Diagnostic pathways in acute appendicitis: Clinical score plus ultrasound outperform CT scan or upfront surgery, especially in doubtful cases

Background Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide. Material and Methods A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was co...

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Veröffentlicht in:World journal of surgery 2024-06, Vol.48 (6), p.1350-1359
Hauptverfasser: Coccolini, Federico, Martinez‐Perez, Aleix, Licitra, Gabriella, De Angelis, Nicola, Cremonini, Camilla, Strambi, Silvia, Zocco, Giuseppe, Puglisi, Adolfo, Tartaglia, Dario, Chiarugi, Massimo
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container_issue 6
container_start_page 1350
container_title World journal of surgery
container_volume 48
creator Coccolini, Federico
Martinez‐Perez, Aleix
Licitra, Gabriella
De Angelis, Nicola
Cremonini, Camilla
Strambi, Silvia
Zocco, Giuseppe
Puglisi, Adolfo
Tartaglia, Dario
Chiarugi, Massimo
description Background Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide. Material and Methods A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes. Results Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p 
doi_str_mv 10.1002/wjs.12160
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Material and Methods A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes. Results Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p &lt; 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT‐scan groups, respectively (p &lt; 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT‐scan (4.1%) (p &lt; 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4–6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08). Conclusion The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low‐resource settings worldwide. CT‐scan association may improve the detection of patients who may potentially be submitted to conservative treatment.</description><identifier>ISSN: 0364-2313</identifier><identifier>ISSN: 1432-2323</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1002/wjs.12160</identifier><identifier>PMID: 38549035</identifier><language>eng</language><publisher>United States</publisher><subject>Acute Disease ; Adolescent ; Adult ; age ; Aged ; Appendectomy ; appendicitis ; Appendicitis - diagnostic imaging ; Appendicitis - surgery ; complication ; conservative ; CT‐scan ; diagnosis ; Female ; histopathological ; Humans ; Male ; Middle Aged ; mortality ; outcomes ; Prospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed - methods ; treatment ; Ultrasonography - methods ; ultrasound ; Young Adult</subject><ispartof>World journal of surgery, 2024-06, Vol.48 (6), p.1350-1359</ispartof><rights>2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3250-5c67200780a272201b1e83210954ff661cd76e3d3cade55d41d7ac1704b98be53</citedby><cites>FETCH-LOGICAL-c3250-5c67200780a272201b1e83210954ff661cd76e3d3cade55d41d7ac1704b98be53</cites><orcidid>0000-0001-6364-4186</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fwjs.12160$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fwjs.12160$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38549035$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Coccolini, Federico</creatorcontrib><creatorcontrib>Martinez‐Perez, Aleix</creatorcontrib><creatorcontrib>Licitra, Gabriella</creatorcontrib><creatorcontrib>De Angelis, Nicola</creatorcontrib><creatorcontrib>Cremonini, Camilla</creatorcontrib><creatorcontrib>Strambi, Silvia</creatorcontrib><creatorcontrib>Zocco, Giuseppe</creatorcontrib><creatorcontrib>Puglisi, Adolfo</creatorcontrib><creatorcontrib>Tartaglia, Dario</creatorcontrib><creatorcontrib>Chiarugi, Massimo</creatorcontrib><title>Diagnostic pathways in acute appendicitis: Clinical score plus ultrasound outperform CT scan or upfront surgery, especially in doubtful cases</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><description>Background Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide. Material and Methods A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes. Results Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p &lt; 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT‐scan groups, respectively (p &lt; 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT‐scan (4.1%) (p &lt; 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4–6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08). Conclusion The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low‐resource settings worldwide. CT‐scan association may improve the detection of patients who may potentially be submitted to conservative treatment.</description><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Adult</subject><subject>age</subject><subject>Aged</subject><subject>Appendectomy</subject><subject>appendicitis</subject><subject>Appendicitis - diagnostic imaging</subject><subject>Appendicitis - surgery</subject><subject>complication</subject><subject>conservative</subject><subject>CT‐scan</subject><subject>diagnosis</subject><subject>Female</subject><subject>histopathological</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>mortality</subject><subject>outcomes</subject><subject>Prospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>treatment</subject><subject>Ultrasonography - methods</subject><subject>ultrasound</subject><subject>Young