Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis. Issue 11 (21st July 2017)

• Record Type: Journal Article
• Authors: Andersson, M; Kolodziej, B; Andersson, R E; Andersson, R E; Andersson, M; Eriksson, T; Ramsing, A; Westman, L; Björkman, J; Håkansson, H O; Lundström, T; Björkman, H; Johansson, P; Hjert, O; Edin, R; Ekström, A; Wenander, C; Wallon, C; Andersson, P; Frisk, J; Arvidsson, B; Lantz, R; Wallin, G; Wickberg, Å; Stenberg, E; Erixon, C; Schmidt, W; Räntfors, J; Göthberg, G; Styrud, J; Elias, K; Boström, Le; Kretschmar, G; Jonsson, M; Brav, C; Nilsson, I; Kamran, F; Hammarqvist, F; Rutqvist, J; Almström, M; Hedberg, M; Lindh, V; Rosemar, A; Wangberg, H; Gustafsson, J; Neovius, G; Juhlin, C; Christofferson, R; Månsson, C; Zittel, T; Fagerström, N;
• Is Part Of: British journal of surgery. Volume 104:Issue 11(2017)
• Page Start: 1451
• Page End: 1461
• Publication Date: 2017-07-21
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.10637
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: 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 ). Abstract : Reduces imaging and admissions