Protocol Based Selective Imaging Versus Routine Computed Tomography or Ultrasound in Suspected Appendicitis (PROSECCO)

What this Trial Is About

Researchers are evaluating different imaging approaches for adults suspected of having appendicitis to see how they affect clinical outcomes. The study compares protocol-based selective imaging using clinical scoring to routine imaging with ultrasound and/or CT scans. The main questions are whether selective imaging and selective observation combined with scoring affect outcomes like negative appendectomies or complicated appendicitis cases. Participants will be randomly assigned to one of three groups: routine imaging with ultrasound and CT as needed; selective imaging based on the Adult Appendicitis Score (AAS); or selective observation using the Appendicitis Severity Score (ASS) combined with AAS-based selective imaging. In the routine group, patients undergo ultrasound first, followed by CT if results are inconclusive, and urgent surgery if appendicitis is found. In the selective imaging group, patients with high AAS scores have surgery, those with moderate scores get imaging, and low scores are discharged. In the observation group, patients with low AAS are discharged, moderate scores are managed by ASS and observation protocols with re-evaluation, and high scores lead to surgery. During the study, participants will have imaging tests, scoring assessments, and possible observation periods. Researchers will monitor outcomes such as negative appendectomies and complicated appendicitis within 30 days of randomization, along with quality of life, costs, and adverse events up to one year. The study's total follow-up includes tracking appendicitis occurrences for up to two years. This allows evaluation of the safety and effectiveness of selective imaging protocols compared to routine imaging in suspected appendicitis cases.

Protocol Based Selective Imaging Versus Routine Computed Tomography or Ultrasound in Suspected Appendicitis