Rate Of Appendicitis Research Articles

Role of Red Blood Cell Distribution Width (RDW) and Neutrophil Lymphocyte Ratio (NLR) in Diagnosis of Appendicitis in Paediatric Patients in H. Adam Malik Medan Central General Hospital

Acute appendicitis in paediatric patient is among the causal of abdominal emergency which requires immediate operation (Victor, et al, 2012; Ballester et al., 2009; Huckins et al., 2013). The incidence of acute appendicitis in paediatric patient in the world ranges from 1 to 8 % of all pediatric patients coming to the Emergency Department (ED) with acute abdominal pain (Jangra et al., 2013). Appendicitis is rare in children under 5 years, and very rare in the first year of life. In some instances, boys are more than girls around 55% to 65% of patients (Stevenson, Edward, 2003). The incidence rate of perforated appendicitis in the age group of children is about 30% to 40%. Appendicitis in the neonate is very rare, and the surgeon should be careful of the accompanying conditions, such as Hirschsprung’s disease and necrotic enterocolitis. (Stevenson, Edward, 2003).

Is the laparoscopic approach appropriate for pediatric subhepatic appendicitis?

Subhepatic appendicitis in children is an unusual condition that can be challenging for the pediatric surgeons to treat. The aim of our study was to compare the outcomes of laparoscopic appendectomies based on the position of the appendix. The data of 1736 patients who had undergone laparoscopic appendectomy in our tertiary center were retrospectively reviewed. We compared two groups: subhepatic location (n = 56) and non-subhepatic location (n = 1680). A P-value of less than 0.05 was considered statistically significant. There was no statistically significant difference between the demographic variables of the groups. More than half of the subhepatic appendicitises were gangrenous (44.6%) or perforated (16.1%), whereas most of the non-subhepatic appendicitises were phlegmonous (56.9%). Extracorporeal ligation of the appendix was the preferred technique in both the subhepatic and non-subhepatic groups (69.6% and 89.8%, respectively). The subhepatic group had a statistically significant higher incidence of technical difficulties (1.6%) and abdominal drain (18.6%) than the non-subhepatic group, as well as a longer operative time and hospital stay. However, intraoperative and postoperative complications were similar in both groups. Laparoscopic subhepatic appendectomy is safe and does not lead to increased complications. However, the technique is made difficult by the fact that the appendix is an atypical location, and the rate of complicated appendicitis is higher.

Association of Health Care Utilization With Rates of Perforated Appendicitis in Children 18 Years or Younger

The pediatric perforated appendix rate is a quality metric measured by the Agency for Healthcare Research and Quality (AHRQ) that reflects access to care. The association of health care utilization prior to presentation with appendicitis is unknown. To determine whether increased health care utilization prior to presentation with appendicitis is associated with lower perforated appendicitis rates in children. Retrospective cohort study of privately insured children drawn from large employer and insurance company administrative data found in the Truven MarketScan national insurance claims database. Cases of appendicitis were identified among 38 348 children 18 years or younger from January 1, 2010, through December 31, 2013, with corresponding primary health care encounters from January 1, 2009, through December 31, 2012. In all, 19 109 eligible children were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for appendicitis after excluding those patients who did not have continuous insurance coverage during the study period. Statistical analysis was performed from September 1, 2016, to October 15, 2017. Health care utilization was determined by the number of outpatient clinic encounters for each patient in the 1 to 12 months before presentation with appendicitis. Perforated appendicitis was defined according to the AHRQ by using ICD-9 codes for perforation and hospital length of stay of 3 or more days. Logistic regression models were used for perforated appendicitis after adjustment for age, sex, income, gastrointestinal comorbidities, geographic region, and insurance type. We identified 38 348 children 18 years or younger with ICD-9 diagnosis codes for appendicitis, and 19 109 children remained for analysis after applying exclusion criteria. Of these, 11 422 were boys (59.8%); the mean (SD) age was 12.4 (3.9) years. Of the 19 109 children identified who underwent appendectomy, 5509 (28.8%) presented with perforated appendicitis. Children with perforation had lower outpatient health care utilization in the year before presentation compared with those diagnosed with acute appendicitis (4554 of 5509 children [82.7%] vs 11 937 of 13 600 [87.8%]; P < .001). In the adjusted model, outpatient health care utilization before presentation was associated with lower odds of perforated appendicitis (odds ratio [OR], 0.63; 95% CI, 0.58-0.69; P < .001). This association increased with visit frequency in the year before presentation (OR, 0.86; 95% CI, 0.77-0.95 for 1-2 visits, P = .003; OR, 0.61; 95% CI, 0.55-0.67 for 3-6 visits, P < .001; and OR, 0.43; 95% CI, 0.38-0.48 for ≥7 visits [5-18 years], P < .001). Covariates associated with perforation included younger age, geographic region, family income, and higher out-of-pocket insurance plans. Among insured children 18 years or younger, increased health care utilization was associated with lower rates of perforated appendicitis. Primary health care relationships may facilitate timely presentation or serve as a marker for health-related self-efficacy, thereby contributing to outcomes for acute surgical conditions.

