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Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Cty Council Jonkoping, Dept Surg, Ryhov Cty Hosp, Jonkoping, Sweden.
County Council Jonköping, Sweden.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. County Council Jonköping, Sweden.
2017 (engelsk)Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 104, nr 11, s. 1451-1461Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BackgroundThe 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. MethodPatients presenting with suspicion of appendicitis between September 2009 and January 2012 from age 10years were included at 21 emergency surgical centres and from age 5years 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. ResultsThe 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 (192 versus 345 per cent; Pamp;lt;0001), fewer admissions (295 versus 428 per cent; Pamp;lt;0001), and fewer negative explorations (16 versus 32 per cent; P=0030) and operations for non-perforated appendicitis (68 versus 97 per cent; P=0034). Intermediate-risk patients randomized to the imaging and observation groups had the same proportion of negative appendicectomies (64 versus 67 per cent respectively; P=0884), 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 (534 versus 463 per cent; P=0020). ConclusionAIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 ( ). Reduces imaging and admissions

sted, utgiver, år, opplag, sider
WILEY , 2017. Vol. 104, nr 11, s. 1451-1461
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Identifikatorer
URN: urn:nbn:se:liu:diva-141707DOI: 10.1002/bjs.10637ISI: 000410320900005PubMedID: 28730753OAI: oai:DiVA.org:liu-141707DiVA, id: diva2:1151731
Merknad

Funding Agencies|Futurum - the Academy for Health and Care Jonkoping County Council, Sweden; Research Council of South-Eastern Sweden

Tilgjengelig fra: 2017-10-24 Laget: 2017-10-24 Sist oppdatert: 2017-10-24

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