Evidence map›Paper›PMID 27884453›Full record

ArticleJournal of pediatric surgery2017

A call for a standardized definition of perforated appendicitis.

Andrew P Rogers, Tiffany J Zens, Charles M Leys, Peter F Nichol, Daniel J Ostlie

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of pediatric surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
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

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
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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

5 authors.

Andrew P RogersDivision of Pediatric Surgery, Department of Surgery, University Of Wisconsin School of Medicine and Public Health; University of Wisconsin Hospital and Clinics, American Family Children's Hospital, Madison, WI, USA; Molecular and Applied Nutrition Training Program, University of Wisconsin-Madison, Madison, WI. Electronic address: rogers@surgery.wisc.edu.
Tiffany J ZensDivision of Pediatric Surgery, Department of Surgery, University Of Wisconsin School of Medicine and Public Health; University of Wisconsin Hospital and Clinics, American Family Children's Hospital, Madison, WI, USA.
Charles M LeysDivision of Pediatric Surgery, Department of Surgery, University Of Wisconsin School of Medicine and Public Health; University of Wisconsin Hospital and Clinics, American Family Children's Hospital, Madison, WI, USA.
Peter F NicholDivision of Pediatric Surgery, Department of Surgery, University Of Wisconsin School of Medicine and Public Health; University of Wisconsin Hospital and Clinics, American Family Children's Hospital, Madison, WI, USA.
Daniel J OstlieDivision of Pediatric Surgery, Department of Surgery, University Of Wisconsin School of Medicine and Public Health; University of Wisconsin Hospital and Clinics, American Family Children's Hospital, Madison, WI, USA.

Funding

TRAINING IN NUTRITIONT32DK007665 · NIDDK · UNIVERSITY OF WISCONSIN-MADISON · PI GUY E GROBLEWSKI, Chi- Liang Eric Yen · 1993 to 2026
$9.2M
NIDDK NIH HHS T32 DK007665
6 · The paper itself

Abstract

backgroundAbscess rates have been reported to be as low as 1% and as high as 50% following perforated appendicitis (PA). This range may be because of lack of universal definition for PA. An evidence-based definition (EBD) is crucial for accurate wound classification, risk-stratification, and subsequent process optimization. ACS NSQIP-Pediatric guidelines do not specify a definition of PA. We hypothesize that reported postoperative abscess rates underrepresent true incidence, as they may include low-risk cases in final calculations.

methodsLocal institutional records of PA patients were reviewed to calculate the postoperative abscess rate. The ACS NSQIP-Pediatric participant use file (PUF) was used to determine cross-institutional postoperative abscess rates. A PubMed literature review was performed to identify trials reporting PA abscess rates, and definitions and rates were recorded.

results20.9% of our patients with PA developed a postoperative abscess. The ACS NSQIP-Pediatric abscess rate was significantly lower (7.61%, p<0.001). In the eighteen published studies analyzed, average abscess rate (14.49%) was significantly higher than ACS NSQIP-Pediatric (p<0.001). There was significantly more variation in trials that do not employ an EBD of perforation (Levene's test F-value =6.980, p=0.018).

conclusionsA standard EBD of perforation leads to lower variability in reported postoperative abscess rates following PA. Nonstandard definitions may be significantly altering the aggregate rate of postoperative abscess formation. We advocate for adoption of a standard definition by all institutions participating in ACS NSQIP-Pediatric data submission. LEVEL OF EVIDENCE: III.

Indexed as

Abdominal AbscessAcute DiseaseAppendectomyAppendicitisChildHumansIncidencePostoperative ComplicationsPractice Guidelines as TopicAbscessEvidence-basedNSQIPPerforated appendicitisWound classification

Identifiers

PMID27884453
PMCPMC5502110

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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.