An interventional study of Abdominal imaging and Score based selective abdominal imaging in Appendicitis, sponsored by Helsinki University Central Hospital. Recruiting at 3 sites in Finland. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-18.
Sponsored by Helsinki University Central Hospital · Not applicable, Interventional, and Diagnostic
The goal of this clinical trial is to compare protocol based selective imaging to routine imaging in adult patients with suspected appendicitis. The main question[s] it aims to answer are:
Participants will be randomized into three groups:
Researchers will compare selective imaging groups separately with routine imaging to see if number of negative appendectomies or number of complicated appendicitis is not significantly increased.
419 studies on the registry are indexed under Appendicitis; 67 are open to participants now.
This study's planned enrollment of 900 is above the median of 111 across 252 interventional studies indexed under Appendicitis.
Browse Appendicitis studies →Helsinki University Central Hospital is the lead sponsor of 311 studies on the registry; 61 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
- Suspicion of appendicitis
Exclusion Criteria:
Patients will have first abdominal ultrasound, and if findings are negative or inconclusive for appendicitis abdominal CT scan is made. If ultrasound is not available, CT scan can be the first imaging study. If appendicitis is found in the imaging study patient is scheduled for urgent laparoscopic appendectomy. Other patients are discharged or treated according to possible alternative diagnosis.
Diagnostic Test: Abdominal imaging
Adult Appendicitis Score (AAS) is calculated as soon as possible. Patients with AAS 16 or higher are scheduled for urgent laparoscopic appendectomy. Patients with AAS 11- 15 will have abdominal imaging as in the group 1. If appendicitis is found in the imaging study patient is scheduled for urgent laparoscopic appendectomy. Patients with AAS 10 or less are discharged without imaging studies.
Other: Score based selective abdominal imaging
Patients with Adult Appendicitis Score (AAS) 10 or less are discharged without imaging studies. Patients with AAS 11 or more are managed based on Appendicitis Severity Score (ASS). ASS is used to identify patients with low risk of complicated disease. Patients with high ASS (\>4) are managed as patients in arm 2. Patients with low ASS (\<=4) begin observation protocol where patients can leave hospital and they are re-evaluated with repeated scoring after 12-24 hours from randomization. After re-scoring patients may be discharged if AAS is below 16 and decreasing and ASS is below 5 or if AAS is below 11. If AAS is 16 or higher or increasing, patients are scheduled for urgent laparoscopic appendectomy. After observation period, patients with decreasing AAS between 11-15 and ASS higher than 4 or patients with stable AAS between 11-15 are send for imaging study.
Other: Score based selective observation combined with selective abdominal imaging
Abdominal ultrasound and/or abdominal CT
Abdominal imaging is done selectively based on Adult Appendicitis Score
Observation based on Appendicitis Severity Score combined Adult Appendicitis Score based selective abdominal imaging
Negative appendectomy
Number of negative appendectomies (surgical removal of non-inflamed appendix)
Time frame: Within 30 days from randomization
Complicated appendicitis
Number of patients with complicated appendicitis (AAST grade 3 or higher)
Time frame: Within 30 days from randomization
histologically proven appendicitis
Number of patients with histologically proven appendicitis undergoing surgery
Time frame: Within 30 days from randomization
CT scan
Number of patients having abdominal computed tomography
Time frame: Within 30 days from randomization
Adverse events
Number patients with of adverse events (surgical complications, surgical site infections or delayed significant diagnosis)
Time frame: Within one year from randomization
Appendicitis
Number of patients diagnosed with appendicitis
Time frame: Within 2 years from randomization
Quality of life (EQ-5D-5L index value)
Quality of life determined by weekly EQ-5D-5L index values.
Time frame: During the first 30 days from randomization
Quality of life (EQ-5D-5L EQ-VAS score)
Quality of life determined by weekly EQ-5D-5L EQ-VAS score.
Time frame: During the first 30 days from randomization
Costs in Euros
Overall costs of diagnostics and treatment
Time frame: During the first 30 days from randomization
Plan to share: No
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