Acute appendicitis complicating pregnancy: a 33 case series, diagnosis and management, features, maternal and neonatal outcomes.

The occurrence of acute appendicitis during pregnancy may pose diagnostic and therapeutic difficulties. In fact pregnancy can make the clinical diagnosis delicate and the use of morphological examinations is still subject to controversy. The debates concerning the ideal surgical approach during pregnancy continue. On the other hand, in some cases the occurrence of acute appendicitis, especially in its complicated form, which is frequent in pregnant women, exposes to obstetrical complications and an increased risk of premature delivery We aims to describe the clinical and management features of acute appendicitis in pregnant women and the maternal and neonatal outcomes and carry out a review of the literature on this topic. It is a retrospective analysis of a series of 33 cases of appendicitis in pregnant women who were diagnosed and managed, in collaboration between the departments of General and digestive surgery, Gynecology and Obstetrics and Anaesthesia at Farhat Hached Universitary Hospital Sousse Tunisia between January 2005 and December 2015. The average age of the patients was 29 (20-40). Fourteen patients were in the first trimester, twelve in the 2nd and seven in the third trimester. The main symptom was pain in the right iliac fossa. The mean delay between consultation and surgery was 2.7 days. Twenty five patients had a preoperative ultrasound. Eight of the 33 pregnant patients presented complicated appendicitis with localized or generalized peritonitis. Thirty patients underwent laparotomic appendectomy: 28 with a Mc Burney incision and 2 with a midline incision and only three patients underwent laparoscopy. Preventive tocolysis was given to 14 patients, maternal mortality was null. Twenty four pregnancies were followed until delivery: one case of premature birth and one case of preterm labor were observed. Pregnancy makes it difficult to diagnose appendicitis, which explains the high rate of complicated acute appendicitis in our series. An early treatment improves maternal and fetal outcome.

LAPAROSCOPIC APPENDECTOMY DOES NOT INCREASE THE RATE OF NEGATIVE APPENDECTOMY along with a lower rate of perforated appendicitis - RESULTS IN 1899 PATIENTS at Zagreb UHC.

SUMMARY – Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs. open (p=0.24); negative appendectomy (adults) – lap vs. open (p=0.15); negative-negative appendectomy (children) – lap vs. open (p=0.36); negative-negative appendectomy (adults) – lap vs. open (p=0.21); negative-positive appendectomy (children) – lap vs. open (p=0.53); negative-positive appendectomy (adults) – lap vs. open (p=0.56); and laparoscopy group negative appendectomy in children vs. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.

