Lower Negative Appendectomy Rate Research Articles

Pathological Assessment of the Appendix in Appendectomies Performed in Children.

Acute appendicitis is known as the most common diagnosis of acute abdomen leading to surgery. Therefore, timely diagnosis is of special importance. This study was conducted with the aim of pathological assessment of the appendix in appendectomies performed in children to determine the rate of negative appendectomies and the predictors of negative appendectomy and to evaluate the paraclinical tools used in the diagnosis of acute appendicitis. This is a cross-sectional descriptive study. All children who underwent appendectomy at Shahid Motahari Hospital in Urmia from March 2021 to March 2022 were examined. The required data including demographic, paraclinical, and final pathology characteristics were collected and recorded. The investigated cases were classified into positive and negative appendectomy categories for comparison. Among 234 pathology samples of the appendix, 22 cases were related to accidental appendectomy. In addition, 11.3% of cases were negative appendectomy and 88.7% were positive appendectomy. The age range of 8 to 14 years and male gender were associated with a lower negative appendectomy rate (both P<0.001). Inflammatory (49.5%) and gangrenous appendicitis (30.2%) were the most commonly reported histopathologies. Sonography had a sensitivity of 84%, a specificity of 79%, and an overall diagnostic accuracy of 83%. A relatively significant number of accidental and negative appendectomies are performed. More careful investigation and the use of expectant and medical treatment instead of surgery, especially in females and young children, can be effective in improving diagnostic accuracy and preventing negative appendectomies.

Preoperative Imaging in the Diagnosis of Acute Appendicitis is Associated with Low Negative Appendectomy Rate

Preoperative Imaging in the Diagnosis of Acute Appendicitis is Associated with Low Negative Appendectomy Rate

The Introduction of Adult Appendicitis Score Reduced Negative Appendectomy Rate

Implementation of a clinical risk score into diagnostics of acute appendicitis may provide accurate diagnosis with selective use of imaging studies. The aim of this study was to prospectively validate recently described diagnostic scoring system, Adult Appendicitis Score, and evaluate its effects on negative appendectomy rate. Adult Appendicitis Score stratifies patients into three groups: high, intermediate, and low risk of appendicitis. The score was implemented in diagnostics of adult patients suspected of acute appendicitis in two university hospitals. We analyzed the effects of Adult Appendicitis Score on diagnostic accuracy, imaging studies, and treatment. The study population was compared with a reference population of 829 patients suspected of acute appendicitis originally enrolled for the study of construction of the Adult Appendicitis Score. This study enrolled 908 patients of whom 432 (48%) had appendicitis. The score stratified 49% of all appendicitis patients into high-risk group with specificity of 93.3%. In the low-risk group, prevalence of appendicitis was 7%. The histologically confirmed negative appendectomy rate decreased from 18.2% to 8.7%, p<0.001, compared to the original dataset. Adult Appendicitis Score is a reliable tool for stratification of patients into selective imaging, which results in low negative appendectomy rate.

Role of inflammatory markers in decreasing negative appendectomy rate: A study based on computed tomography findings.

This study aimed to investigate the role of inflammatory markers in decreasing negative appendectomy rate (NAR) based on their relation with findings of acute appendicitis (AA) on computed tomography (CT). Ninety-two patients who underwent CT examination with suspected AA were included. We investigated the relation between CT findings of AA and laboratory inflammatory markers and also performed receiver operating characteristic (ROC) analysis to calculate cut-off values of inflammatory markers and CT findings of AA. Appendectomy cases were re-evaluated considering cut-off values to make the operation decision and NAR was recalculated. Chi-squared test was used to compare the actual and recalculated NAR. Cut-off values of appendiceal diameter, appendiceal wall thickness, and caecal wall thickness were 7.9, 2, and 2.3 mm, respectively, for the diagnosis of AA. Cut-off values of WBC , NLR, and CRP on ROC analysis were 7.47, 4.06 and 13, respectively, for the diagnosis of AA. When the actual and recalculated NAR (21.9% versus 9.1%) were compared, the difference was found to be almost significant (p=0.058). Inflammatory markers are not sufficiently powerful on their own to accurately diagnose AA. However, particularly in equivocal cases, proposed cut-off values may be helpful for accurate diagnosis and a lower NAR can be achieved.

