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Elisa Z, Camilla P, Giulia M, Nicola Z, Daniela C, Francesca G, Marco G, Claudio C, Alessandro P, Fabio B, Antoniello LM, Piergiorgio G. Concordance in Intraoperative Surgeons' Opinion in the Diagnosis and Management of Acute Appendicitis: The Role of Training. JOURNAL OF SURGICAL EDUCATION 2024; 81:1083-1088. [PMID: 38908992 DOI: 10.1016/j.jsurg.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/24/2024] [Accepted: 05/07/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE Acute appendicitis is a wide spectrum disease, from simple inflammation to evident intestinal perforation. The correct interpretation of the degree of inflammation is crucial to guarantee appropriate treatment and adherence to protocols and guidelines. In order to investigate this concordance, the authors compared the definition of appendicitis and the predicted treatment among all surgeons affiliated to a single Pediatric Surgery School (consisting of 8 different centers). DESIGN Twenty-two short recordings of intra-operative manipulation of appendices were shown to 56 surgeons, blindly to clinical information. Four items were collected and analyzed: classification of appendicitis, type and length of predicted antibiotic therapy, day of re-alimentation. Data were analyzed to identify the concordance kappa coefficient, stratified according to expertise of the responding surgeon. RESULTS The 1232 evaluations obtained in all valued items low overall concordance. Subgroup analysis identified a good agreement between younger surgeons only in the choice of antibiotic (k 0.47). However, if the centers were divided between University and non-University Hospitals, a strong agreement was found in the former both for classification (k 0.45 vs 0.32) and type of antibiotic (k 0.42 vs 0.24). CONCLUSIONS The overall concordance between surgeons in different centers in the diagnostic classification and predicted treatment of appendicitis is quite low. University Hospital have a highest concordance in both items at all levels of expertise; it might be postulated that teaching to younger surgeon increase the comparison between experts and finally the concordance and adherence to protocols within the center.
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Affiliation(s)
- Zambaiti Elisa
- Pediatric Surgery Unit, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Torino, TO, Italy.
| | - Pagliara Camilla
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy; Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, TS, Italy
| | - Mottadelli Giulia
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy; Umberto Bosio Center for Digestive Diseases, Pediatric Surgery Unit, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy
| | - Zampieri Nicola
- Department of Surgery, Policlinico G.B.Rossi, University of Verona, Verona, VR, Italy
| | - Codrich Daniela
- Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, TS, Italy
| | - Grandi Francesca
- Complex Operative Unit-Pediatric Surgery, Hospital of Bolzano, Bolzano, BZ, Italy
| | - Gasparella Marco
- Pediatric Surgery Unit, Ca' Foncello Hospital, Treviso, TV, Italy
| | - Carlini Claudio
- Umberto Bosio Center for Digestive Diseases, Pediatric Surgery Unit, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy
| | - Pane Alessandro
- Pediatric Surgery Unit, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Torino, TO, Italy
| | - Beretta Fabio
- Pediatric Surgery Unit, Presidio Ospedaliero Santa Chiara, Trento, TN, Italy
| | - Luca Maria Antoniello
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy
| | - Gamba Piergiorgio
- Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy
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Hageman IC, Midrio P, van der Steeg HJJ, Jenetzky E, Iacobelli BD, Morandi A, Sloots CEJ, Schmiedeke E, Broens PMA, Fascetti Leon F, Çavuşoğlu YH, Gorter RR, Trajanovska M, King SK, Aminoff D, Schwarzer N, Haanen M, de Blaauw I, van Rooij IALM. The European Anorectal Malformation Network (ARM-Net) patient registry: 10-year review of clinical and surgical characteristics. Br J Surg 2024; 111:znae019. [PMID: 38364059 PMCID: PMC10870250 DOI: 10.1093/bjs/znae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024]
Affiliation(s)
- Isabel C Hageman
- Department of Pediatric Surgery, Radboudumc Amalia Children’s Hospital, Nijmegen, The Netherlands
- Surgical Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Paola Midrio
- Pediatric Surgery Unit, Cà Foncello Hospital, Treviso, Italy
| | | | - Ekkehart Jenetzky
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Johannes Gutenberg-University, Mainz, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Barbara D Iacobelli
- Medical and Surgical Department of the Fetus-Newborn-Infant, Ospedale Bambin Gesù, Rome, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cornelius E J Sloots
- Department of Pediatric Surgery, Erasmus Medical Center–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Eberhard Schmiedeke
- Department of Pediatric Surgery and Urology, Centre for Child and Youth Health, Klinikum Bremen-Mitte, Bremen, Germany
| | - Paul M A Broens
- Department of Surgery, Division of Pediatric Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Yusuf H Çavuşoğlu
- Department of Pediatric Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children’s Hospital Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Misel Trajanovska
- Surgical Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sebastian K King
- Surgical Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Paediatric Surgery, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Dalia Aminoff
- AIMAR—Associazione Italiana Malformazioni AnoRettali, Rome, Italy
| | - Nicole Schwarzer
- SOMA—Selfhelp Organization for People with Anorectal Malformations e.V., Munich, Germany
| | - Michel Haanen
- VA-Dutch Patient Organization for Anorectal Malformations, Huizen, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboudumc Amalia Children’s Hospital, Nijmegen, The Netherlands
