Diagnosis and management of acute appendicitis. EAES consensus development conference 2015

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.

Electronic supplementary material

The online version of this article (doi:10.1007/s00464-016-5245-7) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 183

Record: found
Abstract: found
Article: not found

Estimated risks of radiation-induced fatal cancer from pediatric CT.

D. Brenner, C Elliston, E. Hall … (2001)

In light of the rapidly increasing frequency of pediatric CT examinations, the purpose of our study was to assess the lifetime cancer mortality risks attributable to radiation from pediatric CT. Organ doses as a function of age-at-diagnosis were estimated for common CT examinations, and estimated attributable lifetime cancer mortality risks (per unit dose) for different organ sites were applied. Standard models that assume a linear extrapolation of risks from intermediate to low doses were applied. On the basis of current standard practice, the same exposures (milliampere-seconds) were assumed, independent of age. The larger doses and increased lifetime radiation risks in children produce a sharp increase, relative to adults, in estimated risk from CT. Estimated lifetime cancer mortality risks attributable to the radiation exposure from a CT in a 1-year-old are 0.18% (abdominal) and 0.07% (head)-an order of magnitude higher than for adults-although those figures still represent a small increase in cancer mortality over the natrual background rate. In the United States, of approximately 600,000 abdominal and head CT examinations annually performed in children under the age of 15 years, a rough estimate is that 500 of these individuals might ultimately die from cancer attributable to the CT radiation. The best available risk estimates suggest that pediatric CT will result in significantly increased lifetime radiation risk over adult CT, both because of the increased dose per milliampere-second, and the increased lifetime risk per unit dose. Lower milliampere-second settings can be used for children without significant loss of information. Although the risk-benefit balance is still strongly tilted toward benefit, because the frequency of pediatric CT examinations is rapidly increasing, estimates that quantitative lifetime radiation risks for children undergoing CT are not negligible may stimulate more active reduction of CT exposure settings in pediatric patients.

0 comments Cited 394 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

A practical score for the early diagnosis of acute appendicitis.

Alfredo Alvarado (1986)

We conducted a retrospective study of 305 patients hospitalized with abdominal pain suggestive of acute appendicitis. Signs, symptoms, and laboratory findings were analyzed for specificity, sensitivity, predictive value, and joint probability. The total joint probability, the sum of a true-positive and a true-negative result, was chosen as a diagnostic weight indicative of the accuracy of the test. Eight predictive factors were found to be useful in making the diagnosis of acute appendicitis. Their importance, according to their diagnostic weight, was determined as follows: localized tenderness in the right lower quadrant, leukocytosis, migration of pain, shift to the left, temperature elevation, nausea-vomiting, anorexia-acetone, and direct rebound pain. Based on this weight, we devised a practical diagnostic score that may help in interpreting the confusing picture of acute appendicitis.

0 comments Cited 270 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Understanding GRADE: an introduction.

Gabrielle Goldet, Jeremy Howick (2013)

Grading of recommendations, assessment, development, and evaluations (GRADE) is arguably the most widely used method for appraising studies to be included in systematic reviews and guidelines. In order to use the GRADE system or know how to interpret it when reading reviews, reading several articles and attending a workshop are required. Moreover, the GRADE system is not covered in standard medical textbooks. Here, we explain GRADE concisely with the use of examples so that students and other researchers can understand it. In order to use or interpret the GRADE system, reading several articles and attending a workshop is currently required. Moreover, the GRADE system is not covered in standard medical textbooks. We read, synthesized, and digested the GRADE publications and contacted GRADE contributors for explanations where required. We composed a digested version of the system in a concise way a general medical audience could understand. We were able to explain the GRADE basics clearly and completely in under 1500 words. While advanced critical appraisal requires judgment, training, and practice, it is possible for a non-specialist to grasp GRADE basics very quickly. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

0 comments Cited 128 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Ramon R. Gorter: +31 20 444 2424 , rr.gorter@vumc.nl

Journal

Journal ID (nlm-ta): Surg Endosc

Journal ID (iso-abbrev): Surg Endosc

Title: Surgical Endoscopy

Publisher: Springer US (New York )

ISSN (Print): 0930-2794

ISSN (Electronic): 1432-2218

Publication date (Electronic): 22 September 2016

Publication date PMC-release: 22 September 2016

Publication date (Print): 2016

Volume: 30

Issue: 11

Pages: 4668-4690

Affiliations

[1 ]Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands

[2 ]Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands

[3 ]Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands

[4 ]Department of Surgery, St Mary’s Hospital, London, UK

[5 ]Department of Surgery, Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany

[6 ]Department of Surgery, University Hospital of Heraklion, Heraklion, Greece

[7 ]Department of Surgery, University of Torino, Torino, Italy

[8 ]Department of Surgery, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany

[9 ]Department of Surgery, Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy

[10 ]Department of Surgery, Maria Middelares Ghent, Ghent, Belgium

[11 ]Department of Surgery, Hospital Clinic of Barcelona, Barcelona, Spain

[12 ]Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands

[13 ]Department of Surgery, Noordwest Clinics Alkmaar, Alkmaar, The Netherlands

[14 ]Department of Surgery, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

[15 ]Medical Library, Vrije Universiteit, Amsterdam, The Netherlands

[16 ]Department of Surgery, School of Medicine, Bahcesehir University, Istanbul, Turkey

[17 ]Department of Surgery, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel

[18 ]Department of Surgery, Stepping Hill Hospital, Stockport, UK

[19 ]Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

[20 ]Department of Surgery, Medical School University of Pécs, Pecs, Hungary

[21 ]Department of Surgery, University Hospital Vall Hebrón, Barcelona, Spain

[22 ]Department of Pediatric Surgery, VU University Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands

Article

Publisher ID: 5245

DOI: 10.1007/s00464-016-5245-7

PMC ID: 5082605

PubMed ID: 27660247

SO-VID: 810c1fd8-0c59-49a2-936d-a557e9dda422

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 4 August 2016

Date accepted : 9 September 2016

Funding

Funded by: EAES

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: appendicitis,uncomplicated appendicitis,complicated appendicitis,appendectomy,laparoscopic appendectomy

Data availability:

ScienceOpen disciplines: Surgery

Keywords: appendicitis, uncomplicated appendicitis, complicated appendicitis, appendectomy, laparoscopic appendectomy

Diagnosis and management of acute appendicitis. EAES consensus development conference 2015

Read this article at

Abstract

Electronic supplementary material

Related collections

25th European Students' Conference

Most cited references 183

Estimated risks of radiation-induced fatal cancer from pediatric CT.

A practical score for the early diagnosis of acute appendicitis.

Understanding GRADE: an introduction.

Author and article information

Contributors

Journal

Affiliations

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 190

Cited by 104

Most referenced authors 2,345