Acute Appendicitis Clinical Trial
— RCTAppAlgOfficial title:
Randomized Control Trial Comparing Proposed Algorithm and Current Best Practice in the Evaluation of Suspected Appendicitis
Verified date | September 2018 |
Source | Singapore General Hospital |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Acute appendicitis is one of the most common causes of acute abdominal pain requiring
surgical intervention. In the current era, with diagnostic imaging technique like Computed
Tomography (CT), negative appendectomy rates have been greatly reduced. However, the
radiation risk with CT poses as a concern. Rules for clinical decision guiding CT utilization
is thus essential to minimize unnecessary CT scans, which not only poses a radiation risk but
also contributes to increased healthcare costs.
Through the development of an algorithm based on Alvarado Score for the management of acute
appendicitis, investigators hope to reduce CT utilization with an acceptable negative
appendectomy rate, and hence reducing unnecessary radiation and the healthcare costs
involved.
Status | Active, not recruiting |
Enrollment | 160 |
Est. completion date | September 30, 2018 |
Est. primary completion date | September 30, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 21 Years to 80 Years |
Eligibility |
Inclusion Criteria: - Patients between the ages of 21 to 80 who are admitted to Singapore General Hospital and Sengkang Health for suspected appendicitis based on admission diagnosis from the Emergency Department Exclusion Criteria: - Patients who are pregnant - Patients below 21 or above 80 years of age - Patients with generalized peritonitis on presentation - Patients with palpable right iliac fossa mass on presentation - Patients with evidence of acute confusional state/dementia - Patients at high risk of surgery (ASA>4) from the study - Patients who are immunocompromised (on chemotherapy, steroids etc.) |
Country | Name | City | State |
---|---|---|---|
Singapore | Sengkang Health | Singapore | |
Singapore | Singapore General Hospital | Singapore |
Lead Sponsor | Collaborator |
---|---|
Singapore General Hospital | National Medical Research Council (NMRC), Singapore, Sengkang Health |
Singapore,
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986 May;15(5):557-64. — View Citation
Berrington de González A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet. 2004 Jan 31;363(9406):345-51. — View Citation
Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology. 2000 May;215(2):337-48. Review. — View Citation
Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007 Nov 29;357(22):2277-84. Review. — View Citation
Brenner DJ. Minimising medically unwarranted computed tomography scans. Ann ICRP. 2012 Oct-Dec;41(3-4):161-9. doi: 10.1016/j.icrp.2012.06.004. Epub 2012 Aug 22. — View Citation
Hong JJ, Cohn SM, Ekeh AP, Newman M, Salama M, Leblang SD; Miami Appendicitis Group. A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surg Infect (Larchmt). 2003 Fall;4(3):231-9. — View Citation
Jones K, Peña AA, Dunn EL, Nadalo L, Mangram AJ. Are negative appendectomies still acceptable? Am J Surg. 2004 Dec;188(6):748-54. — View Citation
Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008 Jul;248(1):254-63. doi: 10.1148/radiol.2481071451. Review. — View Citation
National Research Council (US) Board on Radiation Effects Research. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII, Phase I, Letter Report (1998). Washington (DC): National Academies Press (US); 1998. No abstract available. — View Citation
Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med. 2000 Jul;36(1):39-51. Review. — View Citation
Smink DS, Finkelstein JA, Garcia Peña BM, Shannon MW, Taylor GA, Fishman SJ. Diagnosis of acute appendicitis in children using a clinical practice guideline. J Pediatr Surg. 2004 Mar;39(3):458-63; discussion 458-63. — View Citation
Yildirim E, Karagülle E, Kirbas I, Türk E, Hasdogan B, Teksam M, Coskun M. Alvarado scores and pain onset in relation to multislice CT findings in acute appendicitis. Diagn Interv Radiol. 2008 Mar;14(1):14-8. — View Citation
* Note: There are 12 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Percentage of CT performed | The percentage of CT scans performed for patients within each management arm | Through study completion, an average of 2 years. | |
Secondary | Percentage of negative appendectomy | Patients who were operated with a pre-operative diagnosis of acute appendicitis with subsequent histology showing no features of acute appendicitis | Through study completion, an average of 2 years. | |
Secondary | Percentage of missed diagnosis | Patients who were not diagnosed with acute appendicitis during the initial admission but were subsequently readmitted within 2 weeks of discharge due to progression of symptoms, with eventual surgery showing acute appendicitis on histology. | 2 weeks after discharge | |
Secondary | Length of stay | Duration of total hospitalization (measured in days) from point of admission to discharge. | 2 weeks after discharge | |
Secondary | Cost of stay | Total cost of stay incurred by the patient in Singapore Dollars during admission before government subsidies were taken into consideration | 2 weeks after discharge |
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