Please select the eligibility criteria that correspond to the clinical trial below.
Title: Structured Management of Patients With Suspicion of Appendicitis Using a Clinical Score and Selective Imaging
Brief Summary: Patients with acute abdominal pain and suspicion of appendicitis are common. The management of these patients is controversial with large variations between hospitals. The clinical diagnosis is regarded as insufficient necessitating the use of diagnostic techniques like ultrasound, computerized tomography and diagnostic laparoscopy. However, the role of these diagnostic techniques is not clear.

This aim of this prospective interventional study is to analyze the impact of the implementation of a clinical score to improve the clinical diagnosis and to serve as a basis for a structured management of these patients by comparison of the results after the implementation of the score with that of a baseline period. In the group of patients with indeterminate diagnosis according to the clinical score, the value of diagnostic imaging will be evaluated and compared with a period of in-hospital observation by randomization. The hypothesis is that a clinical score will decrease the use of unnecessary diagnostic imaging and unnecessary admissions to hospital for observation.


Options:
A: Inclusion Criteria:

* 18 years and older who present to the York Hospital Emergency Department with signs and symptoms suggestive of acute appendicitis, but in whom the diagnosis remains unclear as determined by an attending emergency physician or consulting surgeon and in which a CT scan is needed to further assist in the diagnosis

Exclusion Criteria:

* pregnant patients
* patients with known IV dye or oral contrast allergy
* patients in whom acute appendicitis is not the primary diagnosis
* patients with renal insufficiency that may have significant adverse effect from IV dye
B: Inclusion Criteria:

* Age range from 18 to 60 years
* CT scan diagnosed uncomplicated acute appendicitis

Exclusion Criteria:

* Age under 18 years or age over 60 years
* Pregnancy or breast-feeding
* Allergy to contrast media or iodine
* Renal insufficiency
* metformin medication (DM)
* Peritonitis (a perforated appendix)
* Lack of co-operation (unable to give consent)
* A severe other medical condition
* CT-scan: other diagnosis, fecal lithiasis in appendix, perforation, abscess, suspicion of a tumour
C: Before CT scanning

Inclusion Criteria:

* Clinical suspicion of appendicitis
* Age more than 18 years

Exclusion Criteria:

* Clinical signs of generalized peritonitis
* Previous take of antibiotics within the 5 days preceding the presentation
* Allergy or intolerance to lactamases and/or clavulanate potassium
* Corticosteroid or anticoagulant therapy
* Patient with a known inflammatory bowel disease (Crohn's disease or ulcerative colitis)
* Pregnant women
* Patient with iode allergy
* Renal insufficiency (creatinine \> 200 )

CT scanning:

Inclusion Criteria:

* Appendix diameter \> 6 mm

Exclusion Criteria:

* Appendix non visualised
* Signs of localized peritonitis:

  * extradigestive gas
  * fluid collection around the appendix
  * generalized intraperitoneal fluid
D: Inclusion Criteria:

* patients from 10 years of age with \<5 days of abdominal pain and suspicion of appendicitis

Exclusion Criteria:

* pregnant women, children \<10 years of age

Answer: D