BACKGROUND: @entity697 is one of the most common acute abdominal conditions. Among other parameters, the decision to perform surgical exploration in suspected @entity698 involves diagnostic accuracy, @entity1 age and co-morbidity, @entity1 's own wishes, the surgeon's core medical values, expected natural course of non-operative treatment and priority considerations regarding the use of limited resources. Do objective clinical findings, such as radiology and laboratory results, have greater impact on decision-making than "soft" clinical variables? In this study we investigate the parameters that surgeons consider significant in decision-making in cases of suspected @entity698 ; specifically we describe the process leading to surgical intervention in real settings. The purpose of the study was to explore the process behind the decision to undertake surgery on a @entity1 with suspected @entity698 as a model for decision-making in surgery. METHODS: All appendectomy procedures (n   =   201) at the Department of Surgery at Karolinska University Hospital performed in 2009 were retrospectively evaluated. Every two consecutive @entity1 seeking for @entity490 after each case undergoing surgery were included as controls. Signs and symptoms documented in the medical records were registered according to a standardized protocol. The outcome of this retrospective review formed the basis of a prospective registration of @entity1 undergoing appendectomy. During a three- month period in 2011, the surgeons who made the decision to perform acute appendectomy on 117 consecutive appendectomized @entity1 at the Karolinska University Hospital, Huddinge, and S  dersjukhuset, were asked to answer a questionnaire about symptoms, signs and diagnostic measures considered in their treatment decision. They were also asked which three symptoms, signs and diagnostic measures had the greatest impact on their decision to perform appendectomy. RESULTS: In the retrospective review, tenderness in the right fossa had the greatest impact (OR 76) on treatment decision. In the prospective registration, the most frequent symptom present at treatment decision was @entity158 in the right fossa (94  %). Tenderness in the right fossa (69  %) was also most important for the decision to perform surgery. Apart from local status, image diagnostics and blood sample results had the greatest impact. CONCLUSION: Local tenderness in the right fossa, lab results and the results of radiological investigations had the greatest impact on treatment decision.

Surgical decision-making in XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity697 :: ('MESH:D000208', 'Disease') :: ['Acute appendicitis'] @entity698 :: ('MESH:D001064', 'Disease') :: ['appendicitis'] @entity158 :: ('MESH:D010146', 'Disease') :: ['pain'] @entity490 :: ('MESH:D015746', 'Disease') :: ['abdominal pain']
@entity697 :: (MESH:D000208,Disease) :: ['acute appendicitis']
