The Role of Imaging in the Diagnosis of Acute Appendicitis During the COVID-19 Pandemic

The Role of Imaging in the Diagnosis of Acute Appendicitis During the COVID-19 Pandemic: a Retrospective Cohort Study

This is a retrospective observational study in the form of a cohort study evaluating the use of pre-operative imaging for the diagnosis of acute appendicitis in a tertiary centre during the first and second waves of the COVID-19 pandemic in the United Kingdom. The study group includes all patients who underwent emergency appendicectomy for suspected acute appendicitis between March 2020 and February 2021, while the control group includes all patients who underwent emergency appendicectomy for suspected acute appendicitis between March 2019 and February 2020. The final histology will be used as primary outcome, as the study hypothesis is that increasing the use of pre-operative imaging will reduce the negative appendicectomy rate.

Study Overview

• Status: Completed
• Conditions: Appendicitis
• Intervention / Treatment: Diagnostic test: Pre-operative imaging

• Study Type: Observational
• Enrollment (Actual): 313

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, NW1 2BU
    • University College London Hospitals NHS Foundation Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All consecutive patients operated at a tertiary centre

Description

Inclusion Criteria:

• Patients of all ages who underwent emergency appendicectomy (either laparoscopic or open) for suspected acute appendicitis
• Patients of all ages who underwent partial ileo-caecectomy or right hemicolectomy for suspected acute appendicitis

Exclusion Criteria:

• Patients who underwent elective interval appendicectomy for a previous appendiceal phlegmon
• Patients who underwent appendicectomy or right hemicolectomy for appendiceal tumours
• Patients who underwent diagnostic laparoscopy for suspected acute appendicitis, where the appendix was not removed

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Pandemic Group; All patients who underwent emergency appendicectomy for suspected acute appendicitis between March 2020 and February 2021	Diagnostic test: Pre-operative imaging; Use of pre-operative imaging or the diagnosis of acute appendicitis
Control Group; All patients who underwent emergency appendicectomy for suspected acute appendicitis between March 2019 and February 2020	Diagnostic test: Pre-operative imaging; Use of pre-operative imaging or the diagnosis of acute appendicitis

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Negative Appendicectomy Rate (NAR)	Number of patients with final histology negative for acute appendicitis	Up to 3 weeks post-operatively (when final Histology is ready)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-Operative Length of Stay	Post-operative length of hospital stay (from post-operative day 1)	Assessed on day 30 after the completion of the study
Post-Operative Complications Rate	Number of patients who had post-operative complications	Within 30 post-operative days

Collaborators and Investigators

• Sponsor: University College London Hospitals
• Investigators: Principal Investigator: Gerardo Perrotta, MD, University College London Hospitals

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2021
• Primary Completion (Actual): January 31, 2022
• Study Completion (Actual): January 31, 2022

Study Registration Dates

• First Submitted: January 7, 2022
• First Submitted That Met QC Criteria: January 22, 2022
• First Posted (Actual): January 25, 2022

Study Record Updates

• Last Update Posted (Actual): February 3, 2022
• Last Update Submitted That Met QC Criteria: February 2, 2022
• Last Verified: February 1, 2022

More Information

Terms related to this study

• Keywords: COVID-19; ultrasonography; appendicitis; computer tomography; negative appendicectomy rate; pre-operative imaging
• Additional Relevant MeSH Terms: Digestive System Diseases; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; Gastrointestinal Diseases; Gastroenteritis; Intestinal Diseases; Cecal Diseases; Intraabdominal Infections; COVID-19; Appendicitis
• Other Study ID Numbers: NARCO2021

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No