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Open Access 01-02-2021 | Computed Tomography | Original Article

DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis

Authors: Patrizia Malkomes, Franziska Edmaier, Juliane Liese, Alexander Reinisch-Liese, Hanan El Youzouri, Teresa Schreckenbach, Andreas M. Bucher, Wolf Otto Bechstein, Andreas A. Schnitzbauer

Published in: Langenbeck's Archives of Surgery | Issue 1/2021

Abstract

Purpose

The management of patients with suspected appendicitis remains a challenge in daily clinical practice, and the optimal management algorithm is still being debated. Negative appendectomy rates (NAR) continue to range between 10 and 15%. This prospective study evaluated the accuracy of a diagnostic pathway in acute appendicitis using clinical risk stratification (Alvarado score), routine ultrasonography, gynecology consult for females, and selected CT after clinical reassessment.

Methods

Patients presenting with suspected appendicitis between November 2015 and September 2017 from age 18 years and above were included. Decision-making followed a clear management pathway. Patients were followed up for 6 months after discharge. The hypothesis was that the algorithm can reduce the NAR to a value of under 10%.

Results

A total of 183 patients were included. In 65 of 69 appendectomies, acute appendicitis was confirmed by histopathology, corresponding to a NAR of 5.8%. Notably, all 4 NAR appendectomies had other pathologies of the appendix. The perforation rate was 24.6%. Only 36 patients (19.7%) received a CT scan. The follow-up rate after 30 days achieved 69%, including no patients with missed appendicitis. The sensitivity and specificity of the diagnostic pathway was 100% and 96.6%, respectively. The potential saving in costs can be as much as 19.8 million €/100,000 cases presenting with the suspicion of appendicitis.

Conclusion

The risk-stratified diagnostic algorithm yields a high diagnostic accuracy for patients with suspicion of appendicitis. Its implementation can safely reduce the NAR, simultaneously minimizing the use of CT scans and optimizing healthcare-related costs in the treatment of acute appendicitis.

Trial registration

ClinicalTrials.gov Identifier: NCT02627781 (December 2015)

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Title: DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis
Authors: Patrizia Malkomes
Franziska Edmaier
Juliane Liese
Alexander Reinisch-Liese
Hanan El Youzouri
Teresa Schreckenbach
Andreas M. Bucher
Wolf Otto Bechstein
Andreas A. Schnitzbauer
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Appendicitis
Appendicitis
Appendectomy
Published in: Langenbeck's Archives of Surgery / Issue 1/2021
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-02022-7

At a glance: The STEP trials

Springer Medicine

DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

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