DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis

  • 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.

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Author:Patrizia MalkomesORCiDGND, Franziska EdmaierGND, Juliane LieseORCiDGND, Alexander Reinisch-LieseORCiDGND, Hanan el YouzouriGND, Teresa SchreckenbachORCiDGND, Andreas M. BucherGND, Wolf Otto BechsteinORCiDGND, Andreas SchnitzbauerORCiDGND
Parent Title (English):Langenbeck's archives of surgery
Place of publication:Berlin ; Heidelberg
Document Type:Article
Date of Publication (online):2020/11/19
Date of first Publication:2020/11/19
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2023/01/31
Tag:Acute appendicitis; Clinical trial; Diagnostic algorithm; Negative appendectomy rate; Risk-stratification
Page Number:12
First Page:141
Last Page:152
Open Access funding enabled and organized by Projekt DEAL.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0