How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence

Kabir, Syed Adnan; Kabir, S.I.; Sun, Rui; Jafferbhoy, Sadaf; Karim, Ahmed

doi:10.1016/j.ijsu.2017.03.013

Cited by 70 publications

(72 citation statements)

References 59 publications

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“…A significant concern for clinicians in managing paediatric abdominal pain in ED is the possibility of missed or delayed diagnosis of appendicitis reported to be within the range of 20–40% . This can lead to significant morbidity, including perforation, abscess formation, sepsis and intra‐abdominal adhesions . The rate of misdiagnosis or delayed diagnosis is in keeping with our study findings of an AUC of 0.84 (95% CI 0.76–0.91); however, the small sample size of children who were diagnosed with appendicitis may introduce bias and therefore this will need to be clarified in a larger cohort study.…”

Section: Discussionsupporting

confidence: 84%

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Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department

Lee

O’Brien

Skarin

et al. 2019

Emerg Medicine Australasia

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Objective: Abdominal pain is a common paediatric presentation to the ED. Accurate diagnosis of acute appendicitis is challenging, with the best-performing clinical scoring systems having sensitivities between 72% and 100%. The aim of this study is to assess the diagnostic accuracy of clinician gestalt according to seniority in diagnosing paediatric acute appendicitis in ED.Methods: This is a prospective multicentre observational study of clinician's prediction of appendicitis in children under the age of 16 years presenting to four EDs with abdominal pain over a 1 month period at each site. Clinician-estimated likelihood of acute appendicitis was compared with the final diagnosis determined by histopathology or operative findings and supplemented by telephone follow up for those without an operation. The primary outcome was diagnostic accuracy of clinician gestalt according to clinician seniority in diagnosing appendicitis.Results: There were 381 children enrolled with completed clinician questionnaires, and 224 children had complete follow up or underwent appendicectomy. The median age was 9 years (interquartile range 6-12) and the incidence of appendicitis was 31/224 (13.8%, 95% confidence interval 9.3-18.4). The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value of clinician gestalt were 0.84 (0.76-0.91), 81% (63-93%), 76% (69-82%), 35% (28-42%) and 96% (92-98%), respectively, giving an overall diagnostic accuracy of 76% (70-82%). AUC stratified by clinician seniority (junior, intermediate and senior) were 0.89 (0.80-0.98), 0.82 (0.69-0.95) and 0.76 (0.56-0.96), respectively. Conclusions: The diagnostic accuracy of ED clinician gestalt in paediatric appendicitis is comparable to current clinical scoring systems irrespective of seniority.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department

Lee

O’Brien

Skarin

et al. 2019

Emerg Medicine Australasia

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“…Fever is one of the variables present in most of the RIFP diagnostic scales (Alvarado, RIPASA, and AIR). However, many authors believe that the predictive value of fever for AA is limited [29,30]. Andersson [31], in a study of 496 patients, demonstrated that a temperature > 37.7 °C had a sensitivity and specificity of 70%…”

Section: Discussionmentioning

confidence: 99%

Clinical Prediction Rules in acute appendicitis: Which combination of variables is more effective at predicting?

Olmo¹,

López²,

Esteban³

et al. 2020

Preprint

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Background: Clinical prediction rules have been designed to reduce diagnostic variability and improve the effectiveness of the diagnostic process. However, there are no unanimous criteria regarding which of them is the most efficient for the diagnosis of right iliac fossa pain. Aim: The primary aim of this study was to assess the diagnostic efficacy of the most commonly used clinical prediction rules. The second aim was to identify the combination of the smallest number of clinical and analytical variables that would allow a cost-effective diagnostic approach to assess the right iliac fossa pain. Methods: A retrospective observational study was conducted of 458 patients who were evaluated for right iliac fossa pain between January 2010 and December 2016. The selected scores (Alvarado, AIR, RIPASA, and AAS) were applied to all cases to validate their effectiveness and simultaneously establish the smallest number of variables that were needed for an efficient diagnosis. Univariate and multiple regressions were used for validation. Results: Of the four scores tested, the Alvarado score was the most efficient diagnostic approach. However, the most reduced and predictive combination of the evaluated variables included anorexia, white blood cell count> 8275 leukocytes/μL, neutrophilia (>75%), abdominal pain < 48 hours, migrating pain to the right lower quadrant and axillary temperature out the range of 37-39ºC. Conclusions: A new and effective score for predicting appendicitis in patients presenting with right iliac fossa pain has been established.

