Diagnostic accuracy of procalcitonin for overall and complicated acute appendicitis in children: a meta-analysis

Cui, Wei; Liu, Haipeng; Ni, Hong; Zhu, Liran

doi:10.1186/s13052-019-0673-3

Cited by 27 publications

(19 citation statements)

References 28 publications

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“…Yu et al reported that PCT had little value in diagnosing AA, with lower diagnostic accuracy than CRP and WBC, but a greater diagnostic value in identifying complicated AA [58]. In a recent meta-analysis, it was confirmed that PCT was more accurate in diagnosing complicated AA, with a pooled sensitivity of 0.89 (95% CI 0.84-0.93), specificity of 0.90 (95% CI 0.86-0.94), and diagnostic odds ratio of 76.73 (95% CI 21.6-272.9) [59].…”

Section: Q14: What Is the Role Of Serum Biomarkers In Evaluating Pementioning

confidence: 89%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Section: Q14: What Is the Role Of Serum Biomarkers In Evaluating Pementioning

confidence: 89%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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“…Accurate differentiation between simple and complicated appendicitis is emerging as a potentially key issue as the historical standard of care, that is prompt appendectomy, is increasingly questioned in pediatric patients [7,16]. Since AA has a rate of been complicated of approximately 40%, different methods for predicting complicated [7,13,[17][18][19]. This study not only describe the independent risk factors for complicated appendicitis, but establish early identification of risk factors in order to predict complicated appendicitis.…”

Section: Discussionmentioning

confidence: 95%

A clinical prediction model for complicated appendicitis in children younger than five years of age

Feng

Xing

et al. 2020

BMC Pediatr

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Background: No reliably specific method for complicated appendicitis has been identified in children younger than five years of age. This study aimed to analyze the independent factors for complicated appendicitis in children younger than five years of age, develop and validate a prediction model for the differentiation of simple and complicated appendicitis. Methods: A retrospective study of 382 children younger than five years of age with acute appendicitis from January 2007 to December 2016 was conducted with assessments of demographic data, clinical symptoms and signs, and pre-operative laboratory results. According to intraoperative findings and postoperative pathological results, acute appendicitis was divided into simple and complicated appendicitis. Univariate and multivariate analyses were used to screen out the independent factors of complicated appendicitis, and develop a prediction model for complicated appendicitis. Then 156 such patients from January 2017 to December 2019 were collected as validation sample to validate the prediction model. Test performance of the prediction model was compared with the ALVARADO score and Pediatric Appendicitis Score (PAS). Results: Of the 382 patients, 244 (63.9%) had complicated appendicitis. Age, white blood cell count, and duration of symptoms were the independent factors for complicated appendicitis in children younger than five years of age. The final predication model for complicated appendicitis included factors above. In validation sample, the prediction model exhibited a high degree of discrimination (area under the curve [AUC]: 0.830; 95% confidence interval [CI]: 0.762-0.885) corresponding to a optimal cutoff value of 0.62, and outperformed the PAS (AUC: 0.735; 95% CI: 0.658-0.802), ALVARADO score (AUC: 0.733; 95% CI: 0.657-0.801). Conclusion: Age, white blood cell count, and duration of symptoms could be used to predict complicated appendicitis in children younger than five years of age with acute appendicitis. The prediction model is a novel but promising method that aids in the differentiation of acute simple and complicated appendicitis.

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“…In patients with atypical forms of AA, routine diagnostic laboratory workup for suspected AA should include WBC, the differential with the calculation of the absolute neutrophil count (ANC), neutrophil -to-lymphocyte ratio (NLR), C-reactive protein (CRP), red cell distribution width [48,49] and urinalysis. Recently, ischemia-modi ed albumin (IMA) and procalcitonin levels have been used to determine the prediction of severity in AA patients [28,29]. A combination of clinical examination (with new palpation sign), laboratory tests, and US may signi cantly improve diagnostic sensitivity and speci city and eventually replace the need for CT scan in both women of childbearing age and children [30,37].…”

Section: Discussionmentioning

confidence: 99%

A New Palpation Sign for the Diagnosis of Atypical Forms of Acute Appendicitis (Children and Women of Childbearing Age)

Marek

Záhorec

Durdík

2021

Preprint

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BackgroundEven today, the diagnosis of acute appendicitis (AA) is still problematic. Here, we offer a new palpation sign for the diagnosis of AA. In this study, we evaluate the efficacy of the sign for the diagnosis of atypical forms of AA (i.e., in children and women of childbearing age).MethodsWe have retrospectively analysed 2245 patients - children (aged 0–12), men (aged 12–18) and women of childbearing age (aged 12–45) with suspected AA, 401 of whom underwent surgery. Patients were divided into one of three age categories and, based on clinical data and histological findings, were defined as either false negative, false positive, or positive. Confirmed positive AA was defined based on histological findings, and confirmed negative AA was defined by histological findings as well as on clinical follow-up. Pearson’s correlation analysis was used for the assessment of the correlation between the patient’s gender, age as well as their clinical and histological findings.ResultsBased on these statistical results, we came to the following results. In children (aged 0–12, male/female) and in women of childbearing age (aged 12–45), we observed 14 (3,46%) false negative clinical findings for the palpation sign. In children and women of childbearing age, we observed a higher percentage of palpation sign positivity compared to false positivity. The new palpation sign minimizes unindicated revisions of the abdominal cavity, serves as a reliable indicator for surgery and is suitable for the diagnosis of AA in atypical forms (i.e., in children and women of childbearing age) with a sensitivity of 95,57%, a specificity of 95,78%, a positive predictive value of 67,86%, a negative predictive value of 99,50%, a positive likelihood ratio of 24,28, a negative likelihood ratio of 0,05 and an accuracy of 95,9%. The negative appendectomy rate in women of childbearing age was 9.22% and in children 6,72%.ConclusionWe conclude that the new palpation sign is effective (r > 0.95) for the diagnosis of atypical forms of AA (i.e., in children and women of childbearing age). It is aimed principally at the medical practitioners in different parts of the world and in a state of emergency (Covid-19 pandemic, wars, etc.) where the diagnostic facilities and technological resources are limited.

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Diagnostic accuracy of procalcitonin for overall and complicated acute appendicitis in children: a meta-analysis

Cited by 27 publications

References 28 publications

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

A clinical prediction model for complicated appendicitis in children younger than five years of age

A New Palpation Sign for the Diagnosis of Atypical Forms of Acute Appendicitis (Children and Women of Childbearing Age)

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