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Joong Sub Choi - One of the best experts on this subject based on the ideXlab platform.
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the epidemiology of Appendicitis and appendectomy in south korea national registry data
Journal of Epidemiology, 2010Co-Authors: Young-sun Park, Joong Sub ChoiAbstract:Background: Appendicitis is one of the most frequent acute surgical conditions of the abdomen, and appendectomy is one of the most commonly performed operations in the world. However, epidemiological data on Appendicitis have not been reported for South Korean or East Asian populations.Methods: We analyzed the epidemiological features and lifetime risk of Appendicitis and appendectomy in South Korea using data collected for the national health insurance database from 2005 through 2007.Results: Appendectomy was performed in 59.70% of inpatients diagnosed with Appendicitis. The overall incidences of Appendicitis, total appendectomy, and perforated appendectomy were 22.71, 13.56, and 2.91 per 10 000 population per year, respectively. The incidence of Appendicitis and appendectomy showed clear seasonality, with a peak in summer. The standardized lifetime risks of Appendicitis and appendectomy were constant from 2005 through 2007. A life table model suggests that the lifetime risk of Appendicitis is 16.33% for males and 16.34% for females, and that the lifetime risk of appendectomy is 9.89% for males and 9.61% for females.Conclusions: As compared to results obtained in research on Western populations, Appendicitis and appendectomy had a similar perforation rate and seasonality, but a higher overall incidence, in South Koreans. Between 2005 and 2007, the incidence of Appendicitis and appendectomy was constant. Overall, an estimated 15 incidental appendectomies are performed to prevent 1 inpatient with suspected Appendicitis, and 26 incidental appendectomies are performed to prevent 1 appendectomy. Incidental appendectomy may have greater preventive value in Koreans.
James W Tsung - One of the best experts on this subject based on the ideXlab platform.
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the effect of point of care ultrasonography on emergency department length of stay and computed tomography utilization in children with suspected Appendicitis
Academic Emergency Medicine, 2014Co-Authors: Inna Elikashvili, Ee Tein Tay, James W TsungAbstract:Objectives The role of clinician-performed ultrasonography (US) for suspected Appendicitis is unclear. Published data conclude that US has high specificity to rule in the diagnosis of Appendicitis, with variable sensitivity to rule it out. Newer data suggest that point-of-care (POC) US may have similar test characteristics. Our objective was to evaluate the effect of POC US in children with suspected Appendicitis and its effect on emergency department (ED) length of stay (LOS) and computed tomography (CT) utilization. Methods This was a prospective observational convenience sample of children with suspected Appendicitis requiring imaging evaluation that adhered to the Standards for the Reporting of Diagnostic accuracy studies (STARD) criteria. Outcomes were determined by operative or pathology report in those who had Appendicitis, and 3-week phone follow-up in those patients who were nonoperative. Differences in ED LOS were analyzed by one-way analysis of variance (ANOVA) between patients who received dispositions after POC US, radiology US, or CT. Test performance characteristics were calculated for all imaging modalities. Results Among 150 enrolled patients, 50 had Appendicitis (33.3%). There were no missed cases of Appendicitis in discharged patients at 3-week phone follow-up, nor negative laparotomies in those who went to the operating room. Those who had dispositions after POC US (n = 25) had a significantly decreased mean ED LOS (154 minutes, 95% confidence interval [CI] = 115 to 193 minutes) compared with those requiring radiology US (288 minutes, 95% CI = 257 to 319 minutes) or CT scan (487 minutes; 95% CI = 434 to 540 minutes). Baseline CT rate was 44.2% (95% CI = 30.7% to 57.7%) prior to study start and decreased to 27.3% (95% CI = 20.17% to 34.43%) during the study. CTs were avoided in four patients with conclusive POC US results and inconclusive