Systematic quantitative overviews of the literature to determine the value of diagnostic tests for predicting acute appendicitis: study protocol

Abstract

<p>Abstract</p> <p>Background</p> <p>Suspected acute appendicitis is the most frequent cause for emergency operations in visceral surgery worldwide. In approximately twenty percent of all cases however, the diagnosis is incorrect and patients undergo surgery without having acute appendicitis. Operations of bland appendices put patients at risk and entail a serious waste of resources. Several highly accurate tests have been introduced to diagnose acute appendicitis. The false positive rate however, has not changed over the last twenty years. Given the variation that exists in both practice and research, the uncertainty regarding the quality of the underlying evidence, there is a clear need for comprehensive, systematic and quantitative overviews of the diagnostic value of the various tests purported to be predictive of acute appendicitis.</p> <p>Methods</p> <p>Literature will be identified searching general bibliographic databases (MEDLINE and EMBASE), specialist computer databases (DARE, Cochrane Database of Systematic Reviews, conference proceedings, MEDION, SCISEARCH, BIOSIS) without language restrictions. We will contact experts and the manufacturers of tests. Hand-searching will complete our searches. Identified articles will be selected according to populations, tests, outcomes and study design. Papers meeting the selection criteria will be appraised to rate their methodological quality. Analysis will include exploration of heterogeneity in results. We will conduct meta-analyses to generate summary estimates of test accuracy measures and summary ROC curves where appropriate. If meta-analysis is considered to be inappropriate, we will describe the identified evidence in the context of appraised quality.</p> <p>Discussion</p> <p>These reviews should lead to formulation of recommendations for current practice and future research.</p

Should appendectomy be performed laparoscopically? Clinical prospective randomized trial

“…Currently, there is no consensus on the advantages and disadvantages of the laparoscopic technique over the open technique. While many retrospective and prospective studies reported less pain and shorter hospitalization and return to normal activities with LA, there are studies contradicting these findings and not supporting these benefits (8,9).…”

Efficacy of Use of Red Cell Distribution Width as a Diagnostic Marker in Acute Appendicitis

“…Difficulties in the diagnosis of AA continue despite improvements in diagnostic methods, and rates of negative appendectomy and perforation are still high (17). Bachmann et al (18) stated that because the tests used for the diagnosis of AA cannot be used in actual practice, their use can only be suggested. Many parameters (CRP, WBC, neutrophil/lymphocyte ratio, interleukins 4, 5, 6, 10, and 12, tumor necrosis factor-alpha, endoxin erythrocyte sedimentation rate, procalcitonin, fibrinogen, etc.)…”

Is urinary 5-HIAA determination a valuable method in diagnosis of acute appendicitis in children?

“…Early diagnosis is a major concern for the prevention of complications and decreasing general costs of the treatment. [1][2][3][4] Enterochromaffin cells (EC) are found in mucosal layer of entire intestinal system but they are mostly prominent in distal appendix and comprise the major cell type in the intestinal endocrine system. [5] Serotonin is the main secretory product of these EC.…”