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Cited by 1,446Appendicitis Diagnosis and ManagementIntraperitoneal and Appendiceal MalignanciesGastrointestinal disorders and treatments

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

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Di Saverio, Salomone, Podda, Mauro, De Simone, Belinda, Ceresoli, Marco, Augustin, Goran, Gori, Alice, Boermeester, Marja, Sartelli, Massimo +52 more·2020·World Journal of Emergency Surgery
DOI 10.1186/s13017-020-00306-3PMC PMC7386163
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Abstract

Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods: This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. Conclusions: The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.

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  • Abdominal pain accounts for 10% of all emergency department visits.

    “abdominal pain, which accounts for 10% of all emergency department visits30,31.”

    From Evaluation and mitigation of the limitations of large language models in clinical decision-making (2024) · cites this paper as [31]

    The Background states that acute abdominal pain accounts for 7–10% of emergency department accesses. The citing sentence drops “acute” and presents the upper end of the range as a single figure of 10%. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • All guidelines recommended physical examinations as an essential part of the diagnostic process, preferably as the first action.

    “All guidelines recommended physical examinations as an essential part of the diagnostic process, preferably as the first action.”

    From Evaluation and mitigation of the limitations of large language models in clinical decision-making (2024) · cites this paper as [36]

    In Results, Topic 1: Diagnosis, the WSES guideline includes physical examination and clinical signs in its diagnostic approach, and Recommendation 1.10 makes imaging conditional on clinical assessment. This supports an early role for examination, but this single guideline does not establish what all guidelines recommend or explicitly say physical examination should be the first action. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

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Authors
Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., Boermeester, M., Sartelli, M., Coccolini, F., Tarasconi, A., de’ Angelis, N., Weber, D. G., Tolonen, M., Birindelli, A., Biffl, W., Moore, E. E., Kelly, M., Soreide, K., Kashuk, J., Ten Broek, R., Gomes, C. A., Sugrue, M., Davies, R. J., Damaskos, D., Leppäniemi, A., Kirkpatrick, A., Peitzman, A. B., Fraga, G. P., Maier, R. V., Coimbra, R., Chiarugi, M., Sganga, G., Pisanu, A., de’ Angelis, G. L., Tan, E., Van Goor, H., Pata, F., Di Carlo, I., Chiara, O., Litvin, A., Campanile, F. C., Sakakushev, B., Tomadze, G., Demetrashvili, Z., Latifi, R., Abu-Zidan, F., Romeo, O., Segovia-Lohse, H., Baiocchi, G., Costa, D., Rizoli, S., Balogh, Z. J., Bendinelli, C., Scalea, T., Ivatury, R., Velmahos, G., Andersson, R., Kluger, Y., Ansaloni, L., & Catena, F.
Affiliations
  • Azienda Ospedaliero-Universitaria Cagliari (IT)
  • University of Milano-Bicocca (IT)
  • University Hospital Centre Zagreb (HR)
  • University of Amsterdam (NL)
  • Ospedale di Macerata (IT)
  • Azienda Ospedaliera Universitaria Pisana (IT)
  • Ospedale di Parma (IT)
  • The University of Western Australia (AU)
  • University of Helsinki (FI)
  • Aziende Socio Sanitarie Territoriale della Valcamonica (IT)
  • University of Hawaiʻi at Mānoa (US)
  • Denver Health Medical Center (US)
  • Canberra Hospital (AU)
  • Hebrew University of Jerusalem (IL)
  • Letterkenny University Hospital (IE)
  • Cambridge University Hospitals NHS Foundation Trust (GB)
  • Edinburgh Royal Infirmary (GB)
  • Foothills Medical Centre (CA)
  • University of Pittsburgh (US)
  • Universidade Estadual de Campinas (UNICAMP) (BR)
  • University of Washington (US)
  • UC San Diego Health System (US)
  • Agostino Gemelli University Polyclinic (IT)
  • Radboud University Medical Center (NL)
  • Sapienza University of Rome (IT)
  • Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
  • Immanuel Kant Baltic Federal University (RU)
  • Medical University Plovdiv (BG)
  • Tbilisi State Medical University (GE)
  • Westchester Medical Center (US)
  • United Arab Emirates University (AE)
  • Bronson Methodist Hospital (US)
  • Hospital General Universitario de Alicante Doctor Balmis (ES)
  • St. Michael's Hospital (CA)
  • John Hunter Hospital (AU)
  • Virginia Commonwealth University (US)
  • Harvard University (US)
  • Linköping University (SE)
  • Rambam Health Care Campus (IL)
  • Ospedale “M. Bufalini” di Cesena (IT)
ORCID
Venue
World Journal of Emergency Surgery
Publisher
Springer Science and Business Media LLC
Published
2020-04-15
Volume
15
Issue
1
Pages
27-27
ISSN
1749-7922 (ISSN-L)
DOI
10.1186/s13017-020-00306-3
PMC
PMC7386163
OpenAlex
W3017264036
Cited by
1,446
References
1
Citations by year
2026: 238 · 2025: 240 · 2024: 252 · 2023: 247 · 2022: 232 · 2021: 187 · 2020: 47
FWCI
42.52
Type
journal article
Language
en
Open access
Licence
Locations
  • World Journal of Emergency Surgery (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, cc-by)
  • TSpace (University of Toronto) (submittedVersion, cc-by)
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  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • DiVA (Linkoping University) (submittedVersion, other-oa)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • BOA (University of Milano-Bicocca) (submittedVersion, cc-by)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • IrInSubria (University of Insubria) (submittedVersion)
  • Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion, other-oa)
  • UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion, other-oa)
  • Archive of Doctoral Theses and Digital Collections (University of Calabria) (submittedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, cc-by)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, cc-by)
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  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
  • NOVA (University of Newcastle Australia) (submittedVersion, cc-by)
  • Apollo (cc-by)
  • Apollo
Topics
  • Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
  • Health Sciences › Medicine › Surgery › Intraperitoneal and Appendiceal Malignancies
  • Health Sciences › Medicine › Surgery › Gastrointestinal disorders and treatments
Keywords
acute appendicitis, appendicitis diagnosis, appendicitis treatment, conservative treatment, appendectomy timing, appendiceal perforation, appendiceal abscess, clinical scoring systems, pediatric appendicitis, clinical algorithms
MeSH terms
Acute Disease, Anti-Bacterial Agents, Appendectomy, Appendicitis, Humans, Laparoscopy, Abdominal Pain, Practice Guidelines as Topic, Evidence-Based Medicine

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