Report of a Clinical Practice Guideline for Appendicitis

Abstract

Surgery| April 01 2005 Report of a Clinical Practice Guideline for Appendicitis AAP Grand Rounds (2005) 13 (4): 43–44. https://doi.org/10.1542/gr.13-4-43 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Report of a Clinical Practice Guideline for Appendicitis. AAP Grand Rounds April 2005; 13 (4): 43–44. https://doi.org/10.1542/gr.13-4-43 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: appendicitis, clinical practice guideline Source: Smink DS, Finkelstein JA, Garcia Peña BM, et al. Diagnosis of acute appendicitis in children using a clinical practice guideline. J Pediatr Surg. 2004;39:458–463. A multidisciplinary team of surgeons, emergency medicine physicians, radiologists, and nurses at Children’s Hospital Boston developed a clinical practice guideline (CPG) for the diagnosis and management of acute appendicitis. Appendicitis demands prompt attention and treatment because of its natural progression to perforation. Lacking the perfect diagnostic test, many clinicians have turned their attention to detailed radiologic testing, ranging from ultrasound to computerized tomography (CT) scanning. The authors performed a retrospective cohort study at the Children’s Hospital Boston to evaluate their CPG for acute appendicitis for diagnostic accuracy in children 4 years and older. Patients managed using the CPG during 2001 were compared to children evaluated for acute appendicitis at their institution during 1997 (a period prior to most of the clinical trials using newer radiographic techniques for the diagnosis of appendicitis). Emergency department (ED) staff initially evaluated children and, if acute appendicitis was considered in the differential diagnosis, a surgical consult was obtained prior to ordering radiological studies. Surgical evaluations were performed by PGY 4 or higher surgery residents with supervision of the pediatric surgery attending. Approximately 10% of patients had classic history and physical findings of acute appendicitis and were operated upon acutely. The remaining 90% of patients were further evaluated by CT scan (with rectal and intravenous contrast) or ultrasound. The results of these studies determined whether the patient was managed with surgical or nonsurgical treatment. Those children without evidence of appendicitis on clinical or radiological examinations were discharged from the ED. The study group in 2001 included 571 patients with a mean age of 11.8 years (range 4–21) compared with a total of 388 from the control group in 1997 (mean age 11.4, range 4–22). There were 272 appendectomies in the 2001 group (48%) of which 15 (5.5%) were negative, and 255 appendectomies in the 1997 group (66%) of which 27 (10.6%) were negative (P=.03). Perforation rates were similar in the 2 groups of patients (22.2% among those managed with the CPG vs 28.5% in those in the 1997 group, P=.11). However, admissions for observation decreased dramatically from 143 (37%) in the 1997 group to 34 (6%) in the 2001 group (P<.001). The sensitivity and specificity of the CPG were measured at 98.8% (95% CI, 97.5–100%) and 95.2% (92.9–97.6%), respectively. The authors conclude that a multidisciplinary written CPG was useful in reducing negative appendectomies and admissions for serial examination. Dr. Cavett has disclosed no financial relationships relevant to this commentary. Acute appendicitis remains the most common surgical emergency in childhood, and any help in its early and accurate diagnosis would be of great benefit. An important component to this CPG is the use of focused appendiceal CT with colon contrast (FACT-CC). Recent articles state the radiation exposure from an abdominal CT can be the equivalent of 100–250 chest x-rays and that children... You do not currently have access to this content.