Prioritization of Patients With Suspected Acute Appendicitis Using the Appendistat Score (APS)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 592
- 试验地点
- 2
- 主要终点
- Area under the receiver operating characteristic (ROC) curve (AUC) of the Appendistat Score (APS) for predicting histologically confirmed complicated appendicitis
研究概览
简要总结
Introduction
Although non-operative management of acute appendicitis may be appropriate in selected cases, surgery remains the gold standard treatment. Prioritization of patients at risk of developing complicated appendicitis is essential for improving outcomes. The aim of this study was to assess the predictive value and clinical utility of the Appendistat (APS) scoring system as a triaging tool to prioritize patients with a high risk of developing complicated appendicitis.
Methods This was a chart review, cross-sectional observational diagnostic study, with a single-gate retrospective design, including 592 patients who underwent appendicectomy. Based on final histological diagnosis, patients were categorized as normal, acute uncomplicated appendicitis (AUA), or acute complicated appendicitis (ACA). The predictive value matrix of the APS score for identifying patients with a histological diagnosis of complicated appendicitis was calculated.
详细描述
Detailed Description
Introduction Although conservative treatment for acute appendicitis may be appropriate in selected patients, appendicectomy remains the gold standard treatment of choice for acute appendicitis, as advocated by clinical guidelines (1,2). The timing of surgery is critical for improving patient outcomes. Guidelines from the National Confidential Inquiry into Patient Outcome and Death (NCEPOD) in the UK recommend prompt surgical intervention within hours of presentation (NCEPOD Category 2) (3). Evidence suggests that delays beyond 24 hours are associated with considerable safety concerns (4,5). Specifically, postponing surgical treatment beyond this timeframe can increase the likelihood of appendiceal perforation, necrosis, gangrene, and postoperative complications (6). Westfall and Charles demonstrated that the relative risk of perforation increases by 9% for each day of delayed treatment (7). However, challenges in emergency theatre capacity across NHS trusts frequently result in delays exceeding 24 hours, placing patients at risk of progression from uncomplicated to complicated appendicitis. A triaging tool capable of predicting patients at high risk of perforation is therefore required to ensure prioritization for timely surgical intervention.
The Appendistat (APS) scoring system was developed to identify patients at risk of complicated appendicitis. The score employs a logistic regression analysis of objective variables, including age, sex, white cell count (WCC), C-reactive protein (CRP), and bilirubin, to identify patients likely to develop complicated appendicitis (8). The APS score can be readily calculated during the initial assessment of patients suspected of acute appendicitis and can be integrated into electronic patient record (EPR) systems without the need to include symptoms, signs, or imaging results.
The purpose of this study was to assess the predictive value and clinical utility of the APS score in identifying patients at risk of complicated appendicitis on admission to a busy surgical emergency unit (SEU) at John Radcliffe Hospital, Oxford.
Methods
研究设计
- 研究类型
- Observational
- 观察模型
- Case Crossover
- 时间视角
- Cross Sectional
入排标准
- 年龄范围
- 16 Years 至 95 Years（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients aged 16-years and above, with a conclusive histological report were included.
排除标准
- •hysterectomy, and those without a conclusive pathology report were excluded
结局指标
主要结局
Area under the receiver operating characteristic (ROC) curve (AUC) of the Appendistat Score (APS) for predicting histologically confirmed complicated appendicitis
时间窗: At time of hospital admission (within 24 hours of presentation)
Diagnostic accuracy of APS assessed by calculating the AUC of the ROC curve for discriminating complicated appendicitis from
次要结局
- Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Appendistat Score (APS) for detecting complicated appendicitis(At time of hospital admission (within 24 hours of presentation))
- Mean Appendistat Score (APS) values in patients with histologically confirmed uncomplicated vs. complicated appendicitis(At time of hospital admission (within 24 hours of presentation))