radiology US results. The sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR–) for POC US were 60% (95% CI = 46% to 72%), 94% (95% CI = 88% to 97%), 10 (95% CI = 4 to 23), and 0.4 (95% CI = 0.3 to 0.6). For radiology US they were 63% (95% CI = 48% to 75%), 99% (95% CI = 94% to 99%), 94 (95% CI = 6 to 1,500), and 0.4 (95% CI = 0.3 to 0.6); and for CT they were 83% (95% CI = 58% to 95%), 98% (95% CI = 85% to 99%), 45 (95% CI = 3 to 707), and 0.2 (95% CI = 0.05 to 0.5). Conclusions It may be feasible to reduce ED LOS and avoid CT scan when using POC US to evaluate children with suspected Appendicitis. Test characteristics for POC US have high specificity to rule in Appendicitis, similar to radiology US. Addition of POC US prior to sequential radiology imaging was safe, without missed cases of Appendicitis or negative laparotomies. Resumen Objetivos El papel de la ecografia (Eco) realizada por medicos clinicos para la sospecha de apendicitis no esta claro. Los datos publicados concluyen que la Eco tiene una alta especificidad para el diagnostico de apendicitis con una sensibilidad variable a la hora de descartarla. Los datos mas recientes indican que la Eco en el punto de atencion (PDA) puede tener caracteristicas diagnosticas similares. El objetivo fue evaluar el efecto de la Eco en el PDA en los ninos con sospecha de apendicitis y su efecto en la duracion de la estancia (DDE) en el servicio de urgencias (SU) y en la utilizacion de la tomografia computarizada (TC). Metodologia Estudio observacional prospectivo de una muestra de conveniencia de ninos con sospecha de apendicitis que requirieron evaluacion mediante una prueba de imagen segun los criterios STARD (Standards for the Reporting of Diagnostic Accuracy Studies). Los resultados se determinaron por el informe de la cirugia o de la anatomia patologica en aquellos que tuvieron apendicitis, y por el seguimiento telefonico a las tres semanas en aquellos pacientes que no fueron intervenidos. Las diferencias en la DDE en el SU se analizaron mediante el analisis de la varianza (ANOVA) en los pacientes en los que se realizo una toma de decision tras la Eco en el PDA, tras la Eco realizada por radiologos o tras la TC. Las caracteristicas del rendimiento de la prueba diagnostica se calcularon para todas las modalidades de imagen. Resultados De los 150 pacientes incluidos, 50 tuvieron apendicitis (33,3%). No hubo casos perdidos de apendicitis tras el alta de los pacientes a las 3 semanas de seguimiento telefonico, ni laparotomias negativas en aquellos que fueron a quirofano. Aquellos que tuvieron una disposicion tras la Eco en el PDA (n = 25) tuvieron una media significativamente menor de DDE en el SU por ANOVA de una via (154 minutos, IC 95% = 115 a 193 minutos) en comparacion con aquellos que requirieron Eco realizada por radiologos (288 minutos, IC 95% = 257 a 319 minutos) o TC (487 minutos; IC 95% = 434 a 540 minutos). El porcentaje de utilizacion de la TC en el momento inicial fue de un 44,2% (IC 95% = 30,7% a 57,7%) previamente al inicio del estudio, y descendio a un 27,3% (IC 95% = 20,17% a 34,43%) durante el estudio. Las TC se evitaron en cuatro pacientes con resultados concluyentes en la Eco en el PDA y resultados no concluyentes en la Eco realizada por radiologos. La sensibilidad, la especificidad y las razones de probabilidad positiva y negativa para Eco en el PDA fueron, respectivamente, de 60% (IC 95% = 46% a 72%), 94% (IC 95% = 88% a 97%), 10 (IC 95% = 4 a 23), y 0,4 (IC 95% = 0,3 a 0,6), respectivamente; para la Eco realizada por radiologos de 63% (IC 95% = 48% a 75%), 99% (IC 95% = 94% a 99%), 94 (IC 95% = 6 a 1.500) y 0,4 (IC 95%= 0,3 a 0,6); y para la TC de 83% (IC 95% = 58% a 95%), 98% (IC 95% = 85% a 99%), 45 (IC 95% = 3 a 707) y 0,2 (IC 95% = 0,05 a 0,5). Conclusiones Puede ser factible reducir el DDE en el SU y evitar las TC cuando se usa la Eco en el PDA para evaluar a ninos con sospecha de apendicitis. Las caracteristicas de la prueba diagnostica para la Eco en el PDA tienen alta especificidad para el diagnostico de apendicitis, similar a la Eco realizada por radiologos. Ademas, la Eco en el PDA previa a la imagen de radiologia secuencial es segura, sin casos perdidos de apendicitis o laparotomias negativas.
Young-sun Park - One of the best experts on this subject based on the ideXlab platform.