Influence of Appendectomy Timing in the Pathological Outcome and the Morbidity of Acute Appendicitis in Children: A Retrospective Study

Introduction: Surgery is indicated for acute appendicitis but there is controversy regarding precise timing for appendectomy. Objective: Our aim was to evaluate the impact of time delay from emergency department presentation to surgery in developing complicated appendicitis in children and associated morbidity. Methods: 540 charts of children, who underwent appendectomy, between January 2013 and December 2016 were retrospectively reviewed. Groups were divided by time of intervention. Group 1: less than 24h (n=209, 38.7%), group 2: 24h to 48h (n=293, 54.5%), and group 3: greater than 48h (n=38, 6.8%). We considered complicated appendicitis gangrenous, abscess or perforated appendix per operatively and on histopathologic examination. Statically analysis and was performed to search the predictors of complicated appendicitis and evaluate postoperative complications. Results: Among 540 children included in the study, 164 (30.4%) had complicated acute appendicitis. There was no correlation between delay to surgery and the risk of developing a complicated form of the disease for group 1 and Group 2. Beyond the 48th h (group 3), the rate of developing complicated appendicitis and post-operative complications increased significantly. Hospital stay was not affected by delayed surgery. Conclusion: A short in-hospital delay before surgery less than 48 h, for acute appendicitis in child, is not associated with an increased rate of complex appendicitis neither associated morbidity.

Institutional and population based analyses on misdiagnosis of appendicitis in Khulna, Bangladesh

The aim of the present study was to identify factors associated with misdiagnosis of appendicitis to propose solutions to decrease the misdiagnosis rate of appendicitis. The study conducted an institutional and a population based analyses on misdiagnosis of appendicitis conducted in Khulna district, Bangladesh. The study dealt with 2 groups of patients. Group 1 consisted of the patients treated in Gazi Medical College Hospital (GMCH), Khulna either in out-patient department (OPD) within the last 3 years (from 2014 to 2016), treating doctors suggested appendicectomy and in indoor-patient department (IPD) within the last 5 years (from 2012 to 2016), the diagnosis was done either during operation or admitted as postoperative complications. Patients for Group 2 were selected purposively from the patients who were from different villages of Rupsha and Fakirhat Upazila or from Khulna city previously underwent appendicectomy within the last 5 years (from 2012 to 2016) in different hospitals other than GMCH, Khulna and previous symptoms were still existed. The study revealed that the majority of the patients were female (OPD 81.5%, IPD 68.8% in Group 1 and 83.2% in Group 2). The misdiagnosis rate of appendicitis for the patients attended GMCH OPD and GMCH IPD was 23.0% and 8.9%, respectfully. The overall misdiagnosis rate of appendicitis for the patients attended GMCH was 14.0%. In case of the patients attended GMCH OPD, most of them had UTI and chronic cystitis (45.5%). In case of the patients attended GMCH IPD, most of them had non-inflamed appendix (84.4%). The misdiagnosis rate of appendicitis for the patients in Group 2 was 23.2%. Some factors were identified and bearing in mind the factors, all the concerned should be more careful and conscious while making the diagnosis of appendicitis to avoid misdiagnosis and patients’ suffering.Mediscope Vol. 4, No. 2: Jul 2017, Page 29-34

Effect of Healthcare Utilization Prior to Presentation on Perforated Pediatric Appendicitis Rates

The purpose of this study is to determine whether utilization of healthcare (ie primary care visits) in the year prior to presentation is associated with lower complicated appendicitis rates in children.