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Hageman IC, van der Steeg HJJ, Jenetzky E, Trajanovska M, King SK, de Blaauw I, van Rooij IALM. A Quality Assessment of the ARM-Net Registry Design and Data Collection. J Pediatr Surg 2023; 58:1921-1928. [PMID: 37045715 DOI: 10.1016/j.jpedsurg.2023.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Registries are important in rare disease research. The Anorectal Malformation Network (ARM-Net) registry is a well-established European patient registry collecting demographic, clinical, and functional outcome data. We assessed the quality of this registry through review of the structure, data elements, collected data, and user experience. MATERIAL AND METHODS Design and data elements were assessed for completeness, consistency, usefulness, accuracy, validity, and comparability. An intra- and inter-user variability study was conducted through monitoring and re-registration of patients. User experience was assessed via a questionnaire on registration, design of registry, and satisfaction. RESULTS We evaluated 119 data elements, of which 107 were utilized and comprised 42 string and 65 numeric elements. A minority (37.0%) of the 2278 included records had complete data, though this improved to 83.5% when follow-up elements were excluded. Intra-observer variability demonstrated 11.7% incongruence, while inter-observer variability was 14.7%. Users were predominantly pediatric surgeons and typically registered patients within 11-30 min. Users did not experience any significant difficulties with data entry and were generally satisfied with the registry, but preferred more longitudinal data and patient-reported outcomes. CONCLUSIONS The ARM-Net registry presents one of the largest ARM cohorts. Although its collected data are valuable, they are susceptible to error and user variability. Continuous evaluations are required to maintain relevant and high-quality data and to achieve long-term sustainability. With the recommendations resulting from this study, we call for rare disease patient registries to take example and aim to continuously improve their data quality to enhance the small, but impactful, field of rare disease research. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Isabel C Hageman
- Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands; Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Hendrik J J van der Steeg
- Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Ekkehart Jenetzky
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes-Gutenberg-University, Mainz, Germany
| | - Misel Trajanovska
- Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sebastian K King
- Surgical Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia
| | - Ivo de Blaauw
- Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
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Morandi A, Maestri F, Ichino M, Pavesi MA, Macchini F, Di Cesare A, Leva E. Labeling male anorectal malformations: objective evaluation of radiologic imaging before surgery. Front Pediatr 2023; 11:1224620. [PMID: 37609362 PMCID: PMC10442156 DOI: 10.3389/fped.2023.1224620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose Prone cross-table lateral x-ray (CTLxR) and colostogram aid surgical planning for anorectal malformations (ARMs) without perineal fistulas. We suggest objective imaging tools to classify ARMs. Methods Three observers prospectively evaluated CTLxR and colostograms of male ARM patients (2012-2022) without perineal fistulas. The level of the rectal pouch was estimated with pubococcygeal (PC) and ischiatic (I) lines. On CTLxR, we described the "pigeon sign", defined as the rectal pouch ending with a beak-like image, suspicious for a rectourinary fistula. ARM was defined as rectobulbar when the rectal pouch was below the I line, rectoprostatic when between PC and I lines, and rectovesical when above the PC line. Concordance was assessed with Fleiss' kappa. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the "pigeon sign" were calculated. Results Thirteen patients were included in this study. The interobserver agreement on CTLxR was 69.2% (k = 0.54) on pouch ending, 84.6% (k = 0.69) on the "pigeon sign", and 76.9% (k = 0.69) on diagnosis; concordance between observers and intraoperative diagnosis was 66.6% (k = 0.56). The "pigeon sign" had 75% sensitivity, 100% specificity, 100% PPV, and 50% NPV. The interobserver agreement on colostograms was 84.6% (k = 0.77) on pouch ending and 89.7% (k = 0.86) on diagnosis; concordance between observers and intraoperative diagnosis was 92.3% (k = 0.90). Conclusion PC and I lines and the "pigeon sign" are useful tools in examining CTLxR and colostograms. Adequate CTLxR interpretation may modify surgical strategy.
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Affiliation(s)
- A. Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F. Maestri
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Ichino
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. A. Pavesi
- Pediatric Radiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F. Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A. Di Cesare
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E. Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Tofft L, Salö M, Arnbjörnsson E, Stenström P. Accuracy of pre-operative fistula diagnostics in anorectal malformations. BMC Pediatr 2021; 21:283. [PMID: 34134660 PMCID: PMC8207737 DOI: 10.1186/s12887-021-02761-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background Surgical safety during posterior sagittal anorectal plasty (PSARP) for anorectal malformations (ARM) depends on accurate pre-operative fistula localization. This study aimed to evaluate accuracy of pre-operative fistula diagnostics. Methods Ethical approval was obtained. Diagnostic accuracy of pre-PSARP symptoms (stool in urine, urine in passive ostomy, urinary tract infection) and examination modalities (voiding cystourethrogram (VCUG), high-pressure colostogram, cystoscopy and ostomy endoscopy) were compared to final intra-operative ARM-type classification in all male neonates born with ARM without a perineal fistula treated at a tertiary pediatric surgery center during 2001–2020. Results The 38 included neonates underwent reconstruction surgery through PSARP with diverted ostomy. Thirty-one (82%) had a recto-urinary tract fistula and seven (18%) no fistula. Ostomy endoscopy yielded the highest diagnostic accuracy for fistula presence (22 correctly classified/24 examined cases; 92%), and pre-operative symptoms the lowest (21/38; 55%). For pre-operative fistula level determination, cystoscopy yielded the highest diagnostic accuracy (14/20; 70%), followed by colostogram (23/35; 66%), and VCUG (21/36; 58%). No modality proved to be statistically superior to any other. Conclusions Ostomy endoscopy has the highest diagnostic accuracy for fistula presence, and cystoscopy and high-pressure colostogram for fistula level determination. Correct pre-operative ARM-typing reached a maximum of 60–70%.
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Affiliation(s)
- Louise Tofft
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden. .,Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden.
| | - Martin Salö
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden
| | - Einar Arnbjörnsson
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden.,Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden
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