Stavros A Antoniou1,2, Dimitris Mavridis3,4, Katerina Maria Kontouli3, Vasileios Drakopoulos5, Marguerite Gorter-Stam6, Sture Eriksson7, Marc Leone8, Maria Carmen Pérez-Bocanegra9, Neil J Smart10, Marco Milone11, Francesco Maria Carrano12,13, George A Antoniou14,15, Per Olav Vandvik16. 1. Surgical Department, Mediterranean Hospital of Cyprus, Limassol, Cyprus. stavros.antoniou@hotmail.com. 2. Medical School, European University Cyprus, Nicosia, Cyprus. stavros.antoniou@hotmail.com. 3. Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece. 4. Faculté de Médecine, Université Paris Descartes, Paris, France. 5. 1st Department of Surgery & Organ Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece. 6. Department of Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands. 7. Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden. 8. Department of Anesthesiology and Critical Care Medicine, Nord Hospital, Marseille, France. 9. Geriatrics Department, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 10. Department of Surgery, Department of Surgery, Royal Devon & Exeter Hospital, Exeter, UK. 11. Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy. 12. PhD Program in Applied Medical-Surgical Sciences, University of Rome "Tor Vergata", 00133, Rome, Italy. 13. Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy. 14. Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Northern Care Alliance NHS Group, Manchester, UK. 15. Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK. 16. Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
Abstract
BACKGROUND: There is a lack of trustworthy evidence-informed guidelines on the diagnosis and management of acute appendicitis in elderly patients. METHODS: We developed a rapid guideline in accordance with GRADE and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of three general surgeons, an intensive care physician, a geriatrician and a patient advocate. We conducted systematic reviews and the results of evidence synthesis were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus. RESULTS: This rapid guideline provides a weak recommendation against the use of clinical scoring systems to replace cross-sectional imaging in the diagnostic approach of suspected appendicitis in elderly patients. It provides a weak recommendation against the use of antibiotics alone over surgical treatment in patients who are deemed fit for surgery, and a weak recommendation for laparoscopic over open surgery. Furthermore, it provides a summary of surgery-associated risks in elderly patients. The guidelines, with recommendations, evidence summaries and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494 . CONCLUSIONS: This rapid guideline provides evidence-informed trustworthy recommendations on the diagnosis and management of acute appendicitis in elderly patients.
BACKGROUND: There is a lack of trustworthy evidence-informed guidelines on the diagnosis and management of acute appendicitis in elderly patients. METHODS: We developed a rapid guideline in accordance with GRADE and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of three general surgeons, an intensive care physician, a geriatrician and a patient advocate. We conducted systematic reviews and the results of evidence synthesis were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus. RESULTS: This rapid guideline provides a weak recommendation against the use of clinical scoring systems to replace cross-sectional imaging in the diagnostic approach of suspected appendicitis in elderly patients. It provides a weak recommendation against the use of antibiotics alone over surgical treatment in patients who are deemed fit for surgery, and a weak recommendation for laparoscopic over open surgery. Furthermore, it provides a summary of surgery-associated risks in elderly patients. The guidelines, with recommendations, evidence summaries and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494 . CONCLUSIONS: This rapid guideline provides evidence-informed trustworthy recommendations on the diagnosis and management of acute appendicitis in elderly patients.