{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T09:28:43Z","timestamp":1758274123277,"version":"3.43.0"},"reference-count":24,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J R Army Med Corps"],"accepted":{"date-parts":[[2016,3,9]]},"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acute appendicitis is a principal cause of abdominal pain worldwide and most common in young men who constitute the majority of the deployed fighting force. Diagnostic accuracy is paramount to prevent unnecessary intervention, morbidity and force impact.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Method<\/jats:title>\n                  <jats:p>A consecutive series of appendicectomies, performed over 28\u2005months on deployment in Afghanistan, was evaluated to assess the negative appendicectomy (NA) rate, explore the impact of CT on the rates of NA and assess the impact of appendicectomy on manpower in the deployed workforce.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In Afghanistan, the operative NA rate was 9.6%, whereas the histological NA rate was 20.5%. CT was widely used in Afghanistan (36%) and there was a significant reduction in NA rates if CT was performed preoperatively (6.25% vs 26%, p=0.02).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Diagnostic imaging will be limited in future conflicts and reliance on clinical judgement will be necessary. Military clinicians may need to accept higher rates of NA, as prolonged observation may not be possible. CT scanning should be used to a greater extent when available. A conservative management strategy for appendicitis with appropriate antibiotics should be considered in the event of delayed transfer to a surgical facility.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jramc-2015-000614","type":"journal-article","created":{"date-parts":[[2016,4,8]],"date-time":"2016-04-08T13:35:38Z","timestamp":1460122538000},"page":"111-114","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Appendicitis in a deployed military setting: diagnosis, management and impact on the fighting force"],"prefix":"10.1136","volume":"163","author":[{"given":"Rachel","family":"Howes","sequence":"first","affiliation":[{"name":"CT2 Burns, Plastic and Reconstructive Surgery, Salisbury NHS Foundation Trust, Salisbury, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Webster","sequence":"additional","affiliation":[{"name":"The Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Garner","sequence":"additional","affiliation":[{"name":"Rotherham NHS Foundation Trust, Rotherham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,4,7]]},"reference":[{"key":"2025081312460378000_163.2.111.1","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2014-000336"},{"key":"2025081312460378000_163.2.111.2","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-10-00041"},{"key":"2025081312460378000_163.2.111.3","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1016\/j.annemergmed.2009.06.219","article-title":"Disease and non-battle traumatic injuries evaluated by emergency physicians in a US Tertiary Combat Hospital","volume":"54","author":"Bebarta","year":"2009","journal-title":"Ann Emerg Med"},{"key":"2025081312460378000_163.2.111.4","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1055\/s-0029-1245303","article-title":"[The acute (surgical) abdomen\u2014epidemiology, diagnosis and general principles of management]","volume":"48","author":"Grundmann","year":"2010","journal-title":"Z Gastroenterol"},{"key":"2025081312460378000_163.2.111.5","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1093\/oxfordjournals.aje.a115734","article-title":"The epidemiology of appendicitis and appendicectomy in the Unites States","volume":"132","author":"Addiss","year":"1990","journal-title":"Am J Epidemiol"},{"key":"2025081312460378000_163.2.111.6","first-page":"37","article-title":"Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate","volume":"158","author":"Andersson","year":"1992","journal-title":"Eur J Surg"},{"key":"2025081312460378000_163.2.111.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2011.04.046"},{"key":"2025081312460378000_163.2.111.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2010.10.009"},{"key":"2025081312460378000_163.2.111.9","doi-asserted-by":"crossref","unstructured":"Joshi MK , Joshi R , Alam SE , et al . Negative appendectomy: an audit of resident-performed surgery. How can its incidence be minimized? Indian J Surg 2014;77(Suppl 3):913\u20137.","DOI":"10.1007\/s12262-014-1063-0"},{"key":"2025081312460378000_163.2.111.10","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.137.7.799"},{"key":"2025081312460378000_163.2.111.11","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.ijsu.2014.10.017","article-title":"Population level analysis of diagnostic laparoscopy versus normal appendicectomy for acute lower abdominal pain","volume":"12","author":"Bhangu","year":"2014","journal-title":"Int J Surg"},{"key":"2025081312460378000_163.2.111.12","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1308\/003588414X13946184903801","article-title":"The morbidity of negative appendicectomy","volume":"96","author":"Lee","year":"2014","journal-title":"Ann R Coll Surg Engl"},{"key":"2025081312460378000_163.2.111.13","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.ijsu.2008.01.002","article-title":"Predicting negative appendectomy by using demographic, clinical, and laboratory parameters: a cross-sectional study","volume":"6","author":"Mohebbi","year":"2008","journal-title":"Int J Surg"},{"key":"2025081312460378000_163.2.111.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2013.01.021"},{"key":"2025081312460378000_163.2.111.15","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1177\/000313481307900138","article-title":"Accuracies of diagnostic methods for acute appendicitis","volume":"79","author":"Park","year":"2013","journal-title":"Am Surg"},{"key":"2025081312460378000_163.2.111.16","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2411050913"},{"key":"2025081312460378000_163.2.111.17","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31826a9602"},{"key":"2025081312460378000_163.2.111.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h3493"},{"key":"2025081312460378000_163.2.111.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.3603.140"},{"key":"2025081312460378000_163.2.111.20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.6154"},{"key":"2025081312460378000_163.2.111.21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e2156"},{"key":"2025081312460378000_163.2.111.22","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13017-015-0046-1","article-title":"Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: what do meta-analyses say?","volume":"10","author":"Rocha","year":"2015","journal-title":"World J Emerg Surg"},{"key":"2025081312460378000_163.2.111.23","doi-asserted-by":"crossref","first-page":"83","DOI":"10.4240\/wjgs.v4.i4.83","article-title":"Interval routine appendectomy following conservative treatment of acute appendicitis: Is it really needed","volume":"4","author":"Sakorafas","year":"2012","journal-title":"World J Gastrointest Surg"},{"key":"2025081312460378000_163.2.111.24","doi-asserted-by":"crossref","unstructured":"Paudel GR , Agrawal CS , Regmi R , et al . Conservative treatment in acute appendicitis. JNMA J Nepal Med Assoc 50:295\u20139.","DOI":"10.31729\/jnma.60"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2015-000614","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T19:46:10Z","timestamp":1755114370000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2015-000614"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,4,7]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2017,3,28]]},"published-print":{"date-parts":[[2017,4]]}},"alternative-id":["10.1136\/jramc-2015-000614"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2015-000614","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"type":"print","value":"0035-8665"},{"type":"electronic","value":"2052-0468"}],"subject":[],"published":{"date-parts":[[2016,4,7]]}}}