Effect of pain control in suspected acute appendicitis on the diagnostic accuracy of surgical residents

Kang, Kyeongwon; Kim, Woo Jeong; Kim, Kyuseok; Jo, You Hwan; Rhee, Joong Eui; Lee, Jin Hee; Kim, Yu Jin; Lee, Jaehuk; Kang, Sung Bum; Kim, Duck Woo; Lee, Kyung Ho; Kim, Young Hoon; Park, Hyunmi

doi:10.2310/8000.2013.131285

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…For children and adolescents, tailoring the history and physical examination to their age and developmental level is essential, and the examiner's experience plays a vital role, especially with younger children. Administering analgesics does not significantly obscure clinical findings [41]. In pediatric cases, the absence of symptoms such as nausea, vomiting, abdominal tenderness, and leukocytosis effectively rules out appendicitis with a 98% accuracy [42].…”

Section: Clinical Presentationmentioning

confidence: 99%

Misdiagnosis of Acute Appendicitis Cases in the Emergency Room

Mostafa,

El-Atawi

2024

Cureus

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Acute appendicitis (AA) is one of the most frequent surgical emergencies, especially in pediatric populations, with its misdiagnosis in emergency settings presenting significant health risks. This misdiagnosis leads to various complications, such as delayed treatment or unnecessary surgeries. Factors such as age, gender, and comorbidities contribute to diagnostic errors, leading to complications such as peritonitis and increased negative appendectomy rates. This underscores the importance of accurate clinical assessment and awareness of common pitfalls, such as cognitive biases and over-reliance on laboratory tests. This review delves into the prevalence of AA misdiagnosis, its health burden, and the challenges inherent in the diagnostic process. It scrutinizes the effectiveness of different diagnostic approaches, including clinical assessment and imaging techniques. The treatment paradigms for AA are also explored, focusing on surgical interventions and the potential of conservative treatments using antibiotics. The review underscores the criticality of precise diagnosis in preventing adverse outcomes and ensuring effective treatment.

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Section: Clinical Presentationmentioning

confidence: 99%

Misdiagnosis of Acute Appendicitis Cases in the Emergency Room

Mostafa,

El-Atawi

2024

Cureus

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“…La presencia de este fenómeno ha sido evidenciada en diferentes estudios, además de ser un argumento asociado a la evolución clínica. [14][15][16][17] En nuestro país, la escala RIPASA ha reportado una sensibilidad de 93.3% con una especificidad de 8.3%, un valor predictivo positivo de 91.8% y un valor predictivo negativo de 10.1%. 18 Ninguna de las series de evaluación diagnóstica y validación de esta prueba ha reportado el consumo de AINE dentro de sus subgrupos de análisis.…”

Section: Introductionunclassified

Modificación de la efectividad diagnóstica de la escala RIPASA en pacientes con apendicitis aguda y consumo de analgésicos no esteroideos

Ramírez¹,

Trujillo²,

Aguilar³

et al. 2023

Acta Médica Grupo Ángeles

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Objetivo: comparar la efectividad de la escala RIPASA en adultos con sospecha de apendicitis aguda, con y sin tratamiento previo con analgésicos no esteroideos y establecer si hay modificación en su puntaje por la medicación previa. Material y métodos: se incluyeron 80 pacientes entre 18-65 años de edad, con sospecha de apendicitis aguda atendidos en el Nuevo Sanatorio Durango, quienes fueron evaluados mediante la escala RIPASA; se asignaron a dos grupos en relación al antecedente de tratamiento previo o no con analgésicos no esteroideos. Resultados: en 82.5% de los casos se confirmó el diagnóstico de apendicitis aguda. En el grupo con premedicación se descartó apendicitis aguda en 27.5 versus 7.5% en pacientes sin medicación. La apendicitis aguda tuvo mayor prevalencia (92.5%) en el grupo sin medicamentos antiinflamatorios no esteroideos (AINE) versus 72.5% en el grupo medicado p ≤ 0.019. La náusea/vómito, migración del dolor y anorexia presentaron diferencias estadísticamente significativas entre ambos grupos, siendo más prevalentes en aquéllos con terapia farmacológica p ≤ 0.05. Conclusiones: la premedicación con AINE altera el puntaje de la escala RIPASA en pacientes con sospecha de apendicitis aguda.

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“…2,3 However, this belief has been clearly refuted by recent evidence. 1,[4][5][6][7] Multiple pediatric randomized controlled trials and a recent systematic review demonstrated that, when opioid analgesia is provided, there is no difference in accuracy and timeliness of diagnosis of appendicitis and no difference in rates of appendicitis-related complications. 1,5,6,8 Further, a Cochrane review of adults with acute abdominal pain has also demonstrated that analgesia does not mask appendicitis or delay the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Pain management of acute appendicitis in Canadian pediatric emergency departments

Robb

Ali

Poonai

et al. 2016

CJEM

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Objectives: Children with suspected appendicitis are at risk for suboptimal pain management. We sought to describe pain management patterns for suspected appendicitis across Canadian pediatric emergency departments (PEDs). Methods: A retrospective medical record review was undertaken at 12 Canadian PEDs. Children ages 3 to 17 years who were admitted to the hospital in February or October 2010 with suspected appendicitis were included. Patients were excluded if partially assessed or treated at another hospital. Data were abstracted using a study-specific, standardized electronic data extraction tool. The primary outcome was the proportion of children who received analgesia while in the emergency department (ED). Secondary outcomes included the proportion of children receiving intravenous (IV) morphine and the timing of analgesic provision. Results: A total of 619 health records were abstracted; mean (SD) patient age was 11.4 (3.5) years.

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Effect of pain control in suspected acute appendicitis on the diagnostic accuracy of surgical residents

Abstract: Objective: To determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents.

Cited by 7 publications

References 22 publications

Misdiagnosis of Acute Appendicitis Cases in the Emergency Room

Misdiagnosis of Acute Appendicitis Cases in the Emergency Room

Modificación de la efectividad diagnóstica de la escala RIPASA en pacientes con apendicitis aguda y consumo de analgésicos no esteroideos

Pain management of acute appendicitis in Canadian pediatric emergency departments

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