247 Performance of Clinical Gestalt in Predicting Pediatric Appendicitis: Does Experience Matter?

Appendicitis is the most common surgical emergency in children and delays in diagnosis are associated with increased morbidity. Clinical prediction tools can risk stratify patients presenting to the ED with abdominal pain based on symptoms, findings and laboratory results. Gestalt, a synthesis of provider experience and clinical perception, is reported to perform as well as these prediction tools, but has not been well studied. We evaluated the performance of clinical gestalt as a predictor of pediatric appendicitis and stratified on provider characteristics. Attending emergency physicians prospectively enrolled patients aged 5-20 years with suspected appendicitis in an electronic health record (EHR)-based risk stratification tool, entering patient characteristics and symptoms; laboratory data (white blood cell and absolute neutrophil count) was imported from the EHR. Prior to imaging, physicians entered their gestalt for appendicitis on a continuous scale (0-100%). The primary outcome, acute appendicitis, was identified using diagnosis and procedure codes and confirmed by chart review. We calculated the receiver operating characteristic (ROC) curve for gestalt as a continuous variable overall and stratified by provider experience and sex. Of 1000 eligible patients, 800 (80%) were enrolled; patients with gestalt entered after imaging had been ordered were excluded. Their median age was 10 years (IQR 7-14) and 11.7% had appendicitis. Of 281 enrolling physicians, the mean age was 41, with 86% of respondents between 30-49 years and 11% less than 5 years out of residency (mean 12 years post residency); 40% were female. The overall c-statistic for gestalt as a predictor of appendicitis was 0.89. Among physicians with < 5 years experience, the c-statistic was 0.77 versus 0.91 among more experienced physicians. The c-statistic increased with experience for both male and female physicians from 0.81 to 0.91, and 0.70 to 0.89, respectively. The rate of appendicitis in patients in the lowest gestalt category (0-10%) was 0.33%, while in the highest gestalt category (90%-100%), it was 68.8%. In this prospective study, clinical gestalt performed well in predicting appendicitis in children, especially at extremes of appendicitis risk.

Perforated appendicitis in patients with schizophrenia: a retrospective cohort study

ObjectiveAltered pain sensitivity may affect the outcome of appendicitis in patients with schizophrenia. We aimed to compare the prevalence of perforation in appendicitis between patients with and without schizophrenia.DesignRetrospective cohort...

Appendectomy at Gynecologic Surgery: Feasibility and Outcomes in a High Risk Gynecologic Population—Revealing a High Rate of Incidental Appendiceal Cancer

Objective: Appendectomy during gynecologic surgery is not performed routinely by most providers, even in patients with pelvic pain complaints or with gynecologic malignancies. Appendectomy, concordant with cancer debulking, can optimize surgical outcomes, and, in patients with pelvic pain, can help diagnose pathologic etiology for those symptoms. With a lifetime rate of appendicitis of 7%–9%, incidental appendectomy can reduce risk for future complications of appendicitis. Design: A retrospective chart review of all patients operated on from April 2012 to July 2016 was performed. Materials and Methods: Data were abstracted to include: age; body mass index; route and indication for surgery; final pathology; complications; and feasibility. Statistics were calculated, using Excel 2007 and the R Project. Results: Charts for 920 patients were reviewed. Of these, charts for 69 patients were excluded due to extraperitoneal procedures; 110 patients had prior appendectomies. There were no complications. In the remaining charts, there were 14 incidental appendiceal primary cancers, 54 metastatic gynecologic cancers wherein appendectomy contributed to optimal debulking, 15 cases of acute appendicitis, and 8 appendiceal specimens with endometriotic implants. Conclusions: Incidental appendectomy is a safe and feasible procedure for both laparoscopic and open abdominal–pelvic procedures. There was a high rate of incidental primary appendiceal cancers, at 2.97%. There was also a high rate of other pathologies, including metastatic tumors, endometriosis, and appendicitis. Removing the appendix during gynecologic surgery can reduce the risks for present and future gastrointestinal cancer, and appendicitis with rupture, as well as contributing to high-quality surgical care in patients with cancer and pelvic pain. (J GYNECOL SURG 33:145)

Abdominal-pelvic scanning parameters revisited: a case for Z-axis reduction in patients with clinical suspicion for acute appendicitis.

