.

Diagnosis is typically based on a clinical examination and this can be supported by ultrasound and/or CT scan.

Typically the main cure for an appendicitis has been surgery, but more recently other interventions – namely antibiotics have been tried.

The evidence base, clinical trials, studies etc.

Experts have believed for a long time that the appendix has little purpose in the human body as it shows no negative affects to the body once removed, thus the human body can function perfectly fine without it. However, extensive appendicitis research concludes that the appendix protects good bacteria in the gut. Clinical trials and case studies are ongoing to help understand appendicitis.

Trip is an excellent source of evidence around appendicitis including clinical guidelines, systematic reviews, randomised controlled trials, case studies etc. These can easily be found via a search of the site.

Top results for appendicitis

1. Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting

Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting The pediatric Appendicitis Risk Calculator (pARC) is a validated clinical tool for assessing a child's probability of appendicitis. Our objective was to assess the performance of the pARC in community emergency departments (EDs) and to compare its performance with that of the Pediatric Appendicitis Score (PAS).We conducted a prospective validation study from October 1, 2016, to April 30 (...) , 2018, in 11 community EDs serving general populations. Patients aged 5 to 20.9 years and with a chief complaint of abdominal pain and less than or equal to 5 days of right-sided or diffuse abdominal pain were eligible for study enrollment. Our primary outcome was the presence or absence of appendicitis within 7 days of the index visit. We reported performance characteristics and secondary outcomes by pARC risk strata and compared the receiver operator characteristic (ROC) curves of the PAS

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2019 EvidenceUpdates

2. Effects of a Patient Activation Tool on Decision Making Between Surgery and Nonoperative Management for Pediatric Appendicitis: A Randomized Clinical Trial

Effects of a Patient Activation Tool on Decision Making Between Surgery and Nonoperative Management for Pediatric Appendicitis: A Randomized Clinical Trial Strategies to activate and engage patients and caregivers in shared decision making in the acute care setting may result in improved outcomes.To determine whether a patient activation tool (PAT) can improve decision-making and patient-centered outcomes among pediatric patients and their caregivers who choose between surgery and nonoperative (...) management for their child's appendicitis.This single-blind, randomized clinical trial collected data from a single tertiary children's hospital from March 1, 2014, through April 30, 2016, with 1-year follow-up completed on May 1, 2017. Two hundred of 236 eligible children and adolescents aged 7 to 17 years with uncomplicated appendicitis enrolled with their caregivers. After receiving the randomized clinical intervention, caregivers chose surgery or nonoperative management. Data were analyzed from March

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2019 EvidenceUpdates

3. Diagnostic performance of emergency physician-performed point-of-care ultrasonography for acute appendicitis: A meta-analysis

Diagnostic performance of emergency physician-performed point-of-care ultrasonography for acute appendicitis: A meta-analysis To assess the sensitivity and specificity of emergency physician-performed point-of-care ultrasonography (EP-POCUS) for diagnosing acute appendicitis (AA).The PubMed and EMBASE databases were searched, and the diagnostic performance of EP-POCUS was evaluated using bivariate modeling and hierarchical summary receiver operating characteristic curves. Subgroup analysis

2019 EvidenceUpdates

4. Assessment of proadrenomedullin as diagnostic or prognostic biomarker of acute appendicitis in children with acute abdominal pain

Assessment of proadrenomedullin as diagnostic or prognostic biomarker of acute appendicitis in children with acute abdominal pain Acute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics.To investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA.Prospective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological

2019 EvidenceUpdates

5. Antibiotics may be an alternative first-line treatment for uncomplicated appendicitis

Antibiotics may be an alternative first-line treatment for uncomplicated appendicitis Antibiotics may be an alternative first-line treatment for uncomplicated appendicitis Discover Portal Discover Portal Antibiotics may be an alternative first-line treatment for uncomplicated appendicitis Published on 22 January 2019 doi: Appendicectomy surgery could potentially be avoided for around 60% of adults with uncomplicated appendicitis if they receive antibiotics first. Adults in Finland (...) with appendicitis were randomised to have appendicectomy or a course of antibiotics. In 6 out of 10 the appendicitis settled and did not return over the five years they were followed. Of those who did go on to need surgery most did so in the first year. If the findings from the study could be applied to the UK, it is estimated that up to 24,000 appendicectomies might be avoided in England each year. In the UK, appendicitis is usually managed by appendicectomy, so shifting to antibiotic therapy as a first choice

