Acute Appendicitis
Conditions
Keywords
Appendicitis Inflammatory Response Score, Appendectomy, Computed Tomography
Brief summary
Acute appendicitis is one of the most common surgical emergencies, but diagnostic uncertainty may still lead to unnecessary appendectomy in some patients. This prospective observational study aims to evaluate the diagnostic performance of computed tomography (CT) reporting and the Appendicitis Inflammatory Response (AIR) score in adult patients undergoing appendectomy for suspected acute appendicitis. The primary objective is to determine the negative appendectomy rate based on final histopathology. Secondary objectives are to assess the agreement between AIR score, CT findings, intraoperative severity grading, and pathology results, and to explore diagnostic performance across patient subgroups. No study-specific intervention beyond routine clinical care will be performed.
Detailed description
This is a single-center, prospective observational study conducted in adult patients presenting to the emergency department with suspected acute appendicitis. Patients aged 18 years or older who undergo computed tomography (CT) after clinical evaluation, have a CT report compatible with acute appendicitis, and subsequently undergo appendectomy will be eligible for inclusion. Patients younger than 18 years, pregnant patients or those with suspected pregnancy, patients taken directly to surgery without CT evaluation, patients whose CT report suggests a diagnosis other than acute appendicitis, patients requiring an additional non-appendectomy surgical procedure because of another intraoperative pathology, and patients who decline participation will be excluded. Clinical and demographic data will be collected prospectively using a standardized study form. Recorded variables will include age, sex, comorbidities, previous abdominal surgery history, symptom duration, physical examination findings, and laboratory parameters relevant to appendicitis assessment. The Appendicitis Inflammatory Response (AIR) score will be calculated using routine clinical and laboratory data. CT examinations obtained as part of routine emergency care will be reviewed according to the official radiology reports. Intraoperative findings will be graded using the American Association for the Surgery of Trauma (AAST) appendicitis severity grading system. Final histopathologic examination of the resected appendix specimen will be used as the reference standard. The primary outcome measure is the negative appendectomy rate, defined as appendectomy with final pathology not confirming acute appendicitis. Secondary outcome measures include agreement between AIR score and final pathology, agreement between CT report and final pathology, agreement between intraoperative AAST grading and final pathology, and differences in diagnostic performance across patient subgroups such as age, sex, and previous abdominal surgery history. No study-specific intervention will be applied beyond routine diagnostic and therapeutic management. Treatment decisions will be made according to standard clinical practice. All data will be coded and recorded without directly identifiable patient information.
Interventions
None listed
Sponsors
Sanliurfa Education and Research Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older * Presentation to the emergency department with suspected acute appendicitis * Underwent computed tomography after clinical evaluation * Computed tomography report compatible with acute appendicitis * Underwent appendectomy for presumed acute appendicitis * Provided informed consent
Exclusion criteria
* Age younger than 18 years * Pregnancy * Planned additional surgical intervention in the same session for a reason other than appendicitis * Intraoperative finding of a non-appendiceal pathology requiring a different surgical procedure * Refusal to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic agreement between CT report and final histopathology | From CT evaluation to final pathology report, up to 30 days | Concordance between computed tomography findings reported as compatible with acute appendicitis and final histopathologic diagnosis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Negative appendectomy rate | From appendectomy to final pathology report, up to 30 days | The proportion of patients who undergo appendectomy but whose final histopathologic examination does not confirm acute appendicitis. |
| Agreement between AIR score and final histopathology | From admission to final pathology report, up to 30 days | Association between the Appendicitis Inflammatory Response (AIR) score and histopathologic confirmation of acute appendicitis. |
| Agreement between intraoperative AAST grading and final histopathology | From surgery to final pathology report, up to 30 days | Concordance between intraoperative appendicitis severity grading based on the AAST classification and final histopathologic findings. |
| Comparative diagnostic performance of CT report and AIR score | From admission to final pathology report, up to 30 days | Comparison of the diagnostic performance of computed tomography reporting and AIR score in predicting histopathologically confirmed acute appendicitis. |
| Diagnostic performance in patient subgroups | From admission to final pathology report, up to 30 days | Differences in diagnostic performance according to age, sex, comorbidities, and previous abdominal surgery history. |
Countries
Turkey (Türkiye)
Contacts
CONTACTVedat Kaplan, MD
Outcome results
None listed