Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis
| Autor: | M Andersson, B Kolodziej, R E Andersson, T Eriksson, A Ramsing, L Westman, J Björkman, H O Håkansson, T Lundström, H Björkman, P Johansson, O Hjert, R Edin, A Ekström, C Wenander, C Wallon, P Andersson, J Frisk, B Arvidsson, R Lantz, G Wallin, Å Wickberg, E Stenberg, C Erixon, W Schmidt, J Räntfors, G Göthberg, J Styrud, K Elias, Le Boström, G Kretschmar, M Jonsson, C Brav, I Nilsson, F Kamran, F Hammarqvist, J Rutqvist, M Almström, M Hedberg, V Lindh, A Rosemar, H Wangberg, J Gustafsson, G Neovius, C Juhlin, R Christofferson, C Månsson, T Zittel, N Fagerström |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Diagnostic Imaging Male medicine.medical_specialty Adolescent Inflammatory response 030230 surgery Risk Assessment law.invention Young Adult 03 medical and health sciences Patient Admission 0302 clinical medicine Randomized controlled trial law Internal medicine medicine Medical imaging Appendectomy Humans Prospective Studies Young adult Child Prospective cohort study Aged Aged 80 and over Sweden business.industry Length of Stay Middle Aged Appendicitis medicine.disease Surgery Child Preschool 030220 oncology & carcinogenesis Female Suspected appendicitis Risk assessment business Algorithms |
| Zdroj: | British Journal of Surgery. 104:1451-1461 |
| ISSN: | 1365-2168 0007-1323 |
| DOI: | 10.1002/bjs.10637 |
| Popis: | Background 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. Method 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. Results The baseline period included 1152 patients, and the intervention period 2639, of whom 1068 intermediate-risk patients were randomized. In low-risk patients, use of the AIR score-based algorithm resulted in less imaging (19·2 versus 34·5 per cent; P < 0·001), fewer admissions (29·5 versus 42·8 per cent; P < 0·001), and fewer negative explorations (1·6 versus 3·2 per cent; P = 0·030) and operations for non-perforated appendicitis (6·8 versus 9·7 per cent; P = 0·034). Intermediate-risk patients randomized to the imaging and observation groups had the same proportion of negative appendicectomies (6·4 versus 6·7 per cent respectively; P = 0·884), number of admissions, number of perforations and length of hospital stay, but routine imaging was associated with an increased proportion of patients treated for appendicitis (53·4 versus 46·3 per cent; P = 0·020). Conclusion AIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 (http://www.clinicaltrials.gov). |
| Databáze: | OpenAIRE |
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