The purpose of this study was to determine if CT for appendicitis can be abbreviated to begin at the top of the L2 vertebral body level and still maintain the detection rate of appendicitis and other symptomatic pathology without omitting significant incidental findings. Retrospective review of CT abdomen-pelvis exams for suspected appendicitis over a 5-month period was performed. The Z-axis scan length of the original full scans and theoretical limited scans from the top of L2 were recorded and calculated. Images were reviewed for incidental findings above the L2 vertebral body level and categorized by severity per American College of Radiology (ACR) white paper guidelines. Final diagnoses based on imaging findings were also recorded. One hundred nineteen patients (46 males, 73 females, mean age 29±14) were included. Appendicitis was present in 26 cases (22%). Using a theoretical scan beginning at the top of the L2 vertebral body, none of the findings leading to diagnosis of appendicitis would have been missed. A total of 30 incidental findings were found above the L2 vertebral body. Per ACR white paper guidelines, 26 of these findings did not require additional imaging follow-up. Additional follow-up imaging was recommended for 3 of the findings above L2, and 1 right adrenal metastasis was found above L2 in a patient with previously undiagnosed NSCLC. This patient coincidentally also had appendicitis. No symptomatic pathology would have been missed had the scans begun at the top of the L2 vertebral body. Such an abbreviated scan would have resulted in a mean Z-axis reduction of 12.9cm (30.3%). CT using abbreviated Z-axis scan length can reduce radiation dose and provide necessary imaging needed to diagnose appendicitis or other symptomatic pathology without omitting significant incidental findings.

Clinical and socioeconomic factors associated with negative pediatric appendicitis

BackgroundMisdiagnosing appendicitis may lead to unnecessary surgery. The study evaluates the risk factors for negative appendectomies, as well as the clinical and socioeconomic consequences of negative appendectomy across three states. Materials and methodsData were obtained from the California, New York, and Florida State Inpatient Databases 2005-2011. Patients (<18 years) who underwent nonincidental appendectomies (n = 156,660) were evaluated with hierarchical and multivariate negative binomial regression analyses on outcomes including hospital cost, length of stay (LOS), and associated morbidity. ResultsFrom 2005 to 2011, there was a decrease in the rate of negative appendicitis and perforated appendicitis, whereas the rate of true acute nonperforated appendicitis increased. Whites, females, and privately insured patients were associated with higher negative appendicitis rates, whereas those at an increased risk for perforated appendicitis were African-Americans, males, and those with public or no insurance. Compared to patients with acute nonperforated appendicitis, those with negative appendicitis have significantly higher morbidity (2.5% versus 1.3%), longer LOS (3.4 versus 1.8 d), and greater hospital costs averaged over time ($6926 versus $6492 per patient). ConclusionsDespite a low incidence, negative appendicitis is associated with greater morbidity, longer LOS, and higher cost than acute nonperforated appendicitis. Certain subpopulations are at higher risk for undergoing surgery for negative appendicitis, whereas others are at greater risk for presenting with perforated appendicitis. Further research is needed to understand what drives such disparities and to inform efforts to improve quality of hospital care across all groups of patients.

Time to Appendectomy and Risk of Complicated Appendicitis and Adverse Outcomes in Children