2019 NIHR Dissemination Centre

6. Suspected Appendicitis?Child

Suspected Appendicitis?Child New 2018 ACR Appropriateness Criteria ® 1 Suspected Appendicitis–Child American College of Radiology ACR Appropriateness Criteria ® Suspected Appendicitis–Child Variant 1: Child. Suspected acute appendicitis, low clinical risk. Initial imaging. Procedure Appropriateness Category Relative Radiation Level CT abdomen and pelvis with IV contrast Usually Not Appropriate ?? ?? CT abdomen and pelvis without and with IV contrast Usually Not Appropriate ?? ?? ? CT abdomen (...) and pelvis without IV contrast Usually Not Appropriate ?? ?? MRI abdomen and pelvis without and with IV contrast Usually Not Appropriate O MRI abdomen and pelvis without IV contrast Usually Not Appropriate O US abdomen Usually Not Appropriate O US abdomen RLQ Usually Not Appropriate O US pelvis Usually Not Appropriate O Radiography abdomen Usually Not Appropriate ?? Variant 2: Child. Suspected acute appendicitis, intermediate clinical risk. Initial imaging. Procedure Appropriateness Category Relative

2019 American College of Radiology

7. Risk of Appendiceal Neoplasm in Periappendicular Abscess in Patients Treated With Interval Appendectomy vs Follow-up With Magnetic Resonance Imaging: 1-year Outcomes of the Peri-Appendicitis Acuta Randomized Clinical Trial

Risk of Appendiceal Neoplasm in Periappendicular Abscess in Patients Treated With Interval Appendectomy vs Follow-up With Magnetic Resonance Imaging: 1-year Outcomes of the Peri-Appendicitis Acuta Randomized Clinical Trial The step after conservative treatment of periappendicular abscess arouses controversy, ranging from recommendations to abandon interval appendectomy based on low recurrence rates of the precipitating diagnosis to performing routine interval appendectomy owing to novel (...) findings of increased neoplasm risk at interval appendectomy. To our knowledge, there are no randomized clinical trials with sufficient patient numbers comparing these treatments.To compare interval appendectomy and follow-up with magnetic resonance imaging after initial successful nonoperative treatment of periappendicular abscess.The Peri-Appendicitis Acuta randomized clinical trial was a multicenter, noninferiority trial conducted in 5 hospitals in Finland. All patients between age 18 and 60 years

2019 EvidenceUpdates

8. Laparoscopic versus open surgery for suspected appendicitis. (PubMed)

Laparoscopic versus open surgery for suspected appendicitis. The removal of the acute appendix is one of the most frequently performed surgical procedures. Open surgery associated with therapeutic efficacy has been the treatment of choice for acute appendicitis. However, in consequence of the evolution of endoscopic surgery, the operation can also be performed with minimally invasive surgery. Due to smaller incisions, the laparoscopic approach may be associated with reduced postoperative pain

2018 Cochrane

9. What Is the Diagnostic Accuracy of Magnetic Resonance Imaging for Acute Appendicitis?

What Is the Diagnostic Accuracy of Magnetic Resonance Imaging for Acute Appendicitis? TAKE-HOME MESSAGE Magnetic resonance imaging (MRI) is highly sensitive (96%) and speci?c (96%) for the diagnosis of acute appendicitis; subgroup analyses of children and pregnant women demonstrate similarly high diagnostic accuracy. What Is the Diagnostic Accuracy of Magnetic Resonance Imaging for Acute Appendicitis? EBEM Commentators Michael D. April, MD, DPhil Brit Long, MD Department of Emergency Medicine (...) San Antonio Uniformed Services Health Education Consortium San Antonio, TX Results The authors included 30 studies with 2,665 patients. Of these, 12 focused on pregnant patients and 8 focused on pediatric patients. There was variability in the MRI techniquestudied,althoughnearly all studies included a combination of multiplanar T2-weighted imag- ing with and without fat suppres- sion. The overall prevalence of appendicitis in the 30 included studies was 33% (880/2,665 pa- tients). The meta

