Abstract:
OBJECTIVE:Our goal was to perform a comparative effectiveness study of intravenous (IV)-only versus IV + enteral contrast in computed tomographic (CT) scans performed for patients undergoing appendectomy across a diverse group of hospitals. BACKGROUND:Small randomized trials from tertiary centers suggest that enteral contrast does not improve diagnostic performance of CT for suspected appendicitis, but generalizability has not been demonstrated. Eliminating enteral contrast may improve efficiency, patient comfort, and safety. METHODS:We analyzed data for adult patients who underwent nonelective appendectomy at 56 hospitals over a 2-year period. Data were obtained directly from patient charts by trained abstractors. Multivariate logistic regression was utilized to adjust for potential confounding. The main outcome measure was concordance between final radiology interpretation and final pathology report. RESULTS:A total of 9047 adults underwent appendectomy and 8089 (89.4%) underwent CT, 54.1% of these with IV contrast only and 28.5% with IV + enteral contrast. Pathology findings correlated with radiographic findings in 90.0% of patients who received IV + enteral contrast and 90.4% of patients scanned with IV contrast alone. Hospitals were categorized as rural or urban and by their teaching status. Regardless of hospital type, there was no difference in concordance between IV-only and IV + enteral contrast. After adjusting for age, sex, comorbid conditions, weight, hospital type, and perforation, odds ratio of concordance for IV + enteral contrast versus IV contrast alone was 0.95 (95% CI: 0.72-1.25). CONCLUSIONS:Enteral contrast does not improve CT evaluation of appendicitis in patients undergoing appendectomy. These broadly generalizable results from a diverse group of hospitals suggest that enteral contrast can be eliminated in CT scans for suspected appendicitis.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Drake FT,Alfonso R,Bhargava P,Cuevas C,Dighe MK,Florence MG,Johnson MG,Jurkovich GJ,Steele SR,Symons RG,Thirlby RC,Flum DR,Writing Group for SCOAP-CERTAIN.doi
10.1097/SLA.0000000000000272subject
Has Abstractpub_date
2014-08-01 00:00:00pages
311-6issue
2eissn
0003-4932issn
1528-1140journal_volume
260pub_type
杂志文章,多中心研究abstract::The results of surgical treatment in 100 patients with intrahepatic gallstones are reported including follow-up on 61 patients who survived more than three years. Nine patients died in the follow-up period, and of the remainder, 44 showed complete rehabilitation (72%). The results of follow-up examinations were best s...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198007000-00005
更新日期:1980-07-01 00:00:00
abstract::The ability of surgeons to accelerate wound healing through pharmacologic intervention is limited. The effects of locally applied, biosynthetic human epidermal growth factor (EGF) and transforming growth factor-beta (TGF-beta) on tensile strength of experimental incisions were investigated. A single dose of EGF in sal...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198812000-00019
更新日期:1988-12-01 00:00:00
abstract::The contraction of the gallbladder by ultrasonography and release of cholecystokinin (CCK) by specific radioimmunoassay in response to the ingestion of oral fatty meal before and 1 month after gastrectomy in five patients with early gastric cancer was studied. Before gastrectomy, basal concentrations of CCK (13.4 +/- ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1987-01-01 00:00:00
abstract::Seven patients with a mean burn size of 69.6% total body-surface area underwent skin grafting with autologous cultured epidermis. They were compared with a historical group of 18 controls, with a mean burn size of 60%, who underwent grafting with conventional meshed split-thickness autograft. There were no statistical...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199006000-00005
更新日期:1990-06-01 00:00:00
abstract:OBJECTIVE:To assess ischemia and reperfusion (I/R) injury in a hemihepatectomy model in pigs after prolonged continuous or intermittent vascular inflow occlusion in the liver. SUMMARY BACKGROUND DATA:Massive intraoperative blood loss during liver resections can be prevented by temporary vascular inflow occlusion, cons...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199903000-00011
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:To assess the impact of possible risk factors on intestinal resection and postoperative recurrence in Crohn's disease (CD) and to evaluate the disease course. SUMMARY BACKGROUND DATA:The results of previous studies on possible risk factors for surgery and recurrence in Crohn's disease have been inconsistent....
