Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah-Tiqwa, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
ANZ J Surg. 2024 Feb;94(1-2):204-207. doi: 10.1111/ans.18825. Epub 2023 Dec 11.
Correct diagnosis of acute appendicitis may sometimes be challenging. The Negative appendectomy rate (NAR) has declined in the recent years in Europe and USA, in part due to better diagnostic imaging tools. The aim of this study was to examine the rates of negative appendectomy in our institution, investigate trends in its incidence, and identify possible predicting factors.
A retrospective cohort study, including all patients younger than 18 years of age who underwent an appendectomy between 2007 and 2021 in a single tertiary medical center. Data regarding patient's demographics, laboratory and imaging results, pathological results and clinical outcome were collected.
Between 2007 and 2021, a total of 3937 pediatric patients underwent appendectomy due to a working diagnosis of acute appendicitis. Overall, 143 patients (3.6%) had normal appendix on pathological examination. However, in the last 5 years, the rate of normal appendix was 1.9%, together with an increased rate of pre-operative imaging (from 40% to nearly 100%).
Low NAR under 2% is an achievable benchmark in the era of accessible pre-operative imaging. In unequivocal cases, a secondary survey that includes repeated physical examination, blood work and imaging is recommended and may result in near-zero rates of NAR.
急性阑尾炎的正确诊断有时可能具有挑战性。近年来，欧洲和美国的阴性阑尾切除术率（NAR）有所下降，部分原因是诊断成像工具的改善。本研究旨在检查我们机构的阴性阑尾切除术率，调查其发病率的趋势，并确定可能的预测因素。
这是一项回顾性队列研究，纳入了 2007 年至 2021 年期间在一家三级医疗中心因疑似急性阑尾炎而行阑尾切除术的所有年龄小于 18 岁的患者。收集了患者的人口统计学、实验室和影像学结果、病理结果和临床结局数据。
2007 年至 2021 年间，共有 3937 名儿科患者因疑似急性阑尾炎而行阑尾切除术。总体而言，143 名患者（3.6%）的病理检查显示阑尾正常。然而，在过去 5 年中，正常阑尾的比例为 1.9%，同时术前影像学检查的比例增加（从 40%增加到近 100%）。
在可获得术前影像学检查的时代，接近 2%的低 NAR 率是可以实现的目标。在明确的病例中，建议进行包括重复体格检查、血液检查和影像学检查的二次检查，这可能会使 NAR 率接近零。