2018 Annals of Emergency Medicine Systematic Review Snapshots

10. Right Lower Quadrant Pain : Suspected Appendicitis

Right Lower Quadrant Pain : Suspected Appendicitis Revised 2018 ACR Appropriateness Criteria ® 1 Right Lower Quadrant Pain–Suspected Appendicitis American College of Radiology ACR Appropriateness Criteria ® Right Lower Quadrant Pain-Suspected Appendicitis Variant 1: Right lower quadrant pain, fever, leukocytosis. Suspected appendicitis. Initial imaging. Procedure Appropriateness Category Relative Radiation Level CT abdomen and pelvis with IV contrast Usually Appropriate ??? CT abdomen (...) : Right lower quadrant pain, fever, leukocytosis. Possible appendicitis. Atypical presentation. Initial imaging. Procedure Appropriateness Category Relative Radiation Level CT abdomen and pelvis with IV contrast Usually Appropriate ??? CT abdomen and pelvis without IV contrast May Be Appropriate ??? US abdomen May Be Appropriate O US pelvis May Be Appropriate O MRI abdomen and pelvis without and with IV contrast May Be Appropriate O MRI abdomen and pelvis without IV contrast May Be Appropriate O CT

2018 American College of Radiology

11. Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. (PubMed)

Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. Short-term results support antibiotics as an alternative to surgery for treating uncomplicated acute appendicitis, but long-term outcomes are not known.To determine the late recurrence rate of appendicitis after antibiotic therapy for the treatment of uncomplicated acute appendicitis.Five-year observational follow-up of patients in the Appendicitis Acuta (APPAC) multicenter (...) randomized clinical trial comparing appendectomy with antibiotic therapy, in which 530 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were randomized to undergo an appendectomy (n = 273) or receive antibiotic therapy (n = 257). The initial trial was conducted from November 2009 to June 2012 in Finland; last follow-up was September 6, 2017. This current analysis focused on assessing the 5-year outcomes for the group of patients treated with antibiotics

2018 JAMA Controlled trial quality: predicted high

12. Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis (PubMed)

Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis The traditional fear that every case of acute appendicitis will eventually perforate has led to the generally accepted emergency appendicectomy with minimized delay. However, emergency and thereby sometimes night-time surgery is associated with several drawbacks, whereas the consequences of surgery after limited delay are unclear. This systematic review aimed to assess (...) in-hospital delay before surgery as risk factor for complicated appendicitis and postoperative morbidity in patients with acute appendicitis.PubMed and EMBASE were searched from 1990 to 2016 for studies including patients who underwent appendicectomy for acute appendicitis, reported in two or more predefined time intervals. The primary outcome measure was complicated appendicitis after surgery (perforated or gangrenous appendicitis); other outcomes were postoperative surgical-site infection and morbidity

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2018 EvidenceUpdates

13. Appendicitis

Appendicitis Top results for appendicitis - Trip Database or use your Google+ account Turning Research Into Practice ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search button. An example search might look like (#1 or #2 (...) ) and (#3 or #4) Loading history... Population: Intervention: Comparison: Outcome: Population: Intervention: Latest & greatest articles for appendicitis The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms

2018 Trip Latest and Greatest

14. Bedside Sonography Performed by Emergency Physicians to Detect Appendicitis in Children

Bedside Sonography Performed by Emergency Physicians to Detect Appendicitis in Children The aim of this study was to evaluate the ability of emergency physicians with various levels of point-of-care ultrasound (POCUS) experience to detect appendicitis with POCUS among children visiting a pediatric emergency department (ED).A prospective cohort study was conducted in an urban, tertiary care pediatric ED. Children aged 2 to 18 years old who presented with acute abdominal pain suggesting (...) appendicitis were included. Patients were excluded if they had a history of appendectomy or hemodynamic instability requiring resuscitation or were transferred with proven diagnosis of appendicitis. Participating physicians had various levels of POCUS experience. Four of the 22 physicians were experienced in bowel sonography while the others had basic experience in abdominal POCUS. All the participating physicians received a 1-hour didactic and practical training session on appendix ultrasound

2018 EvidenceUpdates

15. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. (PubMed)

Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer from postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated (...) appendicitis is controversial.This is an update of the review first published in 2015.To assess the safety and efficacy of abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 6), Ovid MEDLINE (1946 to 30 June 2017), Ovid Embase (1974 to 30 June 2017), Science Citation Index Expanded (1900 to 30 June 2017), World Health Organization International

