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Future Research

Future Research. Scott Geiger, D.O . PGY-IV Sam Brewer, D.O . PGY-IV. A prospective comparison of CT with no contrast, IV contrast alone, and oral and IV contrast, using the newest CT technology. An analysis of a Bayesian approach using ultrasound to diagnose appendicitis in children.

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Future Research

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  1. Future Research Scott Geiger, D.O. PGY-IV Sam Brewer, D.O. PGY-IV

  2. A prospective comparison of CT with no contrast, IV contrast alone, and oral and IV contrast, using the newest CT technology.

  3. An analysis of a Bayesian approach using ultrasound to diagnose appendicitis in children. • Child with low pretest probability of appy, can nondx or neg u/s r/o appy. • Bayesian approach – statistical model that predicts results

  4. Whether combinations of history, physical examination, and laboratory results can help diagnose or exclude appendicitis.

  5. The Samuel score (pediatric appendicitis score) This scoring system is based on 8 variables, as follows[12] : 1) RLQ tenderness elicited by cough, hopping, or percussion 2) Anorexia 3) Elevated temperature 4) Nausea/vomiting 5) Tenderness over the right iliac fossa 6) Leukocytosis 7) Increased polymorphonuclear neutrophil percentage (ie, left shift on white blood cell differential) 8) Migration of pain Samuel recommended that patients with a score of 5 or lower should be observed, while those with a score of 6 or higher should undergo surgical consultation

  6. Research protocols that focus on techniques for limiting ionizing radiation exposure from CT used to diagnose appendicitis. • US • Scoring systems

  7. Antibiotics only?

  8. Appendectomy versus antibiotic treatment for acute appendicitis (Review) • 5 RCT’s (305  18) • 901 pts • 73.4% cure in abx group • 97.4% in surgery group 2011, issue 11

  9. Conclusions “The upper bound of the 95% CI of abxtxfor cure w/in 2 weeks w/o major complications crosses the 20% margin of appy, so the outcome is inconclusive.”

  10. Study quality low to moderate • “…We conclude that appendectomy remains the standard treatment for acute appendicitis.”

  11. British Journal of Surgery • Hansson, et al. 2009; 96: 473–481 • Gothenburg, Sweden

  12. SED = Swedish krona

  13. Overall • Overall efficacy • Abx– 90.9% • Surgery – 89.2% • 13.9% abx had recurrance in 1 year • Surgery group complications 3x higher

  14. British Medical Journal • Safety and efficacy of antibiotics compared with appendicectomyfor treatment of uncomplicated acute appendicitis: meta-analysis of randomisedcontrolled trials • Varadhan, et al. BMJ 2012;344 (Published 5 April 2012)

  15. 900 adult patients diagnosed with uncomplicated acute appendicitis. A total of 470 patients received antibiotics, and 430 underwent surgery. • ABX  63% success rate at one year • 68 came back with appendicitis requiring surgery, 9 perforated and 4 were gangrenous

  16. May 9, 2012 epub ahead of print • Sahlgrenska University Hospital, Goteborg, Sweden • All acute appypts offered abx only vs surgery • Zosyn for unknown days • 9 days home Cipro + Metro • Success = recovery w/o need of surgery x 1 year

  17. 558 pts • 442 (79%) abx group • 77% recovered • 23% failed  surgery • 11% recurrent appy • Fewer complications • 111 (20%) surgery group

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