Appendicitis

This research aims to improve how appendicitis, a common emergency surgery condition, is managed worldwide by studying different emergency care systems. Appendicitis requires quick diagnosis and treatment to avoid complications. Using appendicitis as a marker, the study looks at access, quality, and efficiency across hospitals in various countries, including low- and middle-income regions, to find ways to enhance emergency surgical care. The study collects data from about 500 hospitals globally between February and May 2025, focusing on patients undergoing appendicectomy using any surgical method, including open, laparoscopic, or robotic approaches. Hospitals will record information for consecutive patients over 14-day periods. The study includes two sub-studies: one on sustainability and waste management in operating rooms and another on the financial impact of surgery on patients, especially in resource-limited settings. Participants will have their care observed through routine health records without extra follow-up visits. Researchers will measure key factors such as time from symptoms to surgical assessment, rates of minimally invasive surgery, complications within 30 days, and hospital stay length. This data will help identify gaps and guide improvements in emergency surgical care worldwide, aiming to make treatment safer, faster, and more affordable.

Trauma is a leading cause of death in children in the US, with abdominal trauma accounting for 30% of pediatric traumatic deaths, second only to brain injury. This research evaluates the use of the Focused Assessment with Sonography for Trauma (FAST) examination, a bedside abdominal ultrasound, to determine if it can safely reduce abdominal CT scans in hemodynamically stable children with blunt abdominal trauma. The study aims to improve care quality and reduce morbidity and mortality by identifying appropriate evaluation strategies for injured children. The trial is a multicenter, randomized, controlled study involving 3,194 children under 18 years presenting within 24 hours of blunt abdominal trauma. Participants are assigned to either the FAST examination arm, where a bedside ultrasound is performed to detect blood in the abdomen, or to the standard care arm without FAST. The FAST exam is quick, radiation-free, and performed by emergency or trauma physicians. The study compares CT scan rates and tracks delayed or missed diagnoses of intra-abdominal injuries over up to 30 days. Throughout the emergency department stay and initial hospitalization (up to 24 hours), participants undergo assessments including FAST or standard evaluation, CT scan monitoring, and tracking of injuries for up to 30 days if hospitalized. Outcomes measured include CT scan frequency, missed injuries, emergency department length of stay, hospitalization rates, physician suspicion of injury, and surgery rates. The study also examines factors influencing CT use in low-risk patients after a negative FAST exam, aiming to optimize diagnostic care in pediatric trauma.

Parkinson's disease (PD) is a condition where symptoms worsen over time, and medications may become less effective, significantly lowering patients' quality of life. Recent findings suggest a close link between PD symptoms and intestinal health, especially in patients with chronic appendicitis. Acupuncture targeting points related to constipation and chronic appendicitis has shown promise in improving both motor and non-motor symptoms of PD, such as anxiety, depression, sleep disturbances, and cognitive dysfunction. This study aims to further understand acupuncture's role in treating PD comprehensively, particularly focusing on intestinal acupuncture. Participants in this randomized, double-blind trial will receive acupuncture treatment at specific points including Tianshu, Zusanli, Hegu, Taichong, Shangjuxu, Jigou, Zhaohai, Lanwei, and Shousanli. The interventions involve comfort needle and comfort embedding needle techniques. The study compares an experimental acupuncture group with a control group receiving sham acupuncture, where the needle only touches the skin without penetration. Treatment schedules and methods are designed to assess acupuncture's effects on PD symptoms in patients with chronic appendicitis. During the study, participants will be evaluated using the MDS Unified Parkinson's Disease Rating Scale III over three months to measure motor symptom changes. Researchers will monitor symptom improvements and adverse events while ensuring participants maintain stable anti-PD medication if used. The trial includes informed consent, clinical examinations, imaging for appendicitis confirmation, and other assessments to ensure safety and data accuracy. The total participation spans the treatment and follow-up periods up to the study's end in 2026.

Researchers are evaluating the impact of regular use of a consumer-grade FODMAP-targeting digestive enzyme blend called FODZYME® on gastrointestinal symptoms in adults who experience self-reported bloating. The study focuses on how this enzyme blend affects symptoms such as bloating and abdominal pain, which are often triggered by fermentable carbohydrates known as FODMAPs. This is a randomized, double-blind, placebo-controlled crossover trial that aims to provide a more flexible alternative to the restrictive Low FODMAP Diet by breaking down FODMAPs before they ferment in the colon. Participants will take the enzyme blend or a placebo with each meal, snack, or substantial beverage, applying it directly to their food. The trial is divided into two main periods: half the participants will start with the enzyme blend for four weeks followed by a two-week washout and then switch to placebo for another four weeks; the other half start with placebo and then switch to the enzyme blend after the washout. The study product is designed to target specific FODMAPs like fructan, GOS, and lactose and is intended for adults with or without IBS symptoms. During the study, participants will complete daily questionnaires and assessments over about 19 weeks, including patient-reported outcome measures for bloating, gastrointestinal symptoms, abdominal pain, food-related quality of life, and anxiety. The study is conducted remotely, allowing participants to complete assessments at home using a smartphone app. Safety is monitored by excluding those with known allergies to corn or previous reactions to digestive enzyme supplements, and researchers will review changes in bloating symptoms as the primary outcome.