Management of appendicitis as an urgent rather than emergency procedure has become an increasingly common practice in children. Controversy remains as to whether this practice is associated with increased risk of complicated appendicitis and adverse events. To examine the association between time to appendectomy (TTA) and risk of complicated appendicitis and postoperative complications. In this retrospective cohort study using the Pediatric National Surgical Quality Improvement Program appendectomy pilot database, 2429 children younger than 18 years who underwent appendectomy within 24 hours of presentation at 23 children's hospitals from January 1, 2013, through December 31, 2014, were studied. The main exposure was TTA, defined as the time from emergency department presentation to appendectomy. Patients were further categorized into early and late TTA groups based on whether their TTA was shorter or longer than their hospital's median TTA. Exposures were defined in this manner to compare rates of complicated appendicitis within a time frame sensitive to each hospital's existing infrastructure and diagnostic practices. The primary outcome was complicated appendicitis documented at operation. The association between treatment delay and complicated appendicitis was examined across all hospitals by using TTA as a continuous variable and at the level of individual hospitals by using TTA as a categorical variable comparing outcomes between late and early TTA groups. Secondary outcomes included length of stay (LOS) and postoperative complications (incisional and organ space infections, percutaneous drainage procedures, unplanned reoperation, and hospital revisits). Of the 6767 patients who met the inclusion criteria, 2429 were included in the analysis (median age, 10 years; interquartile range, 8-13 years; 1467 [60.4%] male). Median hospital TTA was 7.4 hours (range, 5.0-19.2 hours), and 574 patients (23.6%) were diagnosed with complicated appendicitis (range, 5.2%-51.1% across hospitals). In multivariable analyses, increasing TTA was not associated with risk of complicated appendicitis (odds ratio per 1-hour increase in TTA, 0.99; 95% CI, 0.97-1.02). The odds ratios of complicated appendicitis for late vs early TTA across hospitals ranged from 0.39 to 9.63, and only 1 of the 23 hospitals had a statistically significant increase in their late TTA group (odds ratio, 9.63; 95% CI, 1.08-86.17; P = .03). Increasing TTA was associated with longer LOS (increase in mean LOS for each additional hour of TTA, 0.06 days; 95% CI, 0.03-0.08 days; P < .001) but was not associated with increased risk of any of the other secondary outcomes. Delay of appendectomy within 24 hours of presentation was not associated with increased risk of complicated appendicitis or adverse outcomes. These results support the premise that appendectomy can be safely performed as an urgent rather than emergency procedure.

Evaluating the Feasibility of Single Incision Laparoscopic Appendectomy Performed by a Resident Based on Propensity Score Matching.

Conventional laparoscopic appendectomy (CLA) has been considered the standard for the treatment of acute appendicitis. Recently, single incision laparoscopic appendectomy (SILA) has become an alternative option. There are few reports on the results of SILA performed by residents during the training period. The present study, we report our residents' experience. We reviewed clinical characteristics and outcomes of 1005 patients who underwent appendectomy between October 2013 and April 2016. Every operation was performed by only residents. Clinical characteristics and operative outcomes between SILA and CLA group were reviewed after propensity score matching. SILA was used more frequently in younger patients (23.3 versus 36.4 years, P = .000), women (66.4% versus 45.9%, P = .000), and patients with lower body mass index (20.2 versus 22.9 kg/m2, P = .043). After propensity score matching, the rate of complicated appendicitis was lower (12.9% versus 15.5%, P = .573), and the mean operative time was slightly shorter in the SILA group than in the CLA group (56.68 versus 59.09 minutes, P = .068), although these differences were not statistically significant. There were no significant differences between the two groups in hospitalization period (2.7 versus 2.9 days, P = .380), the use of analgesics (2.0 versus 2.1 times, P = .128), and wound complication rate (10.3% versus 14.6%, P = .333). It is a safe and relatively easy procedure with an acceptable postoperative cosmetic outcome that can be incorporated into the routine surgical training.

Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis.

Nonoperative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendectomy. To determine safety and efficacy of NOT based on current literature. Three electronic databases. All articles reporting NOT for AUA in children. Two reviewers independently verified study inclusion and extracted data. Ten articles reporting 413 children receiving NOT were included. Six, including 1 randomized controlled trial, compared NOT with appendectomy. The remaining 4 reported outcomes of children receiving NOT without a comparison group. NOT was effective as the initial treatment in 97% of children (95% confidence interval [CI] 96% to 99%). Initial length of hospital stay was shorter in children treated with appendectomy compared with NOT (mean difference 0.5 days [95% CI 0.2 to 0.8]; P = .002). At final reported follow-up (range 8 weeks to 4 years), NOT remained effective (no appendectomy performed) in 82% of children (95% CI 77% to 87%). Recurrent appendicitis occurred in 14% (95% CI 7% to 21%). Complications and total length of hospital stay during follow-up were similar for NOT and appendectomy. No serious adverse events related to NOT were reported. The lack of prospective randomized studies limits definitive conclusions to influence clinical practice. Current data suggest that NOT is safe. It appears effective as initial treatment in 97% of children with AUA, and the rate of recurrent appendicitis is 14%. Longer-term clinical outcomes and cost-effectiveness of NOT compared with appendicectomy require further evaluation, preferably in large randomized trials, to reliably inform decision-making.

