Case control studies that randomly assign patients to either surgical or non-surgical
treatment yield a relapse rate of approximately 14% at one year. It would be useful to know
the relapse rate of patients who have, instead, been selected for a given treatment based on
a thorough clinical evaluation, including physical examination and laboratory results (all
characteristics forming the Alvarado Score) as well as radiological exams if needed or deemed
helpful. If this clinical evaluation is useful,the investigators would expect patient
selection to be better than chance, and relapse rate lower than 14%. Once the investigators
have established the utility of this evaluation, the investigators can begin to identify
those components that have predictive value (such as blood chemistry analysis, or CT
findings). This is the first step toward developing an accurate diagnostic-therapeutic
algorithm which will avoid the risks and costs of needless surgery.
This will be a single-cohort prospective interventional study. It will not interfere with the
usual procedures, consisting of clinical examination in the Emergency Department (ED) and
execution of the following exams at the physician's discretion: complete blood count with
differential, C reactive protein, abdominal ultrasound, abdominal CT. Patients admitted to
Emergency Department with Lower Abdominal and suspicion of Acute Appendicitis not needing
immediate surgery, are requested by informed consent to undergo observation and non operative
treatment with antibiotic therapy (Amoxicillin and Clavulanic Acid). The patients by protocol
should not have received any previous antibiotic treatment during the same clinical episode.
Patients not undergoing surgery will be physically examined 5 days later. During this
follow-up visit, the patient will be given information about the study, will be invited to
participate, and will be asked to sign an informed consent form. If the patient is under the
age of 18 years, consent will be obtained from a parent or other legal guardian.
Telephone (or email) follow-ups will be conducted at 15 days, 6 months, and 12 months (see
attached schedule) to monitor the state of the illness.