Changing Epidemiology of Acute Appendicitis in the United States: Study Period 1993–2008

Buckius, Michelle T.; McGrath, Brian J.; Monk, John; Grim, Rod; Bell, Theodore; Ahuja, Vanita

doi:10.1016/j.jss.2011.07.017

Cited by 252 publications

(139 citation statements)

References 11 publications

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“…Reduced incidence of acute appendicitis in children was also reported by Aarabi and co‐workers6 in New England in 2000–2006. In contrast to these reports of declining rates, increased rates of appendicitis were reported from Norway8 and the USA10 11, and Livingston et al 9. identified a ‐shaped incidence rate trend, with increasing acute appendicitis rates in children in the USA up to 2004.…”

Section: Discussionmentioning

confidence: 92%

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Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

et al. 2018

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BackgroundThe long‐term incidence of acute appendicitis has been reported to be declining in Europe and North America. Recent reports, however, indicate stabilized or even increased rates. The aim of this study was to investigate the present epidemiology of acute appendicitis and appendicectomy in a population‐based cohort of Swedish children.MethodsThe Swedish National Patient Register was queried for all children with acute appendicitis and/or appendicectomy in 1987–2013. Population‐based incidence rates were calculated. Rates were age‐ and sex‐adjusted, and analysed for temporal and regional trends.ResultsSome 56 774 children with acute appendicitis were identified, of whom 53 478 (94·2 per cent) underwent appendicectomy. The incidence rate of acute appendicitis declined by 43·7 per cent over 26 years, from 177·7 to 100·1 per 100 000 person‐years between 1987 and 2013. The most significant reduction was for non‐perforated appendicitis, from 138·5 to 68·4 per 100 000 person‐years between 1987 and 2009. The incidence rate of perforated appendicitis decreased from 28·0 to 19·9 per 100 000 person‐years and negative appendicectomies reduced from 48·5 to 3·6 per 100 000 person‐years during the study interval.ConclusionThe incidence rates of acute appendicitis and negative appendicectomy have reduced markedly in Swedish children over time, with significantly different trends amongst non‐perforated appendicitis and perforated appendicitis. The full explanation for the observed findings is unclear.

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Section: Discussionmentioning

confidence: 92%

“…Studies from Europe and North America report decreasing rates of acute appendicitis, both in general1, 2, 3, 4 and in children5 6. There have been, however, more recent reports of stabilized7 8 or even increased9, 10, 11 incidence rates during the first decade of the 21st century.…”

Section: Introductionmentioning

confidence: 99%

Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

et al. 2018

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“…In the literature, appendiceal perforation rates range from 21% to 73% with rates as high as 88% in the youngest children [1, 2, 26]. In our cohort, the overall perforation rate was 35.1%.…”

Section: Discussionmentioning

confidence: 67%

“…Appendectomy is one of the most frequently performed surgical procedures in children, and its frequency in the United States has been increasing [1]. Ultrasound and CT are the most commonly used imaging modalities to evaluate patients with symptoms of acute appendicitis, particularly because the findings can lead to a change in the treatment plan in patients with acute appendicitis [2].…”

mentioning

confidence: 99%

Do Clinical Outcomes Suffer During Transition to an Ultrasound-First Paradigm for the Evaluation of Acute Appendicitis in Children?

Kurian

Cohen

et al. 2013

American Journal of Roentgenology

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Objective The objective of our study was to examine whether the rate of complicated appendicitis and the hospital length of stay (LOS) increased during the transition to an ultra-sound-first paradigm for the imaging evaluation of acute appendicitis. Materials and Methods All pediatric patients with surgically proven appendicitis from 2005 to 2011 were identified by searching the hospital billing database for the discharge diagnosis codes for simple appendicitis (ICD-9 [International Classification of Diseases, 9th revision] code 540.9) and complicated appendicitis (ICD-9 codes 540.0 and 540.1). Annual trends of the proportions of these patients who underwent ultrasound and CT were determined and plotted for the study period. Correlation of complicated appendicitis and median hospital LOS with calendar year was assessed using the Spearman (ρ) rank correlation test. Results Eight hundred four patients met the inclusion criteria. The percentage of patients who underwent CT only showed a moderate downward association with year (ρ = –0.32, p < 0.01), and the percentage of patients who underwent ultrasound first showed a moderate upward trend (ρ = 0.44, p < 0.01). The percentage of patients with ultrasound as the only study performed before appendectomy increased moderately over the 7-year study period (ρ = 0.33, p < 0.01). The percentage of patients with complicated appendicitis and the median hospital LOS did not increase significantly over the study duration (ρ = –0.01, p = 0.74 and ρ = –0.04, p = 0.25, respectively). Conclusion The transition to an ultrasound-first pathway for the imaging workup of acute appendicitis in children occurred without evidence of a corresponding increase in the proportion of patients with complicated appendicitis or in the median hospital LOS.

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“…Furthermore the risk of later cancer is much higher for younger patients. Acute appendicitis occurs most frequently in patients aged 10–19 years old,5 a group which is 10 times more sensitive to risk from radiation when compared to adults 6. An Israeli study investigating the relationship between CT scans in patients under the age of 18 and future cancer mortality risk concluded that CT scans alone performed on the paediatric population will cause a 0.29% increase in baseline future cancer mortality 7…”

Section: Morbidity and Mortality Risks Of Abdominal Ct Scanmentioning

confidence: 99%

Harms of CT scanning prior to surgery for suspected appendicitis

Hoffman

Noori

2014

Evid Based Med

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Changing Epidemiology of Acute Appendicitis in the United States: Study Period 1993–2008

Cited by 252 publications

References 11 publications

Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

Do Clinical Outcomes Suffer During Transition to an Ultrasound-First Paradigm for the Evaluation of Acute Appendicitis in Children?

Harms of CT scanning prior to surgery for suspected appendicitis

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