A Clinical Score to Predict Appendicitis in Older Male Children

Kharbanda, Anupam B.; Monuteaux, Michael C.; Bachur, Richard G.; Dudley, Nanette C.; Bajaj, Lalit; Stevenson, Michelle D.; Macias, Charles G.; Mittal, Manoj K.; Bennett, Jonathan E.; Sinclair, Kelly; Dayan, Peter

doi:10.1016/j.acap.2016.11.014

Cited by 17 publications

(14 citation statements)

References 24 publications

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“…There are various clinical diagnostic scores of AA in children (Dingemann and Ure, 2012;Peyvasteh et al, 2017). The Alvarado score and PAS are the most widely used diagnostic scores of AA in children with proven high levels of diagnostic accuracy (Kharbanda et al, 2017;Dokumcu et al, 2018). However, these scores are based on retrospective studies, and thus diagnostic accuracy might be different in prospective studies (Pogoreliã et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children

Zviedre

Eņģelis

Tretjakovs

et al. 2019

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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The aim of the study was to determine whether the Alvarado score (AS) together with laboratory tests could be used to distinguish patients with acute appendicitis (AA) from acute mesenteric lymphadenitis (AML). Fifty-seven patients (7–18 years) with suspected AA were included in the prospective study (October 2010 – October 2013). Thirty-one patients underwent surgery for AA and 26 were not treated surgically and were diagnosed AML on ultrasonography. AS, white blood cell count (WBC), C – reactive protein (CRP) and serum cytokines (EGF, IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, TNF-α) were obtained on admission and were compared between groups. Mean age of the 57 patients was 12.9 (SD 3.2). Accuracy (AR) for AS ≥ 7 alone was 73.7% for AA. Modified AS with certain serum cytokines seemed to be a reliable tool for initial differential diagnosis between AA and AML in school-age children. Based on these results, AS ≥ 7, WBC ≥ 10.7 × 103/µL and serum IL-6 ≥ 4.3 pg/mL assessed altogether will yield more sensitivity for AA. Also for further advanced diagnostics, we propose to take into account the serum IL-6, IL-8, MCP-1, CRP cut-off levels in the differential diagnosis between complicated and uncomplicated AA to decide whether the treatment should be conservative or surgical.

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Section: Discussionmentioning

confidence: 99%

Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children

Zviedre

Eņģelis

Tretjakovs

et al. 2019

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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“…12 Some studies have attempted to device scoring system for clinical diagnosis of appendicitis by using only neutrophil count over the clinical findings as an effort to reduce usage of imaging. [13][14][15] The most common cause of abdominal pain in the Turkish study was upper respiratory infection (23.7%) while it was constipation in the study by Caperell et al In our study also the most common cause was mesenteric adenitis which is common associated symptom in upper respiratory infections in children. In the study by Muhammad, the most common cause was acute appendicitis (40.4%).…”

Section: Discussionmentioning

confidence: 53%

Surgical causes of abdominal pain in children: a retrospective study

2018

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INTRODUCTIONAbdominal pain is an important and common cause of hospital visit in paediatric patients. The anxiety of parents in most cases and the difficulty in obtaining history from children makes it difficult for the doctors to handle these patients. On an average about 5 to 10% of emergency department visit by children is attributable to abdominal pain.1 The presentation of abdominal pain can be acute or chronic. Among the acute causes some require urgent treatment while in others the treatment is nonurgent.It is a triage of sorts which helps in differentiating a serious condition from a benign one. Among the various causes, studies show that about 20% were of surgical etiology.2 Accurate diagnosis of cause of the pain is not possible with the assessment of the symptoms only because abdominal organs are devoid of pain sensation and the pain is usually a due to propagation of impulses to another area or due to visceral pain receptors activation.3,4 The management requires blood counts and urine analysis and is often supplemented with the judicial use of diagnostic modalities like ultrasound, abdomen X ray and CT scan when warranted. The diagnosis of acute appendicitis by only clinical examination has a sensitivity of 75% and specificity of 78% which is not satisfactory in clinical settings.5 This article analyses the common causes of abdomen pain in children and the treatment initiated.The aim of this study was to evaluate the various surgical causes of abdominal pain in children less than 15 yrs. We also evaluated the intervention given and the outcome. METHODSThis was a retrospective study in the department of surgery in our hospital during a period of 3 years from ABSTRACT Background: Abdominal pain is a very prevalent problem in children and one of the common causes for visit to the hospital. They may be of acute or chronic presentation and depending on severity may also require admission to hospital. Methods: This is a retrospective study conducted in our hospital over a period of 3 years. About 200 children who came to the hospital with abdominal pain and received treatment in surgical outpatient or referred to surgery department from emergency were included in this study and all relevant data were collected. Results: The pain was found to be more in boys and in the age group of 9 to 12years. The most common cause was found to be mesenteric adenitis followed by acute appendicitis. About 38% of children required surgical intervention on that admission due to various surgical causes. Conclusions:The database of our retrospective study regarding age and sex incidence, clinicopathological features and therapeutic outcome was comparable to other studies in various literatures.

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“…Popular ones were Alvarado and PAS [ 6 , 7 ]. There were also other reports with different clinical scoring systems [ 10 , 13 , 14 ]. However, neither method was satisfactory to be the only method for decision-making.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Multivariate Analysis of Data from Children with Suspected Appendicitis: A New Tool for Diagnosis

Dökümcü

Kurtmen

Divarcı

et al. 2018

Emergency Medicine International

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Background Decision-making for management may sometimes be difficult in acute appendicitis (AA). Various diagnostic scoring systems exist, but their sensitivity and specificity rates are far from ideal. In this study, the determination of the predictors and the effect of radiological data and developing a new scoring system were aimed. Methods Medical records of patients who were hospitalized for AA between February 2012 and October 2016 were retrospectively reviewed. All data were compared between patients with and without appendicitis. The multivariate analysis was performed to define significant variables and to examine the sensitivity and specificity of each group of predictors including radiological data. A new scoring system (NSS) was formed and was compared with two existing scoring systems: pediatric appendicitis score (PAS) and Alvarado scoring system (ASS) by using reclassification method. Results Negative appendectomy rate was 11.3%. Statistical analysis identified 21 independently significant variables. The heel drop test had the highest odds ratio. Sensitivity and specificity rates of clinical predictors were 84.6% and 94.8%, respectively. Radiological predictors increased the sensitivity rate to 86.9%. Sensitivity and specificity rates for PAS, ASS, and NSS were 86.8% and 83.9%, 84.7% and 81.6%, and 96.8% and 95.6%, respectively. The “re-assessed negative appendectomy rate” was 6.2% and false positive results were remarkably more common in patients with duration of symptoms less than 24 hours. Conclusion Radiological data improves the accuracy of diagnosis. Containing detailed clinical and radiological data, NSS performs superiorly to PAS and ASS, regarding sensitivity and specificity without any age limitation. The efficiency of NSS may be enhanced by determining different predictors for different phases of the inflammatory process.

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A Clinical Score to Predict Appendicitis in Older Male Children

Cited by 17 publications

References 24 publications

Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children

Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children

Surgical causes of abdominal pain in children: a retrospective study

Retrospective Multivariate Analysis of Data from Children with Suspected Appendicitis: A New Tool for Diagnosis

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