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“…Laparoskoskopija, UZ, CT i laboratorijska dijagnostika tehnički su napredovali. 19 Ipak, klinički postavljena dijagnoza akutnog apendicitisa i dalje je nesigurna. Rješenje se pokušava naći uvođenjem numeričkih sustava bodovanja (Alvaradov je najpoznatiji).…”

Section: Raspravaunclassified

Alvarado Score in Children With Diagnosis of Acute Appendicitis

2018

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Sažetak. Alvaradov sustav bodovanja osmišljen je radi smanjenja broja negativnih apendektomija. Rabi se u adultnoj i pedijatrijskoj populaciji, a broj negativnih apendektomija rijetko je manji od 10%. Kako bismo provjerili pouzdanost metode, analizirali smo korelaciju Alvaradova sustava bodovanja i histološke dijagnoze djece apendektomirane zbog sumnje na akutnu upalu crvuljka. U retrospektivnoj studiji obuhvaćeno je 330-ero djece (Zavod za dječju kirurgiju, KBC Zagreb), u razdoblju od siječnja 2014. do prosinca 2016. s kliničkom dijagnozom akutne upale crvuljka. Uključena su sva djeca neovisno o metodi apendektomije. Zbog nepotpune medicinske dokumentacije isključeno je 39-ero djece pa se u ovoj studiji analizira 291 dijete. Svaki je crvuljak postoperativno histološki pregledan u Zavodu za patologiju i citologiju KBC-a Zagreb i postavljena je konačna dijagnoza. U 160-ero djece preoperativno je načinjen ultrazvučni pregled trbuha te je zabilježena prisutnost ili odsutnost znakova upale crvuljka. Od ukupno 291 histološki pregledanog crvuljka njih 35 (12%) bilo je bez znakova upale, 44 (15,1%) bilo ih je u kataralnom stadiju upale, 153 (52,6%) fl egmonozno, a 58 (19,9%) gangrenozno promijenjeno te je u jednog dječaka (0,3%) crvuljak bio perforiran. Srednja vrijednost (bodovnog iznosa prema Alvaradovu sustavu bodovanja) za djecu koja su imala histološki nalaz inocentnog ('nevinog') crvuljka i kataralne upale jest 6, za fl egmonozne crvuljke 7, a gangrenozne 8. Dječak s perforiranim crvuljkom imao je zbroj bodova 6. Analizirane su osjetljivost, specifi čnost i pozitivna prediktivna vrijednost kada je zbroj 7 i veći, a negativna vrijednost kada je zbroj 5 i manji. Osjetljivost Alvaradova bodovnog sustava u ispitivanoj skupini jest 68,9%, a specifi čnost 52,9%. Pozitivna je prediktivna vrijednost 91,7%, a negativna 99%. Alvaradov zbroj statistički je značajno veći u djece s fl egmonoznom upalom crvuljka negoli kod onih s negativnim nalazom (p = 0,003) i kataralnom upalom (p = 0,007). Kod djece koja su imala gangrenoznu upalu crvuljka u odnosu prema inocentnim i kataralno promijenjenima također je statistički značajna razlika Alvaradova zbroja (p < 0,001). U djece s fl egmonozno i gangrenozno upalno promijenjenim crvuljkom nema statistički značajne razlike Alvaradova zbroja (p = 0,054), kao ni kod histoloških dijagnoza kataralne upale i inocentnog crvuljka (p = 0,998). Od ukupnog broja apendektomirane djece u njih 160-ero (54,9%) načinjen je preoperativni ultrazvučni pregled trbuha. Od svih ultrazvučnih nalaza njih 82 (51,2%) potvrđena su histološkom dijagnozom. Od ultrazvučnih nalaza koji nisu histološki potvrđeni bila su 64 (40%) lažno negativna i 14 (8,8%) lažno pozitivnih. Ultrazvučno pozitivan nalaz upalnih promjena crvuljka ima pozitivnu prediktivnu vrijednost 84,1%, a negativan nalaz 11,1%. Alvaradov sustav bodovanja u djece nije klinički pouzdan pokazatelj pozitivnih nalaza akutne upale crvuljka, ali ima visoku prediktivnu vrijednost negativnih apendektomija.Summary. The Alvarado scoring (AS) system was created ...

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How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence

Cited by 70 publications

References 59 publications

Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department

Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department

Clinical Prediction Rules in acute appendicitis: Which combination of variables is more effective at predicting?

Alvarado Score in Children With Diagnosis of Acute Appendicitis

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