A novel biomarker panel to rule out acute appendicitis in pediatric patients with abdominal pain

Huckins, David S.; Simon, Harold K.; Copeland, Karen A. F.; Spiro, David M.; Gogain, Joseph; Wandell, Michael

doi:10.1016/j.ajem.2013.06.016

Cited by 45 publications

(47 citation statements)

References 52 publications

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“…The patient was a male aged 16 years and 70 kg in weight with intermediate risk of AA without fever or an elevation of inflammatory markers and with a clinical onset of <2 hours at the time of obtaining the sample. This is consistent with the results described by Huckins et al ,18 who reported that the diagnostic accuracy of a three-marker panel (WBC, CRP and calprotectin) was lower in patients with a clinical course of <24 hours, and were, therefore, in a very early phase of the disease process. Previous studies have reported that classical biomarkers may modify the diagnostic certainty based on the time of course of appendicitis 22.…”

Section: Discussionsupporting

confidence: 92%

“…These results confirm previous reports on the diagnostic accuracy of a panel of inflammatory biomarkers including WBC, CRP and calprotectin to rule out AA in children and adolescents 18. In the present study, the APPY1 Test showed a high Se (99.1%) and NPV (98.6%) and a low LHR− (0.03) comparable to the results of Huckins et al 18 (Se 96.5%, NPV 96.9%, LHR−0.08).…”

Section: Discussionsupporting

confidence: 91%

“…In the present study, the APPY1 Test showed a high Se (99.1%) and NPV (98.6%) and a low LHR− (0.03) comparable to the results of Huckins et al 18 (Se 96.5%, NPV 96.9%, LHR−0.08). The novelty of the present study was that the determination was made using the APPY1 Test, which provides a qualitative result and not three individual quantitative results, thereby facilitating the interpretation of results in daily clinical practice.…”

Section: Discussionsupporting

confidence: 90%

“…The sample size was calculated based on the study by Huckins et al ,18 considering the Se and Sp of the lower value of the CI (Se 92% and Sp 38%) and a frequency of AA of 30%. It was estimated that a sample size of 308 patients was necessary for a confidence level of 95% and a precision of 6.5%.…”

Section: Methodsmentioning

confidence: 99%

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Diagnostic accuracy of the APPY1 Test in patients aged 2–20 years with suspected acute appendicitis presenting to emergency departments

et al. 2016

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

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Diagnostic accuracy of the APPY1 Test in patients aged 2–20 years with suspected acute appendicitis presenting to emergency departments

et al. 2016

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“…Acute appendicitis in paediatric patient is among the causal of abdominal emergency which requires immediate operation (Victor, et al, 2012;Ballester et al, 2009;Huckins et al, 2013). The incidence of acute appendicitis in paediatric patient in the world ranges from 1 to 8 % of all pediatric patients coming to the Emergency Department (ED) with acute abdominal pain (Jangra et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Role of Red Blood Cell Distribution Width (RDW) and Neutrophil Lymphocyte Ratio (NLR) in Diagnosis of Appendicitis in Paediatric Patients in H. Adam Malik Medan Central General Hospital

Paramita

Fikri

Lubis

2018

ijmsci

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Acute appendicitis in paediatric patient is among the causal of abdominal emergency which requires immediate operation (Victor, et al, 2012; Ballester et al., 2009; Huckins et al., 2013). The incidence of acute appendicitis in paediatric patient in the world ranges from 1 to 8 % of all pediatric patients coming to the Emergency Department (ED) with acute abdominal pain (Jangra et al., 2013). Appendicitis is rare in children under 5 years, and very rare in the first year of life. In some instances, boys are more than girls around 55% to 65% of patients (Stevenson, Edward, 2003). The incidence rate of perforated appendicitis in the age group of children is about 30% to 40%. Appendicitis in the neonate is very rare, and the surgeon should be careful of the accompanying conditions, such as Hirschsprung’s disease and necrotic enterocolitis. (Stevenson, Edward, 2003).

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Diagnostic performance of calprotectin and APPY-1 test in pediatric acute appendicitis: a systematic review and a meta-analysis

Montero

Pascual

Antona

et al. 2022

Eur J Trauma Emerg Surg

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Background Pediatric acute appendicitis (AA) is a challenging pathology to diagnose. In the last decades, multiple biomarkers have been evaluated in different human biological samples to improve diagnostic performance. This study aimed to examine the diagnostic performance of serum, fecal and urinary calprotectin as well as the role of the APPY-1 biomarker panel in pediatric acute appendicitis. Methods We conducted a systematic review of the literature that involved an extensive search in the main databases of medical bibliography (Medline, PubMed, Web of Science and SciELO). Two independent reviewers selected the relevant articles based on the previously defined inclusion and exclusion criteria. Methodological quality of the selected article was rated using the QUADAS2 index. Data extraction was performed by two independent reviewers. A synthesis of the results, a standardization of the metrics and two random-effect meta-analyses, one for serum calprotectin and one for APPY-1, were performed. Results The research resulted in 173 articles. Thirty-eight duplicates were removed. Among the remaining 135 articles, we excluded 125 following the inclusion and exclusion criteria, resulting in the 10 studies included in this review. This systematic review included data from of 3901 participants (1276 patients with confirmed diagnosis of AA and 2625 controls). The age of the participants ranged from 0 to 21 years. Four of the studies compared serum calprotectin values and reported significant differences between groups, but inconsistent results regarding cutoff points, sensitivity and specificity. Two publications compared urinary values of calprotectin and presented inconsistent results regarding sensitivity and specificity as well. One publication evaluated the diagnostic performance of fecal calprotectin, but it did not provide data on measured values. Four studies evaluated the diagnostic performance of APPY-1 test in pediatric acute appendicitis. The calculated pooled sensitivity and specificity of those studies were 97.37 (95% CI 95.60–98.44) and 36.74 (95% CI 32.28–41.44), respectively, and the calculated pooled NLR, 0.0714 (95% CI 0.041–0.115). Conclusion Serum calprotectin has limited diagnostic yield in pediatric acute appendicitis. Its performance seems to increase with the hours of clinical evolution and in advanced AA, although the evidence is limited. There is not enough evidence on the usefulness of urinary or fecal calprotectin in the diagnosis of pediatric acute appendicitis. On the other hand, the APPY-1 is a reliable test to exclude the diagnosis of AA in patients at low or moderate risk according to PAS and Alvarado Score.

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A novel biomarker panel to rule out acute appendicitis in pediatric patients with abdominal pain

Cited by 45 publications

References 52 publications

Diagnostic accuracy of the APPY1 Test in patients aged 2–20 years with suspected acute appendicitis presenting to emergency departments

Diagnostic accuracy of the APPY1 Test in patients aged 2–20 years with suspected acute appendicitis presenting to emergency departments

Role of Red Blood Cell Distribution Width (RDW) and Neutrophil Lymphocyte Ratio (NLR) in Diagnosis of Appendicitis in Paediatric Patients in H. Adam Malik Medan Central General Hospital

Diagnostic performance of calprotectin and APPY-1 test in pediatric acute appendicitis: a systematic review and a meta-analysis

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