Elina Lietzén1, Jari Mällinen2, Juha M Grönroos3, Tero Rautio2, Hannu Paajanen4, Pia Nordström5, Markku Aarnio6, Tuomo Rantanen7, Juhani Sand5, Jukka-Pekka Mecklin6, Airi Jartti8, Johanna Virtanen9, Pasi Ohtonen10, Paulina Salminen3. 1. Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland. Electronic address: elina.lietzen@tyks.fi. 2. Department of Surgery, Oulu University Hospital, Oulu, Finland. 3. Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland. 4. Department of Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland. 5. Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland. 6. Department of Surgery, Jyväskylä Central Hospital and University of Eastern Finland, Jyväskylä, Finland. 7. Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland. 8. Department of Radiology, Oulu University Hospital, Oulu, Finland. 9. Department of Radiology, Turku University Hospital, Turku, Finland. 10. Division of Operative Care and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Abstract
BACKGROUND: One of the main aims of appendicitis research is the differential diagnostics between complicated and uncomplicated acute appendicitis that enable provision of the optimal treatment for each patient. METHODS: Data in the present study were collected prospectively in our randomized antibiotic treatment for uncomplicated acute appendicitis trial (APPAC) comparing surgery and antibiotic treatment for uncomplicated acute appendicitis (NCT01022567). We evaluated 705 patients who had acute appendicitis on computed tomography. Patients with uncomplicated acute appendicitis (n = 368) were compared with all complicated acute appendicitis patients (n = 337), and subgroup analyses were performed between uncomplicated acute appendicitis and an appendicolith appendicitis (CA1; n = 256) and uncomplicated acute appendicitis and perforation and/or abscess (CA2; n = 78). Age, sex, body temperature (°C), duration of symptoms, white blood cell count (E9/L), and C-reactive protein (mg/L) were recorded on admission. Receiver operating characteristic curves were calculated for white blood cell count, C-reactive protein, and temperature. RESULTS: CA2 patients had significantly greater C-reactive protein levels (mean 122 and 47, respectively, P < .001) and longer duration of symptoms than uncomplicated acute appendicitis patients; 81% of CA2 patients and 38% of uncomplicated acute appendicitis patients had symptoms >24 hours before admission (P < .001). In receiver operating characteristic analysis, C-reactive protein and temperature had clinically significant results only in comparison with uncomplicated acute appendicitis and CA2 (area under the curve >0.7), but no optimum cutoff points could be identified. CONCLUSION: In clinical decision making, neither clinical findings nor laboratory markers are reliable enough to estimate the severity of the acute appendicitis accurately or to determine the presence of an appendicolith. The current results emphasize the role of computed tomography in the differential diagnosis of complicated and uncomplicated acute appendicitis.
RCT Entities:
BACKGROUND: One of the main aims of appendicitis research is the differential diagnostics between complicated and uncomplicated acute appendicitis that enable provision of the optimal treatment for each patient. METHODS: Data in the present study were collected prospectively in our randomized antibiotic treatment for uncomplicated acute appendicitis trial (APPAC) comparing surgery and antibiotic treatment for uncomplicated acute appendicitis (NCT01022567). We evaluated 705 patients who had acute appendicitis on computed tomography. Patients with uncomplicated acute appendicitis (n = 368) were compared with all complicated acute appendicitispatients (n = 337), and subgroup analyses were performed between uncomplicated acute appendicitis and an appendicolith appendicitis (CA1; n = 256) and uncomplicated acute appendicitis and perforation and/or abscess (CA2; n = 78). Age, sex, body temperature (°C), duration of symptoms, white blood cell count (E9/L), and C-reactive protein (mg/L) were recorded on admission. Receiver operating characteristic curves were calculated for white blood cell count, C-reactive protein, and temperature. RESULTS:CA2patients had significantly greater C-reactive protein levels (mean 122 and 47, respectively, P < .001) and longer duration of symptoms than uncomplicated acute appendicitispatients; 81% of CA2patients and 38% of uncomplicated acute appendicitispatients had symptoms >24 hours before admission (P < .001). In receiver operating characteristic analysis, C-reactive protein and temperature had clinically significant results only in comparison with uncomplicated acute appendicitis and CA2 (area under the curve >0.7), but no optimum cutoff points could be identified. CONCLUSION: In clinical decision making, neither clinical findings nor laboratory markers are reliable enough to estimate the severity of the acute appendicitis accurately or to determine the presence of an appendicolith. The current results emphasize the role of computed tomography in the differential diagnosis of complicated and uncomplicated acute appendicitis.
Authors: Matthew C Hernandez; Johnathon M Aho; Elizabeth B Habermann; Asad J Choudhry; David S Morris; Martin D Zielinski Journal: J Trauma Acute Care Surg Date: 2017-01 Impact factor: 3.313
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Authors: Suvi Sippola; Juha Grönroos; Ville Sallinen; Tero Rautio; Pia Nordström; Tuomo Rantanen; Saija Hurme; Ari Leppäniemi; Sanna Meriläinen; Johanna Laukkarinen; Heini Savolainen; Johanna Virtanen; Paulina Salminen Journal: BMJ Open Date: 2018-11-03 Impact factor: 2.692