The trial investigates the clinical and cost-effectiveness of using povidone-iodine (PVI) irrigation during surgery for patients with perforated appendicitis. It aims to understand barriers and facilitators for implementing PVI irrigation and to collect cost and patient-reported outcomes for those with non-perforated appendicitis. This is a phase 4 randomized study sponsored by The University of Texas Health Science Center, Houston. Participants undergoing appendectomy for perforated appendicitis will be randomly assigned to receive either PVI irrigation or usual care. In the PVI group, after appendix removal and controlling bleeding, 10 mL/kg of 1% PVI (up to 1,000 mL) is used to irrigate the pelvis and abdominal quadrants, left to dwell for 1 minute, then suctioned out. The usual care group may receive local or large volume saline irrigation as per the surgeon's practice but will not receive PVI irrigation. Participants will be followed to assess cost-effectiveness at 30 days, including hospital costs, length of stay, complications, and patient-reported costs and quality of life up to 12 months. Additional outcomes include days of work missed and postoperative complications. The study includes single-blind monitoring and tracks health-related quality of life with the EQ-5D-5L questionnaire.

Researchers are evaluating the use of artificial intelligence-driven virtual standardized patients (VSPs) to improve the ability of primary care doctors in China to manage common pediatric diseases. The study addresses challenges in China's pediatric healthcare system, including limited capacity in primary care and a lack of effective training tools. It involves a randomized controlled trial with over 459 doctors from various specialties across more than 10 provinces, aiming to enhance pediatric care through innovative training methods. The trial involves three groups: one using a virtual patient platform where doctors interact with AI-driven simulated patients covering diseases like pneumococcal pneumonia, rotavirus enteritis with hypovolemic shock, hand-foot-and-mouth disease, acute appendicitis, and respiratory failure; another group uses case teaching manuals, and the third group uses case teaching videos. Participants engage in a two-week learning period with their assigned training method. During the study, doctors' management skills will be assessed through clinical vignettes to measure adherence to best clinical practice guidelines. Researchers will monitor diagnosis accuracy, examination scores relevant to disease handling, and doctors' focus on patient needs. The study runs for about six months and includes over 300 primary healthcare institutions to ensure wide representation. The trial also evaluates the acceptance and costs of the training methods used.

This research aims to evaluate the current standard care for general surgical patients undergoing emergency laparotomy, focusing on factors that affect clinical outcomes and the quality of life in the year following abdominal surgery. It seeks to understand what factors are linked to adverse post-operative events, whether care differs based on sex or age, and how quality of life changes over time. The study also plans to compare outcomes before and after introducing standardized care protocols for these patients. The study observes two groups: one receiving the traditional care routine without standardized protocols and another treated under a newly introduced standardized laparotomy care protocol. No experimental treatments are given as part of the study; rather, the study compares outcomes between these two existing care approaches. This approach allows the assessment of improvements in patient survival and equality in care provision. Participants will be monitored for outcomes including in-hospital mortality within 30 days, serious complications during the hospital stay within 30 days, long-term mortality over one year, and responses to quality of life questionnaires during the year after surgery. Data collection and evaluation will help assess the effectiveness and equality of care over time. The overall participation duration spans one year after the surgery procedure.

This research investigates the impact of polyethylene glycol (PEG) bowel preparation on the gut microbiota in people who have had an appendectomy compared to those who have not. It explores how PEG, commonly used before colonoscopy, may affect intestinal microbes and how the appendix plays a role in protecting and restoring the gut microbiome. The study focuses on the differences in microbial changes and recovery between appendectomy patients and healthy controls over time. Participants will undergo colonoscopy with PEG laxatives used for bowel preparation following standard clinical procedures. Two groups are studied: one with a history of appendectomy or right hemicolectomy including appendectomy, and a control group without such history. Fecal samples will be collected at five time points: before colonoscopy, at the first non-watery stool after colonoscopy, and at one, three, and six months post-colonoscopy for detailed microbial analysis. During the study, participants will provide stool samples and complete questionnaires about their intestinal and general health. Researchers will analyze changes in gut microbes, diversity, and metabolic functions over six months after colonoscopy. Participant identities will be kept confidential, and they can withdraw at any time. The study will share progress updates and individual results with participants throughout the trial.

Researchers are evaluating the diagnostic accuracy of computed tomography (CT) reporting and the Appendicitis Inflammatory Response (AIR) score in adults suspected of having acute appendicitis who undergo appendectomy. The study aims to measure how often appendectomies are performed unnecessarily, based on final pathology results. It also examines how well the AIR score, CT findings, and surgical severity grading agree with pathology, and explores these diagnostics across different patient groups. This prospective observational study includes adults 18 years and older who visit the emergency department with suspected appendicitis, receive a CT scan showing signs of appendicitis, and then have an appendectomy. No extra treatments or interventions apart from standard care are performed. Clinical, demographic, and diagnostic data including laboratory results, CT reports, and surgical findings are collected and analyzed. Participants will have their clinical data recorded, including symptom details, lab tests, and imaging results. Researchers will compare CT reports, AIR scores, and surgical grades to final pathology findings within 30 days after surgery. The main measurement is the rate of negative appendectomies. Data is collected confidentially, with no study procedures beyond routine care, and the study is expected to end by January 2027.

Researchers are evaluating the safety, effectiveness, and practicality of shorter courses of antibiotics after surgery for simple and complicated appendicitis. This study aims to see if reducing antibiotic use can lower the chance of side effects while still keeping patients safe after their appendectomy. The trial is a randomized controlled study conducted at a single center. Participants are assigned to one of two groups based on their type of appendicitis and post-operative antibiotic treatment. Those in the restrictive group with simple appendicitis receive no post-operative antibiotics, while those with complicated appendicitis receive up to 24 hours of antibiotics. In the liberal group, participants with simple appendicitis receive 24 hours of antibiotics, and those with complicated appendicitis receive up to 4 days of antibiotics. Treatments use standard antibiotics chosen by physicians. During the study, participants will be monitored for up to 30 days after surgery to track any infections or antibiotic-related complications, as well as any deaths. Researchers will assess safety by reviewing these outcomes and gather follow-up information through phone contact. The total involvement includes post-surgery monitoring to evaluate the impact of different antibiotic durations on recovery and adverse events.