Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.
Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.
World J Emerg Surg. 2020 May 1;15(1):30. doi: 10.1186/s13017-020-00309-0.
An objective algorithm for the management of suspected appendicitis guided by the Alvarado Score had previously been proposed. This algorithm was expected to reduce computed tomography (CT) utilization without compromising the negative appendectomy rate. This study attempts to validate the proposed algorithm in a randomized control trial.
A randomized control trial comparing the management of suspected acute appendicitis using the proposed algorithm compared to current best practice, with the rate of CT utilization as the primary outcome of interest. Secondary outcomes included the percentage of missed diagnosis, negative appendectomies, length of stay in days, and overall cost of stay in dollars.
One hundred sixty patients were randomized. Characteristics such as age, ethnic group, American Society of Anesthesiologist score, white cell count, and symptom duration were similar between the two groups. The overall CT utilization rate of the intervention arm and the usual care arm were similar (93.7% vs 92.5%, p = 0.999). There were no differences in terms of negative appendectomy rate, length of stay, and cost of stay between the intervention arm as compared to the usual care arm (p = 0.926, p = 0.705, and p = 0.886, respectively). Among patients evaluated with CT, 75% (112 out of 149) revealed diagnoses for the presenting symptoms.
The proposed AS-based management algorithm did not reduce the CT utilization rate. Outcomes such as missed diagnoses, negative appendectomy rates, length of stay, and cost of stay were also largely similar. CT utilization was prevalent as 93% of the study cohort was evaluated by CT scan.
The study has been registered at ClinicalTrials.gov (NCT03324165, Registered October 27 2017).
先前提出了一种基于 Alvarado 评分的疑似阑尾炎管理的客观算法。该算法有望在不影响阴性阑尾切除率的情况下降低计算机断层扫描（CT）的使用率。本研究试图在一项随机对照试验中验证该算法。
一项随机对照试验比较了使用提出的算法与当前最佳实践管理疑似急性阑尾炎的方法，以 CT 使用率作为主要观察结果。次要结果包括漏诊率、阴性阑尾切除率、住院天数和总住院费用。
共有 160 名患者被随机分配。两组患者的年龄、族裔、美国麻醉医师协会评分、白细胞计数和症状持续时间等特征相似。干预组和常规护理组的总体 CT 使用率相似（93.7%比 92.5%，p = 0.999）。与常规护理组相比，干预组的阴性阑尾切除率、住院时间和住院费用没有差异（p = 0.926，p = 0.705，p = 0.886）。在接受 CT 检查的患者中，75%（112 例）的患者对现有症状做出了诊断。
基于 AS 的管理算法并未降低 CT 使用率。漏诊率、阴性阑尾切除率、住院时间和住院费用等结果也基本相似。93%的研究队列接受了 CT 扫描，因此 CT 使用率很高。
该研究已在 ClinicalTrials.gov 注册（NCT03324165，注册于 2017 年 10 月 27 日）。
