Evidence map›Paper›PMID 27495334›Full record

SynthesisSurgical endoscopy2017

Biomarkers of acute appendicitis: systematic review and cost-benefit trade-off analysis.

Amish Acharya, Sheraz R Markar, Melody Ni, George B Hanna

Open access · hybridAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Surgical endoscopy, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
56citing papers in PubMed, 5 pooled it
8.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

56 citing papers in PubMed, 5 syntheses or guidelines pooled it, 113 citations in OpenAlex.

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  10. Pro-adrenomedullin: a novel diagnostic biomarker of acute appendicitis.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Amish AcharyaDivision of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, South Wharf Road, London, W2 1NY, UK.
Sheraz R MarkarDivision of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, South Wharf Road, London, W2 1NY, UK.
Melody NiDivision of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, South Wharf Road, London, W2 1NY, UK.
George B HannaDivision of Surgery, Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary's Hospital, South Wharf Road, London, W2 1NY, UK. g.hanna@imperial.ac.uk.
Imperial College London · GBSt Mary's Hospital · GB

Funding

Medical Research Council MC_PC_15008
6 · The paper itself

Abstract

backgroundAcute appendicitis is the most common surgical emergency and can represent a challenging diagnosis, with a negative appendectomy rate as high as 20 %. This review aimed to evaluate the clinical utility of individual biomarkers in the diagnosis of appendicitis and appraise the quality of these studies.

methodsA systematic review of the literature between January 2000 and September 2015 using of PubMed, OvidMedline, EMBASE and Google Scholar was conducted. Studies in which the diagnostic accuracy, statistical heterogeneity and predictive ability for severity of several biomarkers could be elicited were included. Information regarding costs and process times was retrieved from the regional laboratory. European surgeons blinded to these reviews were independently asked to rank which characteristics of biomarkers were most important in acute appendicitis to inform a cost-benefit trade-off. Sensitivity testing and the QUADAS-2 tool were used to assess the robustness of the analysis and study quality, respectively.

resultsSixty-two studies met the inclusion criteria and were assessed. Traditional biomarkers (such as white cell count) were found to have a moderate diagnostic accuracy (0.75) but lower costs in the diagnosis of acute appendicitis. Conversely, novel markers (pro-calcitonin, IL 6 and urinary 5-HIAA) were found to have high process-related costs including analytical times, but improved diagnostic accuracy. QUADAS-2 analysis revealed significant potential biases in the literature.

conclusionWhen assessing biomarkers, an appreciation of the trade-offs between the costs and benefits of individual biomarkers is needed. Further studies should seek to investigate new biomarkers and address concerns over bias, in order to improve the diagnosis of acute appendicitis.

Indexed as

Acute DiseaseAppendectomyAppendicitisBilirubinBiomarkersCalcitoninCost-Benefit AnalysisC-Reactive ProteinEmergenciesHumansHydroxyindoleacetic AcidInterleukin-6Leukocyte CountSensitivity and SpecificityBilirubinBiomarkersCalcitoninC-Reactive ProteinHydroxyindoleacetic AcidIL6 protein, humanInterleukin-6Acute appendicitisBiomarkersCost–benefit trade-off

Identifiers

PMID27495334
PMCPMC5315733
OpenAlexW2493849007

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.