Table 1.
Guideline compliance elements from the WSES Jerusalem Consensus Guidelines (2020) for the Diagnosis and Treatment of Acute Appendicitis, and the Surviving Sepsis Campaign Guidelines (2021) [30, 31]
| Guideline domain | Recommendation/suggestion | Quality of evidence | Strength of recommendation |
|---|---|---|---|
| Diagnosis | |||
| Clinical and Ultrasound | WSES 1.7 We recommend the routine use of a combination of clinical parameters and US to improve diagnostic sensitivity and specificity and reduce the need for CT scan in the diagnosis of acute appendicitis | Moderate | Strong; 1B |
| Point-of-care Ultrasound | WSES 1.10 We recommend POCUS as the most appropriate first-line diagnostic tool in both adults and children, if an imaging investigation is indicated based on clinical assessment | Moderate | Strong; 1B |
| CT | WSES 1.9 We suggest that in high-risk patients younger than 40 years old (with AIR score 9–12 and Alvarado score 9–10 and AAS ≥ 16), CT may be avoided before proceeding to diagnostic + / − therapeutic laparoscopy | Moderate | Weak; 2B |
| CT | WSES 1.12 We recommend cross-sectional imaging before surgery for patients with normal investigations but non-resolving right iliac fossa pain, and those over the age of 40 years. After negative imaging, initial nonoperative treatment is appropriate. However, in patients with progressive or persistent pain, explorative laparoscopy is recommended to establish/exclude the diagnosis of acute appendicitis or alternative diagnoses | High | Strong; 1A |
| Surgical treatment | |||
| Source control time to OR | WSES 3.1 We recommend planning laparoscopic appendectomy for the next available operating list within 24 h in case of uncomplicated acute appendicitis, minimizing the delay wherever possible | Moderate | Strong; 1B |
| Source control time to OR | WSES 3.2 We recommend against delaying appendectomy for acute appendicitis of any grade needing surgery beyond 24 h from the admission | Moderate | Strong; 1B |
| Antimicrobial stewardship | |||
| Time to first-dose antibiotics | SSC 14 For adults with possible sepsis without shock, we suggest a time-limited course of rapid investigation and if concern for infection persists, the administration of antimicrobials within 3 h from the time when sepsis was first recognized | Weak | Very low |
| Preoperative antibiotics | WSES 7.1 We recommend a single preoperative dose of broad-spectrum antibiotics in patients with acute appendicitis undergoing appendectomy | High | Strong; 1A |
| Duration of postoperative antibiotics | WSES 7.1 We recommend against postoperative antibiotics for patients with uncomplicated appendicitis | High | Strong; 1A |
| Duration of postoperative antibiotics | WSES 7.2 We recommend against prolonging antibiotics longer than 3–5 days postoperatively in case of complicated appendicitis with adequate source-control | High | Strong; 1A |