The BIDIAP index: a clinical, analytical and ultrasonographic score for the diagnosis of acute appendicitis in children

Abstract

Background Pediatric acute appendicitis (PAA) continues to be a diagnostic challenge today. The diagnostic performance of classical indices is only moderate, especially in pediatric population. This study aimed to define a clinical, radiological and analytical index for the diagnosis of PAA. Materials and methods This prospective study included 151 patients divided into two groups: (1) 53 patients with non-surgical abdominal pain (NSAP) and (2) 98 patients with a confirmed PAA. Sociodemographic and clinical characteristics were compared between groups using the Mann–Whitney U test and the Fisher exact test. To identify the predictors of PAA, we performed a multivariable logistic regression using a forward stepwise analysis and we assigned multiples of integer values to the selected variables. The diagnostic performance of the index was assessed by calculating the area under the receiver operating characteristic curve. Intra-cohort calibration was assessed with the Hosmer–Lemeshow test. Results We developed the BIDIAP index (BIomarkers for the DIagnosis of Appendicitis in Pediatrics), which included three variables that independently predicted higher odds of PAA: appendiceal caliber (≥ 6.9 mm), systemic immune-inflammation index (≥ 890) and peritoneal irritation, which scored 4, 3 and 2 points, respectively. Mean (SD) score of the participants was 2.38 (2.06) in group 1 and 7.89 (1.50) in group 2. The area under the ROC was 0.97 (95% CI 0.95–0.99). The cut-off point was established at 4 points, resulting in a sensitivity of 98.98% and a specificity of 77.78%. Conclusions The BIDIAP index has an exceptional diagnostic performance in PAA. The importance of these results lies in its novelty and in the simplicity of the index. Although external validation will be necessary, initial results look promising.

Flow cytometric characterization of cecal appendix lymphocyte subpopulations in children: a pilot study

“…This study, which constitutes an extension of the BIDIAP cohort [ 16 , 17 ], is a prospective, observational study aimed to characterize lymphocyte subpopulations of the cecal appendix in children using flow cytometry. Three groups of pediatric patients were included in this study: (1) patients in whom appendectomy was performed and in whom the histological report revealed an absence of acute appendiceal inflammation.…”

Evaluación prospectiva del perfil emético y la eficacia analgésica del ibuprofeno y el metamizol intravenosos en el postoperatorio inmediato de la apéndicitis aguda pediátrica

“…El presente estudio es un subanálisis de la cohorte BI-DIAP (17) , un estudio prospectivo unicéntrico realizado en 2021 en España cuyo objetivo principal consistía en evaluar los potenciales nuevos biomarcadores diagnósticos de la AAP. El subanálisis fue diseñado para examinar el perfil analgésico y emético del ibuprofeno y el metamizol (dipirona) en el postoperatorio inmediato de la AAP.…”

Diagnostic performance of serum CA-125 for overall and complicated acute appendicitis: a systematic review and meta-analysis

“…It should be noted, however, that these markers often have high processing times and economic costs and are not available in all Emergency Departments. In this sense, it is pertinent to highlight the role of the ratios derived from the complete blood count (CBC) such as plateletto-lymphocyte ratio (PLR) or systemic immune inflammation index (SII), due to their ease of implementation, fast processing time and low economic cost [5,6]. Although these lines of research are of great interest, at present none of these biomarkers or ratios have reached a diagnostic performance that would allow them to be considered unique diagnostic tests.…”