2018 Cochrane

16. Acute appendicitis

Acute appendicitis Acute appendicitis - Symptoms, diagnosis and treatment | BMJ Best Practice   Search  Acute appendicitis Last reviewed: February 2019 Last updated: June 2018 Summary Acute inflammation of the vermiform appendix. Typically presents as acute abdominal pain starting in the mid-abdomen and later localising to the right lower quadrant. Associated with fever, anorexia, nausea, vomiting, and elevation of the neutrophil count. Diagnosis is usually made clinically. If investigation (...) is required, CT scan or ultrasonography may show dilatation of the appendix outer diameter to more than 6 mm. Definitive treatment is surgical appendectomy. Definition Acute appendicitis is an acute inflammation of the vermiform appendix, Fitz RH. Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment. Am J Med Sci. 1886;92:321-346. most likely due to obstruction of the lumen of the appendix (by faecolith, normal stool, infective agents, or lymphoid

2018 BMJ Best Practice

17. Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis

Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis Uncomplicated appendicitis may resolve spontaneously or require treatment with antibiotics or appendicectomy. The aim of this randomized trial was to compare the outcome of a non-antibiotic management strategy with that of antibiotic therapy in uncomplicated appendicitis.Patients presenting to a university teaching hospital with CT-verified uncomplicated simple appendicitis (appendiceal diameter no larger than 11 mm (...) and without any signs of perforation) were randomized to management with a no-antibiotic regimen with supportive care (intravenous fluids, analgesia and antipyretics as necessary) or a 4-day course of antibiotics with supportive care. The primary endpoint was rate of total treatment failure, defined as initial treatment failure within 1 month and recurrence of appendicitis during the follow-up period.Some 245 patients were randomized within the trial, and followed up for a median of 19 months

2017 EvidenceUpdates

18. Comparison of Superficial Surgical Site Infection Between Delayed Primary Versus Primary Wound Closure in Complicated Appendicitis: A Randomized Controlled Trial

Comparison of Superficial Surgical Site Infection Between Delayed Primary Versus Primary Wound Closure in Complicated Appendicitis: A Randomized Controlled Trial To compare superficial surgical site infection (SSI) rates between delayed primary wound closure (DPC) and primary wound closure (PC) for complicated appendicitis.SSI is common in appendectomy for complicated appendicitis. DPC is preferentially used over PC, but its efficacy is still controversial.A multicenter randomized controlled (...) trial was conducted in 6 hospitals in Thailand, enrolling patients with gangrenous and ruptured appendicitis. Patients were randomized to PC (ie, immediately wound closure) or DPC (ie, wound closure at postoperative days 3-5). Superficial SSI was defined by the Center for Disease Control criteria. Secondary outcomes included postoperative pain, length of stay, recovery time, quality of life, and cost of treatment.In all, 303 and 304 patients were randomized to PC and DPC groups, and 5 and 4 patients

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2017 EvidenceUpdates

19. Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis

Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis The role of imaging in the diagnosis of appendicitis is controversial. This prospective interventional study and nested randomized trial analysed the impact of implementing a risk stratification algorithm based on the Appendicitis Inflammatory Response (AIR) score, and compared routine imaging with selective imaging after clinical reassessment.Patients presenting (...) with suspicion of appendicitis between September 2009 and January 2012 from age 10 years were included at 21 emergency surgical centres and from age 5 years at three university paediatric centres. Registration of clinical characteristics, treatments and outcomes started during the baseline period. The AIR score-based algorithm was implemented during the intervention period. Intermediate-risk patients were randomized to routine imaging or selective imaging after clinical reassessment.The baseline period

2017 EvidenceUpdates

20. There is insufficient evidence to consider non-operative treatment of uncomplicated acute appendicitis.

There is insufficient evidence to consider non-operative treatment of uncomplicated acute appendicitis. Tratamiento con antibióticos de la apendicitis aguda no complicada: aún en fase experimental - Evidencias en pediatría Buscando, por favor espere. Mostrar menú Gestión de biblioteca Aún no ha añadido ningún artículo a su biblioteca. | Buscar Toma de decisiones clínicas basadas en pruebas científicas Toma de decisiones clínicas basadas en pruebas científicas Mostrar menú Gestión de biblioteca (...) Críticamente Georgiou R, Eaton S, Stanton MP, Pierro A, Hall NJ. Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis. Revisores: Cuestas Montañés E 1 , Aparicio Rodrigo M 2 . 1 Servicio de Pediatría y Neonatología. Hospital Privado. Centro Formador. Facultad de Ciencias Médicas. Universidad Nacional de Córdoba. Córdoba. Argentina. 2 CS Entrevías. Departamento de Pediatría. Facultad de Medicina. Universidad Complutense de Madrid. Madrid. España. Correspondencia: Eduardo

2017 Evidencias en Pediatría