Adult</subject><issn>0364-2313</issn><issn>1432-2323</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM1u1DAURi0EokNhwQsgL0Fi2ms7dmbYVcO_KrGgiGXk2DfFlScOvrZGeQjemQxT2LG6d3F0Pukw9lzAhQCQl4c7uhBSGHjAVqJRci2VVA_ZCpRpll-oM_aE6A5AtAbMY3amNrrZgtIr9uttsLdjohIcn2z5cbAz8TBy62pBbqcJRx9cKIHe8F0MY3A2cnIpI59iJV5jyZZSHT1PtUyYh5T3fHezMHbkKfM6DTmNhVPNt5jn1xxpQhdsjPNxx6fal6FG7iwhPWWPBhsJn93fc_bt_bub3cf19ZcPn3ZX12unpIa1dqaVAO0GrGylBNEL3CgpYKubYTBGON8aVF4561Fr3wjfWidaaPrtpketztnLk3fK6WdFKt0-kMMY7YipUqdASm1atT2ir06oy4ko49BNOextnjsB3bF-t9Tv_tRf2Bf32trv0f8j_-ZegMsTcAgR5_-buu-fv56UvwErIpDv</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Coccolini, Federico</creator><creator>Martinez‐Perez, Aleix</creator><creator>Licitra, Gabriella</creator><creator>De Angelis, Nicola</creator><creator>Cremonini, Camilla</creator><creator>Strambi, Silvia</creator><creator>Zocco, Giuseppe</creator><creator>Puglisi, Adolfo</creator><creator>Tartaglia, Dario</creator><creator>Chiarugi, Massimo</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6364-4186</orcidid></search><sort><creationdate>202406</creationdate><title>Diagnostic pathways in acute appendicitis: Clinical score plus ultrasound outperform CT scan or upfront surgery, especially in doubtful cases</title><author>Coccolini, Federico ; Martinez‐Perez, Aleix ; Licitra, Gabriella ; De Angelis, Nicola ; Cremonini, Camilla ; Strambi, Silvia ; Zocco, Giuseppe ; Puglisi, Adolfo ; Tartaglia, Dario ; Chiarugi, Massimo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3250-5c67200780a272201b1e83210954ff661cd76e3d3cade55d41d7ac1704b98be53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acute Disease</topic><topic>Adolescent</topic><topic>Adult</topic><topic>age</topic><topic>Aged</topic><topic>Appendectomy</topic><topic>appendicitis</topic><topic>Appendicitis - diagnostic imaging</topic><topic>Appendicitis - surgery</topic><topic>complication</topic><topic>conservative</topic><topic>CT‐scan</topic><topic>diagnosis</topic><topic>Female</topic><topic>histopathological</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>mortality</topic><topic>outcomes</topic><topic>Prospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>treatment</topic><topic>Ultrasonography - methods</topic><topic>ultrasound</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Coccolini, Federico</creatorcontrib><creatorcontrib>Martinez‐Perez, Aleix</creatorcontrib><creatorcontrib>Licitra, Gabriella</creatorcontrib><creatorcontrib>De Angelis, Nicola</creatorcontrib><creatorcontrib>Cremonini, Camilla</creatorcontrib><creatorcontrib>Strambi, Silvia</creatorcontrib><creatorcontrib>Zocco, Giuseppe</creatorcontrib><creatorcontrib>Puglisi, Adolfo</creatorcontrib><creatorcontrib>Tartaglia, Dario</creatorcontrib><creatorcontrib>Chiarugi, Massimo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Coccolini, Federico</au><au>Martinez‐Perez, Aleix</au><au>Licitra, Gabriella</au><au>De Angelis, Nicola</au><au>Cremonini, Camilla</au><au>Strambi, Silvia</au><au>Zocco, Giuseppe</au><au>Puglisi, Adolfo</au><au>Tartaglia, Dario</au><au>Chiarugi, Massimo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic pathways in acute appendicitis: Clinical score plus ultrasound outperform CT scan or upfront surgery, especially in doubtful cases</atitle><jtitle>World journal of surgery</jtitle><addtitle>World J Surg</addtitle><date>2024-06</date><risdate>2024</risdate><volume>48</volume><issue>6</issue><spage>1350</spage><epage>1359</epage><pages>1350-1359</pages><issn>0364-2313</issn><issn>1432-2323</issn><eissn>1432-2323</eissn><abstract>Background Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide. Material and Methods A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes. Results Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p &lt; 0.001). The mean age was lower in the no radiology group (24 years) compared to 28 and 38 years in US and CT‐scan groups, respectively (p &lt; 0.001). Overall, the negative appendectomy rate 3.8%: no radiology group (5.1%) versus US (2.9%) and CT‐scan (4.1%) (p &lt; 0.001). The sensitivity and specificity analysis showed the best balance in clinical evaluation + score + US. These data reach the best results in those patients with an equivocal Alvarado score (4–6). Inverse probability weighting (IPW), showed as the use of ultrasound, is significantly associated with an increased probability of formulating the correct diagnosis (p 0.004). In the case of a CT scan, this association appears weaker (p 0.08). Conclusion The association of clinical scores and ultrasound seems the best strategy to reach a correct preoperative diagnosis in patients with clinical suspicion of AA, even in those population subgroups where the clinical score may have an equivocal result. This strategy can be especially useful in low‐resource settings worldwide. CT‐scan association may improve the detection of patients who may potentially be submitted to conservative treatment.</abstract><cop>United States</cop><pmid>38549035</pmid><doi>10.1002/wjs.12160</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-6364-4186</orcidid></addata></record>
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subjects Acute Disease
Adolescent
Adult
age
Aged
Appendectomy
appendicitis
Appendicitis - diagnostic imaging
Appendicitis - surgery
complication
conservative
CT‐scan
diagnosis
Female
histopathological
Humans
Male
Middle Aged
mortality
outcomes
Prospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed - methods
treatment
Ultrasonography - methods
ultrasound
Young Adult
title Diagnostic pathways in acute appendicitis: Clinical score plus ultrasound outperform CT scan or upfront surgery, especially in doubtful cases
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