Regional variation in rates of pediatric perforated appendicitis

BackgroundWhile trends in perforated appendicitis (PA) rates have been studied, regional variability in pediatric admissions for PA remains unknown. MethodsA retrospective, cross-sectional analysis of the 2006–2012 Kids' Inpatient Database was conducted to examine variation in PA admission rates by region of the United States and insurance status. PA rates were calculated and reported as per 1000 admissions in accordance with national quality measure specifications. ResultsNational PA rates per 1000 admissions for 2006, 2009, and 2012 were 313.9, 279.2, and 309.1, respectively. Similarly, all regions demonstrated a statistically significant decrease in PA rates between 2006 and 2009 (p<0.001), where the increase in rates between 2009 and 2012 was only statistically significant in the Midwest [Odds Ratio (OR) 1.07; 95% Confidence Interval (95%CI) 1.03–1.12] and West (OR 1.10; 95% CI 1.07–1.14). The Northeast consistently experienced the lowest PA rates. The odds of PA were highest among uninsured patients (OR 1.35; 95% CI 1.31–1.29). The South had the highest proportion of uninsured children, and these patients had the highest odds of perforation (OR 1.57; 95% CI 1.21–2.02). ConclusionsFor children with appendicitis, geographic region and insurance status appear to be associated with perforation upon presentation. Understanding regional variation in pediatric PA rates may inform health policymakers in the constantly evolving insurance coverage landscape. Levels of evidence ratingLevel III Treatment Study — Retrospective comparative study of appendicitis presentation in children by region of the country.

Streptococcal Pharyngitis and Appendicitis in Children.

Several pathologies, including pharyngitis, are associated with abdominal pain that can mimic appendicitis. We sought to further understand the link between appendicitis-like symptoms and streptococcal (strep) pharyngitis. All patients undergoing ultrasound imaging for appendicitis in our emergency department during 2013 were reviewed (n = 1572). A total of 207 patients were identified who underwent both ultrasound for appendicitis and testing for strep pharyngitis. Demographic and outcomes data between rule out appendicitis patients who underwent strep testing and those who did not were compared. Strep testing was more common in younger patients (mean age = 8.26 vs 10.26 years P < .001) and evenly matched by gender (104 male, 103 female). Of the 207 patients tested for strep pharyngitis, 8 (3.9%) patients had appendicitis and 35 (16.9%) patients tested positive for strep pharyngitis. No cases of concurrent strep pharyngitis and appendicitis were identified. The negative appendectomy rate in the strep pharyngitis tested group was 38.5% (5/13), compared with 7.7% (23/296) ( P = .003) in the nontested group. The appendicitis rate among the strep tested group was 3.8% (8/207) compared with 20% (273/1365) in the nontested group ( P < .001). Patients undergoing testing for strep pharyngitis were younger, had lower rates of appendicitis, and had a higher rate of negative appendectomy. A diagnosis of concurrent appendicitis and strep pharyngitis is rare. In cases of patients with sufficient symptoms to warrant testing for strep pharyngitis a diagnosis of appendicitis is less likely and surgical intervention leads to higher negative appendectomy rates.