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the epidemiology of Appendicitis and appendectomy in south korea national registry data
Journal of Epidemiology, 2010Co-Authors: Young-sun Park, Joong Sub ChoiAbstract:Background: Appendicitis is one of the most frequent acute surgical conditions of the abdomen, and appendectomy is one of the most commonly performed operations in the world. However, epidemiological data on Appendicitis have not been reported for South Korean or East Asian populations.Methods: We analyzed the epidemiological features and lifetime risk of Appendicitis and appendectomy in South Korea using data collected for the national health insurance database from 2005 through 2007.Results: Appendectomy was performed in 59.70% of inpatients diagnosed with Appendicitis. The overall incidences of Appendicitis, total appendectomy, and perforated appendectomy were 22.71, 13.56, and 2.91 per 10 000 population per year, respectively. The incidence of Appendicitis and appendectomy showed clear seasonality, with a peak in summer. The standardized lifetime risks of Appendicitis and appendectomy were constant from 2005 through 2007. A life table model suggests that the lifetime risk of Appendicitis is 16.33% for males and 16.34% for females, and that the lifetime risk of appendectomy is 9.89% for males and 9.61% for females.Conclusions: As compared to results obtained in research on Western populations, Appendicitis and appendectomy had a similar perforation rate and seasonality, but a higher overall incidence, in South Koreans. Between 2005 and 2007, the incidence of Appendicitis and appendectomy was constant. Overall, an estimated 15 incidental appendectomies are performed to prevent 1 inpatient with suspected Appendicitis, and 26 incidental appendectomies are performed to prevent 1 appendectomy. Incidental appendectomy may have greater preventive value in Koreans.
Chiung Yu Chen - One of the best experts on this subject based on the ideXlab platform.
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Clinical analysis of the predictive factors for recurrent Appendicitis after initial nonoperative treatment of perforated Appendicitis.
American journal of surgery, 2006Co-Authors: Hong Ming Tsai, Yan Shen Shan, Pin Wen Lin, Xi-zhang Lin, Chiung Yu ChenAbstract:Abstract Background The purpose of this study was to study the clinical symptoms, laboratory data, and the characteristics of computed tomography (CT) imaging of nonoperated perforated Appendicitis for predicting the recurrence of Appendicitis. Methods Thirty-five patients with nonoperated perforated Appendicitis were retrospectively reviewed for this study. During a median follow-up period of 1155 days, 7 patients had to receive an appendectomy owing to recurrent Appendicitis. Accordingly, the patients were divided into 2 groups: the recurrence and the nonrecurrence group. The clinical characteristics between these 2 groups were compared. Results Both of the 2 patients who had a past history of Appendicitis suffered recurrent Appendicitis (the recurrence versus the nonrecurrence group, P P Conclusions It is most likely that Appendicitis will recur if a calcified appendicolith on CT imaging or a past history of Appendicitis is presented. Interval appendectomy may be reserved only for those patients who possess one of these risk factors of recurrent Appendicitis.
Jacob C Langer - One of the best experts on this subject based on the ideXlab platform.
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prospective validation of the pediatric Appendicitis score
The Journal of Pediatrics, 2008Co-Authors: Ran D Goldman, Susan Carter, Derek Stephens, Roula Antoon, William Mounstephen, Jacob C LangerAbstract:Objective To prospectively validate the Pediatric Appendicitis Score (PAS), developed on a cohort of children with abdominal pain suggestive of Appendicitis, in unselected children with abdominal pain who present to the emergency department. Study design Over a 19-month period, we prospectively recruited children 1 to 17 years old who came to our tertiary pediatric emergency department, with a chief complaint of abdominal pain of duration less than 7 days. PAS components included fever >38° C, anorexia, nausea/vomiting, cough/percussion/hopping tenderness (2 points), right-lower-quadrant tenderness (2 points), migration of pain, leukocytosis >10 000 cells/mm 3 , and polymorphonuclear neutrophilia > 7500 cells/mm 3 . A follow-up call was made to verify final outcome. Sensitivity, specificity, and the receiver operating characteristic curve of the PAS with respect to diagnosis of Appendicitis were calculated. Results We collected data on 849 children. 123 (14.5%) had pathologic study–proven Appendicitis. Mean (median, range) score for children with Appendicitis and without Appendicitis was 7.0 (7, 2-10) and 1.9 (1, 0-9), respectively. If a cutoff PAS of ≤2 was used to discharge patients without further investigation, only 3 (2.4%) with Appendicitis would be sent home. If a PAS of ≥7 was used to take children to the operating room without further investigation, only 29 (4%) would not have Appendicitis. For the PAS the area under the receiver operator curve was 0.95. Conclusions The PAS is useful, because a value ≤2 (found in 73% of children without Appendicitis) has high validity for ruling out Appendicitis, and a score ≥7 (found in 61% of children with Appendicitis) has a high validity for predicting the presence of Appendicitis. Children with PAS of 3 to 6 (37% with Appendicitis and 23% without Appendicitis in this study) should undergo further investigation such as observation, ultrasonography, or computed tomography.