Discordance in Appendicitis Grading and the Association with Outcomes: A Post-Hoc Analysis of an EAST Multicenter Study.

The Journal of Surgical Research
Khaled Abdul JawadEAST Appendicitis Research Group

Abstract

The American Association for the Surgery of Trauma (AAST) appendicitis severity grading criteria use independent subscales for radiologists (Rad), surgeons (Surg), and pathologists (Path). We reviewed the EAST Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG) database to determine rates of discordance and clinical consequences of inaccuracy. A confusion matrix was constructed for pairs among Rad, Surg, and Path. Accuracy was reported using chronologically latest diagnosis as gold standard. "Concordance" (C) was achieved when both agreed on the severity grade and "Discordance"(D) when they disagreed. A composite endpoint("COMP"= 30-d incidence of surgical site infection, abscess, wound complication, Clavien-Dindo complication, secondary intervention, ED[Emergency Department] visit, hospital readmission, and mortality) was compared between C versus D groups via χ2 test with Bonferroni correction to define statistical significance(P = 0.05/9 = 0.005). For each pair and diagnosis, subjects were categorized as C or D and compared for the incidence of COMP. Incidence of COMP for Surg and/or Path in C versus D: 16% versus. 26% (p = 0.006, NS by Bonferroni) for acute (A), 39% ver...Continue Reading

References

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Nov 1, 1990·American Journal of Epidemiology·D G AddissR V Tauxe
Mar 1, 1997·Annals of Surgery·D A HaleD P Jaques
Apr 4, 2015·Journal of Pediatric Surgery·Sara C FallonJ Ruben Rodriguez
Jun 4, 2016·The Journal of Trauma and Acute Care Surgery·Gail T TominagaUNKNOWN American Association for the Surgery of Trauma Committee on Patient Assessment
Feb 7, 2017·Current Problems in Diagnostic Radiology·Cameron E GaskillGiana H Davidson

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