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200001000-00006
更新日期:2000-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the clinical outcomes of multivisceral transplantation (MVT) in the setting of diffuse thrombosis of the portomesenteric venous system. BACKGROUND:Liver transplantation (LT) in the face of cirrhosis and diffuse portomesenteric thrombosis (PMT) is controversial and contraindicated in many transpla...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31825429c0
更新日期:2012-06-01 00:00:00
abstract:OBJECTIVE:The authors analyzed the frequency and character of postoperative complications after splenectomy in patients with hematologic malignancies, and correlated these findings with preoperative conditions that could have predicted their outcome. SUMMARY BACKGROUND DATA:Splenectomy is performed for hematologic mal...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199603000-00010
更新日期:1996-03-01 00:00:00
abstract:OBJECTIVE:A retrospective review was performed to determine the results after surgical reconstruction for chronic dysfunction of ileal pouch-anal procedures for ulcerative colitis and familial colonic polyposis at a university medical center. METHODS:During the 20-year period from 1978 to 1998, 601 patients underwent ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199902000-00006
更新日期:1999-02-01 00:00:00
abstract:OBJECTIVE:To develop a prognostic scoring system for risk stratification of patients with hepatic graft failure (GF) undergoing retransplants of the liver (ReLT) and improve patient selection. SUMMARY OF BACKGROUND DATA:Retransplantation of the liver remains controversial because of inferior outcomes compared with the...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31822c5878
更新日期:2011-09-01 00:00:00
abstract:OBJECTIVES:PORTAS-3 was designed to compare the frequency of pneumothorax or haemothorax in a primary open versus closed strategy for port implantation. BACKGROUND DATA:The implantation strategy for totally implantable venous access ports with the optimal benefit/risk ratio remains unclear. METHODS:PORTAS-3 was a mul...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003705
更新日期:2020-12-01 00:00:00
abstract::We reviewed 37 consecutive, hemodynamically stable patients (16 adults, 21 children) who had splenic injuries diagnosed by computed tomography (CT) scan to compare the CT evaluation with operative assessment of injury and eventual treatment. Computed tomographic scans and operative findings were graded by a splenic in...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199005000-00009
更新日期:1990-05-01 00:00:00
abstract:OBJECTIVE:This article describes a preliminary work on virtual reality applied to liver surgery and discusses the repercussions of assisted surgical strategy and surgical simulation on tomorrow's surgery. SUMMARY BACKGROUND DATA:Liver surgery is considered difficult because of the complexity and variability of the org...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199811000-00001
更新日期:1998-11-01 00:00:00
abstract:OBJECTIVE:Determine whether absorbable or nonabsorbable mesh in repair of large hiatus hernias reduces the risk of recurrence, compared with suture repair. BACKGROUND:Repair of large hiatus hernia is associated with radiological recurrence rates of up to 30%, and to improve outcomes mesh repair has been recommended. P...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0000000000000842
更新日期:2015-02-01 00:00:00
abstract::Fifteen mini-pigs were bled to a mean aortic blood pressure of 40 mm Hg and maintained at that level for three hours. The control group consisted of eight animals with shock for three hours, while the test group was comprised of seven animals with a similar shock period but which had undergone splanchnicectomy 14 days...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197712000-00019
更新日期:1977-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the impact of improved surgical management of hepatocellular carcinoma (HCC) on the survival of patients with screened HCC. SUMMARY BACKGROUND DATA:It is unclear whether the advent of new treatment modalities such as liver transplantation and radiofrequency ablation (RFA) in recent years have imp...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31816a747a
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was performed in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients. SUMMARY AND BACKGROUND DATA:Abdominal (AAA) or thorac...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/01.sla.0000090473.63393.e9
更新日期:2003-10-01 00:00:00
abstract::Adenocarcinoma involving the distal esophagus usually is far advanced when the patient is first seen. Adenocarcinoma differs from squamous carcinoma of the esophagus since it is relatively unresponsive to radiation therapy or chemotherapy. Adenocarcinoma of the esophagus resembles gastric cancer in its tendency to for...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198705000-00015