Misdiagnosing adult appendicitis: clinical, cost, and socioeconomic implications of negative appendectomy

BackgroundThe aim of this study was to evaluate the clinical, financial, and socioeconomic factors associated with negative appendectomy (NA). MethodsData were obtained from the California State Inpatient Database (2005 to 2011). Patients (≥18 years) who underwent nonincidental appendectomies (n = 180,958) were evaluated with multivariate regression analyses. ResultsNA rates decreased from 4.5% in 2005 to 2.8% in 2011 (P < .01). Compared with patients with nonperforated appendicitis, NA was associated with longer length of stay, higher morbidity, and higher hospital costs. Multivariate regression demonstrated that African Americans, younger age (18 to 29 years), and females were predictors of NA. Hispanics and patients with public or no insurance were associated with a lower NA rate; however, perforation rates were higher. ConclusionsNA was associated with higher cost, longer length of stay, and higher morbidity compared with nonperforated appendicitis. Lower NA rates but higher perforation rates in some populations suggest a delay in presentation. Further research is needed to understand these disparities and to improve quality of care among low-income minority patients.

Diagnostic imaging utilization in cases of acute appendicitis: multi-center experience.

The purpose of this cross-sectional study was to measure imaging utilization rates and the negative appendectomy rate (NAR) in metropolitan Seoul, Korea. The study included 2321 adolescents and adults (≥15 yr; median [interquartile range] age, 37 [27-50] yr; 46.7% female) undergoing appendectomy in 2011 at eight tertiary and three secondary hospitals. Imaging utilization rate was 99.7% (95% confidence interval, 99.4%-99.9%). CT and ultrasonography utilization rates as an initial imaging modality were 93.1% (92.0%-94.1%), and 6.5% (5.6%-7.6%), respectively. The NAR in patients undergoing CT only, complementary ultrasonography following CT, ultrasonography only, and complementary CT following ultrasonography were 3.3% (2.6%-4.1%), 27% (14%-44%), 9% (4%-16%), and 8% (2%-20%), respectively. The use of ultrasonography instead of CT as the initial imaging modality was significantly associated with higher NAR (adjusted odds ratio [AOR], 2.28 [1.22-4.27]; risk difference, 4.4 [0-8.8] percentage points), however, the population attributable risk was 0.3 [0-0.6] percentage points. We observed a very high CT utilization rate and a low NAR in metropolitan Seoul. Although the use of CT was significantly associated with the lower NAR, CT utilization rate already has reached the level that increase in CT utilization from the status quo would hardly decrease the NAR further.Graphical

Advanced Radiologic Imaging for Pediatric Appendicitis, 2005-2009: Trends and Outcomes

To examine the variability in the use of computed tomography (CT) and ultrasound (US) for children with appendicitis and identify associations with clinical outcomes, and to demonstrate any trends in diagnostic imaging between 2005 and 2009. This was a retrospective review of children evaluated for appendicitis in an emergency department between 2005 and 2009 using an administrative database of 40 pediatric institutions in the United States. Imaging utilization by institutions was studied for association with 3 clinical outcomes. A total of 55 238 children with appendicitis were studied. Utilization of CT and US varied widely across institutions, with medians of 34% (IQR, 21%-49%) for CT and 6% (IQR, 2%-26%) for US. Increased use of US or a combination of CT and US (but not of CT use alone) was associated with a lower negative appendectomy rate. Imaging was not associated with other clinical outcomes. In children with appendicitis, the use of US has increased since 2007, whereas that of CT has decreased. There is considerable variation in the use of CT and US for children with appendicitis at major pediatric institutions. At the institutional level, increased use of US or combined US and CT is associated with a lower negative appendectomy rate. Despite the better diagnostic accuracy of CT compared with US, the use of CT is decreasing.

