Development of a clinical scoring system for appendicitis in children with presumed appendicitis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To develop a clinical scoring system for children with presumed appendicitis who visit the emergency department. Methods: A registry based-retrospective study was conducted in the pediatric emergency department between September 2015 and December 2016. Patients aged 4 to 17 years who had a > 1 of 5 Likert scale for possibility of appendicitis were included. Multiple logistic regressions based on Akaike information criterion were performed using variables regarding clinical features and inflammatory markers to develop the clinical scoring system. Results: A total of 233 patients were included, and 93 (39.9%) had the final diagnosis of appendicitis. The final model with the lowest Akaike information criterion (171.7) consisted of 5 variables, including vomiting (1 point), absence of watery diarrhea (1 point), duration of symptoms ≤ 3 days (1 point), rebound tenderness (1 point), and white blood cell count > 10.0 × 109/L (2 points). If the clinical score was ≥ 4 of 6 points, the area under the receiver operating characteristic curve was 0.78 (95% confidence interval, 0.71-0.86) with a 78.9% sensitivity, 66.7% specificity, positive and negative predictive values of 70.0% and 76.2%, respectively, and positive and negative likelihood ratios of 2.4 and 0.3, respectively. Conclusion: The 5-item clinical scoring system shows a fair performance for prediction of pediatric appendicitis. This simple tool could be applied to predict the pediatric appendicitis, and to avoid the use of potentially unnecessary computed tomography.
Abstract
Purpose: To develop a clinical scoring system for children with presumed appendicitis who visit the emergency department. Methods: A registry based-retrospective study was conducted in the pediatric emergency department between September 2015 and December 2016. Patients aged 4 to 17 years who had a > 1 of 5 Likert scale for possibility of appendicitis were included. Multiple logistic regressions based on Akaike information criterion were performed using variables regarding clinical features and inflammatory markers to develop the clinical scoring system. Results: A total of 233 patients were included, and 93 (39.9%) had the final diagnosis of appendicitis. The final model with the lowest Akaike information criterion (171.7) consisted of 5 variables, including vomiting (1 point), absence of watery diarrhea (1 point), duration of symptoms ≤ 3 days (1 point), rebound tenderness (1 point), and white blood cell count > 10.0 × 109/L (2 points). If the clinical score was ≥ 4 of 6 points, the area under the receiver operating characteristic curve was 0.78 (95% confidence interval, 0.71-0.86) with a 78.9% sensitivity, 66.7% specificity, positive and negative predictive values of 70.0% and 76.2%, respectively, and positive and negative likelihood ratios of 2.4 and 0.3, respectively. Conclusion: The 5-item clinical scoring system shows a fair performance for prediction of pediatric appendicitis. This simple tool could be applied to predict the pediatric appendicitis, and to avoid the use of potentially unnecessary computed tomography.
참고문헌 (20)
- Lahaye MJ, "Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis", Eur Radiol, 25, pp.1464~1470 (2015)
- Boonstra PA, "Less negative appendectomies due to imaging in patients with suspected appendicitis", Surg Endosc, 29, pp.2365~2370 (2015)
- Bolmers MD, "Imaging in pediatric appendicitis is key to a low normal appendix percentage: a national audit on the outcome of appendectomy for appendicitis in children", Pediatr Surg Int, 34, pp.543~551 (2018)
- Krajewski S, "Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain:a meta-analysis", Can J Surg, 54, pp.43~53 (2011)
- Martin AE, "CT scans may not reduce the negative appendectomy rate in children", J Pediatr Surg, 39, pp.886~890 (2004)
- Shah NB, "ALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children", Curr Opin Pediatr, 20, pp.243~247 (2008)
- Wagenaar AE, "Protocol for suspected pediatric appendicitis limits computed tomography utilization", J Surg Res, 199, pp.153~158 (2015)
- Ramarajan N, "An interdisciplinary initiative to reduce radiation exposure: evaluation of appendicitis in a pediatric emergency department with clinical assessment supported by a staged ultrasound and computed tomography pathway", Acad Emerg Med, 16, pp.1258~1265 (2009)
- Alvarado A, "A practical score for the early diagnosis of acute appendicitis", Ann Emerg Med, 15, pp.557~564 (1986)
- Samuel M, "Pediatric appendicitis score", J Pediatr Surg, 37, pp.877~881 (2002)
- Kulik DM, "Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain", J Clin Epidemiol, 66, pp.95~104 (2013)
- Vittinghoff E, "Relaxing the rule of ten events per variable in logistic and Cox regression", Am J Epidemiol, 165, pp.710~718 (2007)
- Akaike H, "Information theory as an extension of the maximum likelihood principle", Second International Symposium on Information Theory, pp.267~281 (1973), Akademiai Kiado
- Peduzzi P, "Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates", J Clin Epidemiol, 48, pp.1503~1510 (1995)
- O’Shea JS, "Diagnosing appendicitis in children with acute abdominal pain", Pediatr Emerg Care, 4, pp.172~176 (1988)
- Santillanes G, "Prospective evaluation of a clinical practice guideline for diagnosis of appendicitis in children", Acad Emerg Med, 19, pp.886~893 (2012)
- Bachur RG, "The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis", Ann Emerg Med, 60, pp.582~590.e3 (2012)
- Benabbas R, "Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and metaanalysis", Acad Emerg Med, 24, pp.523~551 (2017)
- Benito J, "Usefulness of new and traditional serum biomarkers in children with suspected appendicitis", Am J Emerg Med, 34, pp.871~876 (2016)
- Miguez C, "Evaluation of proadrenomedullin as a diagnostic or prognostic biomarker of acute appendicitis in children", Am J Emerg Med, 34, pp.2298~2305 (2016)