TY  - JOUR
A1  - Malkomes, Patrizia
A1  - Edmaier, Franziska
A1  - Liese, Juliane
A1  - Reinisch-Liese, Alexander
A1  - Youzouri, Hanan el
A1  - Schreckenbach, Teresa
A1  - Bucher, Andreas M.
A1  - Bechstein, Wolf Otto
A1  - Schnitzbauer, Andreas
T1  - DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis
T2  - Langenbeck's archives of surgery
N2  - Purpose: The management of patients with suspected appendicitis remains a challenge in daily clinical practice, and the optimal management algorithm is still being debated. Negative appendectomy rates (NAR) continue to range between 10 and 15%. This prospective study evaluated the accuracy of a diagnostic pathway in acute appendicitis using clinical risk stratification (Alvarado score), routine ultrasonography, gynecology consult for females, and selected CT after clinical reassessment.
Methods: Patients presenting with suspected appendicitis between November 2015 and September 2017 from age 18 years and above were included. Decision-making followed a clear management pathway. Patients were followed up for 6 months after discharge. The hypothesis was that the algorithm can reduce the NAR to a value of under 10%.
Results: A total of 183 patients were included. In 65 of 69 appendectomies, acute appendicitis was confirmed by histopathology, corresponding to a NAR of 5.8%. Notably, all 4 NAR appendectomies had other pathologies of the appendix. The perforation rate was 24.6%. Only 36 patients (19.7%) received a CT scan. The follow-up rate after 30 days achieved 69%, including no patients with missed appendicitis. The sensitivity and specificity of the diagnostic pathway was 100% and 96.6%, respectively. The potential saving in costs can be as much as 19.8 million €/100,000 cases presenting with the suspicion of appendicitis.
Conclusion: The risk-stratified diagnostic algorithm yields a high diagnostic accuracy for patients with suspicion of appendicitis. Its implementation can safely reduce the NAR, simultaneously minimizing the use of CT scans and optimizing healthcare-related costs in the treatment of acute appendicitis.
KW  - Acute appendicitis
KW  - Diagnostic algorithm
KW  - Risk-stratification
KW  - Negative appendectomy rate
KW  - Clinical trial
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62835
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-628357
SN  - 1435-2451
N1  - Open Access funding enabled and organized by Projekt DEAL.
VL  - 406
IS  - 1
SP  - 141
EP  - 152
PB  - Springer
CY  - Berlin ; Heidelberg
ER  -