Ultrasound, computed tomography, and laboratory findings in the diagnosis of appendicitis

To determine the diagnostic accuracy and the clinical impact of ultrasound (US) and computed tomography (CT) in diagnosing appendicitis, and to evaluate the impact of laboratory tests on the treatment of acute appendicitis. All patients who, during 2005, underwent an acute ultrasound or CT investigation due to suspected appendicitis, or were diagnosed and/or surgically treated for appendicitis at Umeå University Hospital, Umeå, were included. The type of radiological investigation, its findings, the choice of treatment, final diagnosis, C-reactive protein (CRP), leukocyte particle count (LPC), body temperature, age, and sex were recorded for each patient. The histological result from surgery was considered the gold standard. The material included 305 cases with an overall appendicitis prevalence of 58%. Fifty-two percent of the patients were female. The mean age was 29 years, with a total range of 2-94 years. Twenty percent (60/305) underwent a CT investigation, 40% (123/305) underwent an US investigation, 5% (14/305) underwent both a CT and an US investigation, and 35% (108/305) of patients did not undergo any radiological investigation at all. The sensitivities and specificities were 91% and 94% for CT, and 83% and 98% for US, respectively. The positive likelihood ratio was 15.1 and 45.5 for CT and US, and the negative likelihood ratio was 0.09 and 0.18 for CT and US, respectively. It was not possible to visualize the appendix in 31% of patients examined with US. The prevalence of appendicitis in this group was the same as the prevalence among patients where it was possible to see the appendix, i.e., 35%. The mean CRP for all patients with appendicitis was 59 (95% CI 10-491) mg/l, and the mean LPC was 11.1 (95% CI 2.6-28.1) x10(-9)/l. The mean LPC level was significantly higher for the appendicitis patients. Body temperature could not significantly verify or exclude appendicitis. The overall negative appendectomy rate was 9% (16/176), and it was higher in women, i.e., 11% (9/79). The negative appendectomy rate was slightly higher in the group that was examined by CT and/or US, i.e., 12% (8/69) compared to 7% (8/107) in the group not examined radiologically. Diagnostic accuracy was high for US as well as for CT. US was better for diagnosing positive findings, while CT was better for excluding diagnosis of appendicitis. The diagnostic accuracy of LPC, CRP, and body temperature was low. By combining findings from the radiological examination with the results from the clinical examination and laboratory values, a low negative appendectomy rate can be achieved.

Clinical guidelines, computed tomography scan, and negative appendectomies: a case series

Introduction Prior studies suggest that preoperative abdominal computed tomography (CT) scan can contribute to a low negative appendectomy rate. Our study objective was to evaluate cases of negative appendectomies for clinical criteria and CT use. Methods Retrospective 1-year study of all negative appendectomies at a community hospital. Data included clinical evidence for appendicitis as well as CT results if performed. Results Of 122 cases reviewed, 8 (6.6%) were negative appendectomies. Six were younger than 20 years. Four had a preoperative CT scan. Overall, 106 (87%) of 122 cases received preoperative CT and had a negative appendectomy rate of 3.8%. Sixteen cases did not have preoperative CT and had a negative appendectomy rate of 25% (odds ratio, 8.5; 95% confidence interval, 1.9-38.5; Fisher exact test P = .01). Conclusion Patients who had a CT scan for suspected appendicitis had a lower rate of negative appendectomies than those who had no CT. Most of the negative appendectomies occurred in patients younger than 20 years.

The Status of Appendiceal CT in an Urban Medical Center 5 Years After Its Introduction: Experience with 753 Patients

Appendiceal CT was introduced at our hospital in 1996 and now is used in most patients. The use of appendiceal CT has generated controversy and mixed results in various investigations. Our purpose was to determine the percentage of patients for whom CT was performed, incidence of appendicitis, accuracy of CT, percentage of equivocal interpretations, and negative appendectomy rates for those patients who did and did not undergo CT. Patient records from 2001 that included clinical or CT preoperative examination were analyzed, with follow-up through 2003. Patient age and sex, clinical presentation, CT techniques, CT interpretations, operative reports, pathology reports, and patient disposition were determined. Final diagnoses were provided by pathologic criteria, patient follow-up, or patient survey. Statistical analysis included Fisher's exact test and receiver operating characteristic (ROC) curves. Of 753 patients, 663 (88%) were examined on CT for suspected appendicitis and 90 had an appendectomy without undergoing CT. The incidence of appendicitis in the patients who underwent CT was 39.2%. The sensitivity and specificity of CT were 99% and 95%, respectively; the area under the ROC curve was 0.9896; and the percentage of equivocal CT interpretations was 3.3%. The false-negative appendectomy rates were 3.0% and 5.6% for patients with and without CT, respectively (for all patients, p = 0.326; for female pediatric patients, p = 0.030). Five years ago, the negative appendectomy rate dropped from 20% to 7%, and it is now 3.0%. The incidence of appendicitis in patients who are examined on CT is stable compared with similar cohorts from prior investigations. Patients who do not undergo CT also have a low negative appendectomy rate, but this relatively small group is selected on the basis of a convincing clinical presentation. Female pediatric patients likely would have a lower negative appendectomy rate with greater use of CT.

