Integration of Physical Examination, Old and New Biomarkers, and Ultrasonography by Using Neural Networks for Pediatric Appendicitis

Akgül, Fatma; Er, Anıl; Ulusoy, Emel; Çağlar, Aykut; Çitlenbik, Hale; Keskįnoğlu, Pembe; Şişman, Ali R; Karakuş, Osman Zeki; Özer, Erdener; Duman, Murat; Yılmaz, Durgül

doi:10.1097/pec.0000000000001904

Cited by 14 publications

(14 citation statements)

References 39 publications

(83 reference statements)

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“…The APPY1 panel including serum CP, WBC, and CRP has a high negative predictive value and allows reducing computer tomography utilization in patients suspected of suffering from AA, which is particularly important in case of non-adults [32][33][34][35]. More recently, a research evaluated the accuracy of clinical manifestations, laboratory analyses, and imaging methods for the diagnosis of AA [36]. They found that each marker used individually does not provide satisfying power, and the classic physical examination is still the most important single tool.…”

Section: Discussionmentioning

confidence: 99%

On the Way to Improve Diagnostic Marker Panel for Acute Appendicitis in Adults: the Role of Calprotectin

et al. 2021

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Calprotectin is a positive acute-phase protein participating in innate immune responses and inflammatory processes. This protein is produced mainly in neutrophils, which infiltrate inflamed tissues and then increase the level of calprotectin in plasma, urine, or body secretions. Its measurement is used in the diagnosis of many inflammatory diseases of the gastrointestinal tract. Here, we reviewed the studies evaluating the utility of calprotectin when the patient is suspected of acute appendicitis, one of the most common causes of abdominal pain. Fecal and serum calprotectin provide clinicians additional information as compared to routinely performed laboratory analyses. Moreover, among all forms of the protein, the fecal calprotectin seems to be a particularly promising biomarker due to its high resistance to degradation in the stool. In the future, innovative methods in the form of neural networks may play a valuable role in developing such panels. These findings are important because current literature showed that sensitive and specific markers of acute appendicitis are still urgently needed.

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Section: Discussionmentioning

confidence: 99%

On the Way to Improve Diagnostic Marker Panel for Acute Appendicitis in Adults: the Role of Calprotectin

et al. 2021

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“…Neutrophil count can also be used to help identify an inflamed appendix [ 4 , 8 ] although it is not given as much consideration in the literature compared to WBC count. It can also be elevated in any infective condition and usually indicates a bacterial etiology.…”

Section: Discussionmentioning

confidence: 99%

“…It has been noted in the systematic review by Kabir et al that CRP is better for detecting complicated or late-stage appendicitis as it is a lag indicator and is less useful for early-stage appendicitis [ 10 ]. Other papers have also demonstrated that it is less useful for acute appendicitis but significant elevation is suggestive of abscess or perforation [ 4 , 8 ]. Zani et al found that a CRP cut-off value of 40 identified one-third of paediatric patients with simple appendicitis but two-thirds of complicated appendicitis.…”

Section: Discussionmentioning

confidence: 99%

A Correlation of Blood Panel Results and Histologically Confirmed Appendicitis

Keohane¹,

O’Leary²,

Nagle³

et al. 2020

Cureus

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Background Appendicitis is the most common indication for emergency surgery in the world. There is no one laboratory or radiological test that is used to diagnose it. Various routine and novel blood markers have been identified, however none have proved to be conclusive. The aim of this study was to combine routine blood markers to increase the sensitivity and specificity in diagnosing histologically confirmed appendicitis. Methods We retrospectively reviewed the theatre logs for the calendar year of 2015 to identify all of the appendectomies which were performed. We reviewed all of the admission bloods for the patients - including their white blood cell (WBC) count, their neutrophil count, and their C-Reactive protein (CRP) value. We also reviewed all of the histology to identify the inflamed appendices, and analysed all of this information together. Results The neutrophil count is the most sensitive of the three blood markers with a score of 82%. It has a specificity of 63%. The CRP value is the most specific of the three blood markers with a value of 67% and a sensitivity of 76%. WBC has a sensitivity of 75% and a specificity of 63%. Combining all of the blood values (i.e. elevated white blood cell count or elevated neutrophil count or elevated CRP) demonstrates a sensitivity of 96% and a specificity of 45%. Conclusion Combining routine admission blood markers (WBC, neutrophil count, and CRP) can assist in diagnosing appendicitis in unwell patients with abdominal pain.

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“…The diagnosis of AA can be made more accurately, especially with repeated examinations by the same person. 7,8 Paediatric surgeons are the most competent physicians to diagnose AA. However, children with abdominal pain often present to family physicians, paediatricians and hospital emergency departments.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…For this reason, the patient should be thoroughly evaluated before the operation. The diagnosis of AA can be made more accurately, especially with repeated examinations by the same person 7,8 …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

The importance of physician speciality on the diagnosis of acute appendicitis and its effect on morbidity in children

Bostancı

Şenel

2022

J Paediatrics Child Health

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Aim Most acute appendicitis (AA) patients present first to physicians who are not paediatric surgeons. The aim of this study was to investigate whether there is a relationship between the speciality of the first physician and delays in diagnosis and morbidity in AA. Methods The study was planned prospectively. Patients who were operated on between 15 June 2017 and 2018 due to abdominal pain were included. Demographic data of the patients, speciality of the doctors who examined them and postoperative complications were recorded. The patients were divided into three groups: those who were diagnosed at the first examination, those who were diagnosed at the second examination and those who were diagnosed after three or more examinations. Results A total of 414 patients were included in the study. There were 255 (61.6%) patients in group 1, 135 (32.6%) patients in group 2 and 24 (5.8%) patients in group 3. The mean age of the patients in group 3 was lower (P < 0.05). Postoperative complications and hospital stay were higher in group 3 (P < 0.05). While 91.8% of the patients in group 1 were examined by a paediatrician, this rate was significantly lower in the other groups (P < 0.05). Conclusions If children presenting with abdominal pain are evaluated primarily by paediatricians, consultation with paediatric surgeons is faster. The awareness of doctors of other specialities should be increased through regular periodic training.

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Integration of Physical Examination, Old and New Biomarkers, and Ultrasonography by Using Neural Networks for Pediatric Appendicitis

Cited by 14 publications

References 39 publications

On the Way to Improve Diagnostic Marker Panel for Acute Appendicitis in Adults: the Role of Calprotectin

On the Way to Improve Diagnostic Marker Panel for Acute Appendicitis in Adults: the Role of Calprotectin

A Correlation of Blood Panel Results and Histologically Confirmed Appendicitis

The importance of physician speciality on the diagnosis of acute appendicitis and its effect on morbidity in children

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