Key result
A preoperative scoring system is linked to ~30% fewer immediate off-hours emergency operations.
Why the study?
Preoperative predictors of complicated appendicitis were identified previously but required prospective validation to guide emergency surgical decisions.
Does a scoring system using three preoperative predictors accurately identify complicated appendicitis and safely reduce emergency operations in adult patients with acute appendicitis?
Population
116 adult patients who underwent surgery for acute appendicitis from January 2013 to October 2014
Comparison
Use of three preoperative predictors to guide immediate versus short in-hospital delayed surgery versus historical practice
Design
Prospective cohort study
Authors
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May safely defer emergency surgery without predictors; supports larger prospective validation before routine use.
Cohort (n=116)
No
Does a scoring system using three preoperative predictors accurately identify complicated appendicitis and safely reduce emergency operations in adult patients with acute appendicitis?
Absolute Event Rate: 58% vs 83%
Absolute Risk Reduction: 25%
p-value: p=< 0.01
A three-factor preoperative scoring system accurately predicts complicated appendicitis and safely reduces the need for immediate emergency surgery during night or holiday shifts.
Imaoka et al. (2016) conducted a cohort in Acute appendicitis (n=116). Preoperative scoring system (body temperature ≥37.4 °C, CRP ≥4.7 mg/dl, fluid collection on CT) vs. Historical retrospective cohort (standard care without the scoring system) was evaluated on Immediate emergency operation rate at night or on a holiday (p=< 0.01). Adopting a preoperative scoring system based on body temperature, CRP, and CT findings reduced the immediate emergency operation rate at night or on holidays from 83% to 58% (p < 0.01).
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