The Influence of Age and Gender on the Utility of Computed Tomography to Diagnose Acute Appendicitis

Few studies have examined the effects of age and gender on the utility of diagnostic computed tomography (CT) for appendicitis. We retrospectively studied all adult patients undergoing appendectomy from January 2000 through December 2002 (633 patients). Patients 15-30 years old ("younger") were compared to patients >30 ("older") and further subdivided by gender. CT accuracy and the influence of CT on negative appendectomy (NA) rates for each group were evaluated. CT was associated with a lower NA rate in older patients (23% vs 8%, P = 0.004) but had no effect on NA rate in younger patients (26% vs 20%, P = 0.2). Appendiceal CT had greater sensitivity, negative predictive value, and accuracy in older than in younger patients. When subdivided by gender, CT was associated with lower NA rates for all female patients but had no effect in either age group of men. Although CT may be more accurate in patients older than 30 years, it has the greatest benefit in female patients, where it is associated with lower NA rates in all adult patients. CT should be strongly considered for all female patients before operation for suspected appendicitis. Further study is needed to determine which, if any, male patients benefit from preoperative CT.

The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis

Background: The accuracy of noncontrast helical computed tomography (CT) for appendicitis has recently been demonstrated. What is its clinical utility? Methods: This was a retrospective review of 443 consecutive community hospital patients evaluated for acute appendicitis over an 18-month period using limited pelvic CT scan or clinical acumen alone. Results: Appendicitis was pathologically proven in 158 patients. The negative appendectomy rate was 5.4%. The best radiological indicators for a positive CT for appendicitis were pericecal inflammation (88%) and appendicolith(57%). Appendiceal CT was found to have a 92% sensitivity, 99.6% specificity, and a 97.5% accuracy. There were 260 patients who had a negative CT; 243 of these were sent home. Alternative diagnoses were identified in 22% of patients. Conclusions: The liberal use of noncontrast helical CT results in a low negative appendectomy rate and a high degree of confidence that a negative CT will allow patients to be sent home safely.

Is there a role for abdominal computed tomographic scans in appendicitis?

To better define the effectiveness of abdominal computed tomographic scanning (ACTS) in adult patients with suspected appendicitis. Retrospective analysis. A community teaching hospital. Ninety-seven patients with appendicitis in the differential diagnosis, whose clinical findings were insufficient to perform surgery or to discharge from the hospital, during a 14-month period. None. Accuracy of ACTS, rate of appendectomies that show no appendicitis (negative appendectomy rate), and frequency of ACTS as a definitive diagnostic test. Forty-nine of the 50 patients with appendicitis were correctly diagnosed by ACTS. Forty-three of the 47 patients without appendicitis were correctly diagnosed by ACTS. Positive predictive value was 92%, negative predictive value was 98%, and accuracy was 96%. The ACTS group had a negative appendectomy rate of 5.8% (3/52), lower than the hospital rate of 14% for the preceding 3 years. The ACTS established an alternative diagnosis in 16 patients, allowed 10 other patients to be discharged early or not admitted, and was the critical diagnostic test in 30 of the patients with appendicitis. Therefore, the ACTS played a definitive role in the treatment of 56 (57.7%) of the 97 patients. The ACTS was an accurate test in the diagnosis of appendicitis and was of significant benefit in 57.7% of the patients studied. However, it was difficult to predict which patients were most likely to benefit. Expanded selective use of ACTS for patients with clinically indeterminate appendicitis may result in a lower negative appendectomy rate and fewer patient admissions for observation.