Interval Appendectomy Operative vs. Non-Operative Management of Appendicitis in Saudi Arabia

The goal of this review is to analyze the perfect mechanism for managing acute appendicitis. Both surgical and non-operative approaches are in contention as the best remedies for the appendix complications. To draw a better comparative analysis, the strengths and weaknesses of each proposed mechanism are analyzed. In the Kingdom of Saudi Arabia (KSA), both immediate and interval surgical procedure remain debatable as best remedies for acute appendicitis. To determine the suitability of both immediate and interval appendectomy against non-operative management in KSA, vast literature is analyzed to portray the strengths of each medical maneuver. Background: The primary objective of appendicitis management is to ensure early diagnosis and prevent operative management, which is risky and costly [1]. However, this goal has remained elusive due to delayed diagnosis, a characteristic that is prevalent for most people. In an analysis concerning the changing trends of appendicitis management over the past 30 years, surgery is not the only remedy for appendicitis patients [2]. Some individuals, as exhibited by numerous studies, have been able to recover without the need for surgical procedures, currently conceptualized as appendectomy. However, concentrating on the analysis by a number of scholars, it becomes evident that some delayed attention to symptoms, mainly due to patient’s ignorance, makes appendectomy inevitable. As such, the most common cause of abdominal surgical emergency is appendicitis [3]. Narrowing down to the ground situation in America, not much difference is exhibited. Appendectomy remains the most significant tool at the physicians disposal when faced with relatable appendicitis dilemmas. By the time patients seek medical attention, it is already late, an aspect that motivates physicians to put into use prompt surgical procedures. The growing attention to appendicitis management is proportional to its prevalence rate. Appendicitis accounts for approximately 40,000 hospital admissions each year in England [2]. Similarly, early studies performed by English medical scholars indicated that close to 150 people from England and Wales die from acute appendicitis [4]. The prevalence rate of appendix complications is approximately seven to eight percent of the global population. Regardless of the advanced diagnostic and surgical technology, morbidity of the complication is 10%, and the mortality rate is between 1% and 5%. Despite its high prevalence, acute appendicitis is decreasing the in the US and the European region while proportionally increasing in the developing countries, mainly due to changing lifestyles [5,6,7].Consequently, a histopathological study on KSA in 2015 revealed that diagnosis rate of acute appendicitis was 52% while acute suppurative, acute gangrenous appendicitis and acute perforated appendicitis remained at 28%, 12.5% and 2% respectively [8]. However, it is important to acknowledge that the study was limited to one geographical area, but scientifically, the figures represent a consistent pattern. Significantly, the prevalence rate of subhepatic acute appendicitis accounted for 0.054% of Saudi Arabia’s hospital population [9]. With much research being carried on the best way of handling appendicitis, this next segment of the review covers a summary of current research’s perception concerning the effective medical procedure (operative vs. non-operative). The summary section is not conclusive but rather shows a sample of analyses approaching the best way of handling appendix complications in the general population. Methods:A review of the literature was made using the most common electronic sources including: electronic database, EMBASE, MEDLINE search using

Seasonal Pattern of Acute Appendicitis in Basrah

Appendicitis is the most common acute surgical condition of the abdomen. The aim of the project is to study the seasonal variation in the incidence of acute appendicitis in Basrah and its correlation to gender, age, presentation and length of hospital stay of affected patients. Patients with acute appendicitis who admitted to the surgical unit in Basrah General hospital during the period from January 2010 to December 2013 were prospectively evaluated according to the demographic features, particularly age and sex, length of hospital stay, seasonal variation and the postoperative outcome. Out of 1261 patients included in this study 57% patients were males and 43% of patient were females with age range from 3-70 years. All the patients treated surgically by open and laparoscopic means. 34 patients found to have perforated appendix, 25 patients presented with abdominal mass and 7 patients were presented with appendicular abscess. A significant seasonal effect was observed, with the rate of acute appendicitis being higher in the summer months. It is concluded that acute appendicitis is more common in males, in those aged 10-19years, and during the summer months.