Abstract:In order to study the practical application value of abdominal ultrasonography in the diagnosis and treatment of acute abdomen in children, this study uses the method of collecting clinical actual cases and scientific analysis to estimate the clinical diagnostic value of high-frequency ultrasound and low-frequency ultrasound. In order to further clarify its curative effect and treatment advantages, a retrospective analysis of medical records was conducted, and 95 children with acute abdominal pain and suspecte… Show more
“…In relation to radiological studies for the diagnosis of PAA, abdominal ultrasound (AUS) has an excellent diagnostic yield [ 6 ], especially when combined with clinical and analytical scores (such as PAS score or Alvarado score) [ 1 ]. However, AUS is an operator-dependent test and visualization of the appendix is not achieved in all patients, so it cannot be considered a definitive diagnostic test [ 6 , 7 ]. It should be noted that the use of computed tomography (CT) in the setting of PAA is limited due to the significant radiation dose associated with this particularly vulnerable population.…”
Introduction
NGAL has recently been studied as a biomarker in the diagnostic context of pediatric acute appendicitis (PAA), although existing series are scarce and have limited sample sizes.
Materials and methods
A prospective observational study was designed to validate serum NGAL as a diagnostic tool in PAA. This study included 215 patients, divided into 3 groups: (1) patients undergoing major outpatient surgery (n = 63), (2) patients with non-surgical abdominal pain in whom a diagnosis of PAA was excluded (n = 53) and (3) patients with a confirmed diagnosis of PAA (n = 99). Patients in group 3 were divided into complicated or uncomplicated appendicitis. In 201 patients, a serum sample was obtained at the time of diagnosis and NGAL concentration was determined by ELISA. The Kolmogorov–Smirnov test was used to assess normality. Comparative statistical analyses were performed using the Mann–Whitney U test, the Kruskal-Wallis test and the Fisher’s exact test. To calculate the discriminative ability of the molecule, the area under the receiver-operating characteristic curves (AUC) was calculated. A p value < 0.05 established statistical significance.
Results
Median (interquartile range) of serum NGAL values were 38.88 (27.15–48.04) ng/mL (group 1), 51.84 (37.33–69.80) ng/mL (group 2) and 65.06 (50.50–86.60) ng/mL (group 3). The AUC (group 2 vs 3) was 0.642 (95% CI 0.542–0.741) (p < 0.001) and the best cutoff point was found to be at 40.97 ng/mL, with a sensitivity of 89% and a specificity of 34.6%. No statistically significant differences in serum NGAL values were found between patients with uncomplicated PAA and those with complicated PAA.
Conclusions
This prospective validation study with a large sample size confirms that the diagnostic yield of NGAL in the context of PAA is only moderate, and therefore, it should not be used as a unique diagnostic tool. Furthermore, NGAL is not a valid biomarker to discern between uncomplicated and complicated PAA.
“…In relation to radiological studies for the diagnosis of PAA, abdominal ultrasound (AUS) has an excellent diagnostic yield [ 6 ], especially when combined with clinical and analytical scores (such as PAS score or Alvarado score) [ 1 ]. However, AUS is an operator-dependent test and visualization of the appendix is not achieved in all patients, so it cannot be considered a definitive diagnostic test [ 6 , 7 ]. It should be noted that the use of computed tomography (CT) in the setting of PAA is limited due to the significant radiation dose associated with this particularly vulnerable population.…”
Introduction
NGAL has recently been studied as a biomarker in the diagnostic context of pediatric acute appendicitis (PAA), although existing series are scarce and have limited sample sizes.
Materials and methods
A prospective observational study was designed to validate serum NGAL as a diagnostic tool in PAA. This study included 215 patients, divided into 3 groups: (1) patients undergoing major outpatient surgery (n = 63), (2) patients with non-surgical abdominal pain in whom a diagnosis of PAA was excluded (n = 53) and (3) patients with a confirmed diagnosis of PAA (n = 99). Patients in group 3 were divided into complicated or uncomplicated appendicitis. In 201 patients, a serum sample was obtained at the time of diagnosis and NGAL concentration was determined by ELISA. The Kolmogorov–Smirnov test was used to assess normality. Comparative statistical analyses were performed using the Mann–Whitney U test, the Kruskal-Wallis test and the Fisher’s exact test. To calculate the discriminative ability of the molecule, the area under the receiver-operating characteristic curves (AUC) was calculated. A p value < 0.05 established statistical significance.
