Nationwide prospective audit for the evaluation of appendicitis risk prediction models in adults: Right iliac fossa treatment (RIFT) - Turkey
Makaleler > Tam Makale · 2024
Yazarlar: Ali Yalcinkaya, Ahmet Yalcinkaya, Bengi Balci, Can Keskin, Ibrahim Erkan, Alp Yildiz, Erdinc Kamer, Sezai Leventoglu, Mehmet Caglikulekci, Elbrus Zarbaliyev, Murat Sevmis, Yigit Ulgen, Yuksel Altinel, Serhat Meric, Ahmet Akbas, Nadir Adnan Hacim, Talar Vartanoglu Aktokmanyan, Yunus Emre Aktimur, Fikret Calikoglu, Hasim Furkan Gullu, Ahmet Guray Durma, Sami Acar, Erman Ciftci, Emre Balik, Cemil Burak Kulle, Ibrahim Halil Ozata, Tutku Tufekci, Cihad Tatar, Mert Mahsuni Sevinc, Husnu Sevik, Candeniz Ertürk, Irem Nur Kiraz, Volkan Ozben, Erman Aytac, Zumrud Aliyeva, Arda Ulas Mutlu, Mert Tanal, Mustafa Fevzi Celayir, Emre Bozkurt, Sitki Gurkan Yetkin, Emin Ergin, Wafi Attaallah, Tevfik Kivilcim Uprak, Ahmet Omak, Oguzhan Simsek, Mehmet Abdussamet Bozkurt, Yasin Kara, Emre Bozdag, Hakan Yirgin, Adem Ozcan, Nuri Okkabaz, Yasar Ozdenkaya, Mustafa Celalettin Haksal, Caglar Kazim Pekuz, Sila Duru, Emre Sivrikoz, Yavuz Ozdemir, Necati Tan, Feza Yarbug Karayali, Abdulla Taghiyeva, Ismail Tirnova, Ilknur Erenler Bayraktar, Onur Bayraktar, Emine Zulal Emsal, Munevver Irem Dalkilic, Metin Yesiltas, Hasan Tok, Dursun Ozgur Karakas, Ali Pusane, Ali Ilbey Demirer, Hasan Berk Sahin, Ali Fuat Kaan Gok, Halil Alper Bozkurt, Mehmet Iskender Yildirim, Gorkem Uzunyolcu, Hakan Teoman Yanar, Sefa Ergun, Fadime Kutluk, Server Sezgin Uludag, Abdullah Kagan Zengin, Mehmet Faik Ozcelik, Ahmet Necati Sanli, Yunus Emre Altuntas, Ecem Memisoglu, Ramazan Sari, Osman Akdogan, Hasan Fehmi Kucuk, Omer Faruk Ozkan, Hanife Seyda Ulgur, Emre Furkan Kirkan, Sema Yuksekdag, Ahmet Rencuzogullari, Melik Kagan Aktas, Murat Aba, Ahmet Onur Demirel, Ismail Cem Eray, Burak Aydogan, Suleyman Cetinkunar, Kemal Yener, Alper Sozutek, Yiğit TÜRK
BJS OPEN, SCI Expanded İndekslerine Giren Dergi, Uluslararası, Scopus, 2024, cilt 8, ss zrae120-zrae120
Özet
Background: Appendicitis is the most prevalent surgical emergency. The negative appendicectomy rate and diagnostic uncertainty are important concerns. This study aimed to assess the effectiveness of current appendicitis risk prediction models in patients with acute right iliac fossa pain. Methods: A nationwide prospective observational study was conducted, including all consecutive adult patients who presented with right iliac fossa pain. Diagnostic, clinical and negative appendicectomy rate data were recorded. The Alvarado score, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Adult Appendicitis Score systems were calculated with collected data to classify patients into risk categories. Diagnostic value and categorization performance were evaluated, with use of risk category-based metrics including 'true positive rate' (percentage of appendicitis patients in the highest risk category), 'failure rate' (percentage of patients with appendicitis in the lowest risk category) and 'categorization resolution' (true positive rate/failure rate). Results: A total of 3358 patients from 84 centres were included. Female patients were less likely to undergo surgery than men (71.5% versus 82.5% respectively; relative risk 0.866, 95% c.i. 0.834 to 0.901, P < 0.001); with a three-fold higher negative appendicectomy rate (11.3% versus 4.1% respectively; relative risk 2.744, 95% c.i. 2.047 to 3.677, P < 0.001). Ultrasonography was utilized in 56.8% and computed tomography in 75.2% of all patients. The Adult Appendicitis Score had the best diagnostic performance for the whole population; however, only RIPASA was significant in men. All scoring systems were successful in females patients, but Adult Appendicitis Score had the highest area under the receiver operating characteristic curve value. The RIPASA and the Adult Appendicitis Score had the best categorization resolution values, complemented by their exceedingly low failure rates in both male and female patients. Alvarado and AIR had extremely high failure rates in men. Conclusion: The negative appendicectomy rate was low overall, but women had an almost three-fold higher negative appendicectomy rate despite lower likelihood to undergo surgery. The overuse of imaging tests, best exemplified by the 75.2% frequency of patients undergoing computed tomography, may lead to increased costs. Risk-scoring systems such as RIPASA and Adult Appendicitis Score appear to be superior to Alvarado and AIR.