更新日期:1987-05-01 00:00:00
abstract::A patient with a syphilitic aneurysm of the aorta treated by the insertion of wire is presented. The patient remained well for almost 40 years, but finally succumbed after rupture. The autopsy findings are discussed. To our knowledge, this represents the longest reported survival after treatment of an aortic aneurysm ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197612000-00014
更新日期:1976-12-01 00:00:00
abstract:OBJECTIVE:To compare resection rates and outcome of patients subsequently referred with hepatic metastases whose initial colon cancers were resected by surgeons with different specialty interests. SUMMARY BACKGROUND DATA:Variation in practice among noncolorectal specialist surgeons has led to recommendations that colo...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199912000-00004
更新日期:1999-12-01 00:00:00
abstract::Esophageal leiomyoma, while rare, is the most common benign tumor of the esophagus. Nine cases from a large teaching hospital are reviewed with long-term follow-up. Steps in the diagnosis and management of this lesion are discussed. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198402000-00020
更新日期:1984-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of Medicare Shared Savings Program accountable care organizations (ACOs) on hospital readmission after common surgical procedures. SUMMARY BACKGROUND DATA:Hospital readmissions following surgery lead to worse patient outcomes and wasteful spending. ACOs, and their associated hospitals,...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002737
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:To determine whether the rates of death and complications of carotid endarterectomy (CE) were different in the octogenarian population than in patients younger than age 80. SUMMARY BACKGROUND DATA:The utility of CE depends on the ability of the surgeon and hospital to attain low rates of death and complicati...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200006000-00001
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:"The elderly" is an often used but poorly defined descriptor of surgical patients. Investigators have used varying subjectively determined age cutoffs to report outcomes in the elderly. We set out to use objective outcomes data to determine the "at-risk" elderly population. METHODS: PATIENTS:129,331 patient...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182a196d8
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:Patients with major burns and an animal model of burn injury were studied to determine the mechanism of depressed interleukin-2 (IL-2) production after thermal injury and to determine the effect of such injury on IL-2 receptor (IL-2R) expression and function. SUMMARY BACKGROUND DATA:Major burn injury is know...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199409000-00010
更新日期:1994-09-01 00:00:00
abstract::Barium sulfate granuloma of the rectum may develop when this contrast material is forced through a discontinuity in the rectal mucosa. The ensuing mass may be confused with carcinoma. Preoperative biopsy and attention to plain films will prevent unnecessary inappropriate surgery. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197504000-00009
更新日期:1975-04-01 00:00:00
abstract:OBJECTIVE:The current pathological lymph node (pN) staging is based on the number of positive lymph nodes but does not take into consideration characteristics of the involved lymph nodes itself. The current study aims to examine the prognostic value of extracapsular lymph node involvement (EC-LNI) and intracapsular lym...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0000000000001463
更新日期:2015-11-01 00:00:00
abstract:OBJECTIVE:This study compares outcomes following pancreaticoduodenectomy (PD) for patients treated at local, low-volume centers and those traveling to high-volume centers. BACKGROUND:Although outcomes for PD are superior at high-volume institutions, not all patients live in proximity to major medical centers. Theoreti...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001924
更新日期:2017-08-01 00:00:00
abstract::The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and v...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199207000-00006
更新日期:1992-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of debriefing and feedback on intraoperative nontechnical performance as an instructional strategy in surgical training. BACKGROUND:Regulatory authorities for accreditation in North America have included nontechnical skills such as communication and teamwork in the competencies ...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0000000000001297
更新日期:2016-05-01 00:00:00