Results
Median (interquartile range) of serum NGAL values were 38.88 (27.15–48.04) ng/mL (group 1), 51.84 (37.33–69.80) ng/mL (group 2) and 65.06 (50.50–86.60) ng/mL (group 3). The AUC (group 2 vs 3) was 0.642 (95% CI 0.542–0.741) (p < 0.001) and the best cutoff point was found to be at 40.97 ng/mL, with a sensitivity of 89% and a specificity of 34.6%. No statistically significant differences in serum NGAL values were found between patients with uncomplicated PAA and those with complicated PAA.
Conclusions
This prospective validation study with a large sample size confirms that the diagnostic yield of NGAL in the context of PAA is only moderate, and therefore, it should not be used as a unique diagnostic tool. Furthermore, NGAL is not a valid biomarker to discern between uncomplicated and complicated PAA.
“…In a study conducted by Xu et al . [ 18 ] in 2022 sensitivity and specificity of high frequency ultrasound for diagnosis of acute appendicitis in children was 95% and 100%, respectively. These data are disparate from our study, however, still stresses on the importance of this investigation for diagnosing acute appendicitis.…”
A
BSTRACT
Background:
Acute abdomen is the most commonly attended surgical emergency. It can be caused by intra-abdominal, extra-abdominal and metabolic causes. A few imaging modalities are at disposal of primary care physicians like plain x-ray and ultrasonography.
Materials and Methods:
This study has been done to compare the efficacy of clinical diagnosis, plain radiography and sonography in diagnosis of non-traumatic acute abdomen. Every patient under study admitted in the Department of General Surgery underwent thorough clinical evaluation, biochemical investigations, X-rays and sonography. Findings of clinical evaluation, X-Rays and sonography were compared to the final diagnosis found intraoperatively.
Results:
Clinical diagnosis was made in 47 (94%) out of 50 patients. X-rays were able to diagnose in 20 patients (40%) whereas sonography diagnosed 26 patients (52%).
Conclusion:
The present study showed that clinical evaluation, x-rays or Ultrasound alone are not sufficient to diagnose cause of non-traumatic acute abdomen in all cases. Clinical evaluation combined with x-rays and ultrasound increases the number and accuracy of pre-operative diagnosis in non-traumatic acute abdomen.
“…Nach der klinischen Feststellung eines akuten Abdomens ist eine schnelle Abklärung der Ursache zumeist durch eine bildgebende Diagnostik durchzuführen (Abb. 3 ; [ 1 , 26 ]). …”
Hintergrund
Etwa 8–10 % der pädiatrischen Notfälle präsentieren sich mit akuten Bauchschmerzen. Zum Ausschluss eines akuten Abdomens ist eine gezielte Abklärung notwendig.
Ziel der Arbeit
Dieser Leitartikel gibt einen Überblick über Ursachen, Symptome, Diagnostik und aktuelle Therapieempfehlungen des akuten Abdomens im Kindesalter.
Material und Methoden
Review der aktuellen Literatur.
Ergebnisse
Ursachen eines akuten Abdomens sind in der Regel eine abdominale Entzündung, eine Ischämie, ein Hohlorganverschluss oder eine akute abdominale Blutung. Extraabdominale Erkrankungen, wie eine Otitis media bei Kleinkindern und eine Hodentorsion bei jugendlichen Jungen, können auch Symptome eines akuten Abdomens auslösen. Leitbefunde sind Bauchschmerzen, (galliges) Erbrechen, abdominale Abwehrspannung, Stuhlverhalt, blutiger Stuhl, eine abdominale Prellmarke und ein reduzierter Allgemeinzustand mit Allgemeinsymptomen (Tachykardie, Tachypnoe, Hypotonie) bis zum Schock. In einigen Fällen ist eine (Notfall‑)Operation zur Fokussanierung bzw. zum Organerhalt notwendig. Ein „pediatric inflammatory multisystem syndrome-temporarily associated with rSARS-CoV‑2 infection“ (PIMS-TS) mit gastrointestinaler Beteiligung ist eine neue Ursache, die ein akutes Abdomen verursachen kann, bei der jedoch selten eine Operationsindikation besteht.
Diskussion
Das akute Abdomen kann zu einem Organverlust (z. B. Darm oder Ovar) und zu einer akuten Verschlechterung des Allgemeinzustands des Patienten bis zum Schock führen. Zur rechtzeitigen und zielgerichteten Therapie sind daher eine aufmerksame Anamnese und Untersuchung notwendig.
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