Pre-Coronavirus Disease 2019 Pediatric Acute Appendicitis: Risk Factors Model and Diagnosis Modality in a Developing Low-Income Country
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Purpose: Pediatric acute appendicitis has a stable incidence rate in Western countries with an annual change of -0.36%. However, a sharp increase was observed in the Asian region. The Indonesian Health Department reveals appendicitis as the fourth most infectious disease, with more than 64,000 patients annually. Hence, there is an urgent need to identify and evaluate the risk factors and diagnostic modalities for accurate diagnosis and early treatment. This study also clarifies the usage of pediatric appendicitis score (PAS) for children <5 years of age. Methods: The current study employed a cross-sectional design with purposive sampling through demographic and PAS questionnaires with ultrasound sonography (USG) results. The analysis was performed using the chi-square and Mann–Whitney tests and logistic regression. Results: This study included 21 qualified patients with an average age of 6.76±4.679 years, weighing 21.72±10.437 kg, and who had been hospitalized for 4.24±1.513 days in Siloam Teaching Hospital. Compared to the surgical gold standard, PAS and USG have moderate sensitivity and specificity. Bodyweight and stay duration were significant for appendicitis (p<0.05); however, all were confounders in the multivariate regression analysis. Incidentally, a risk prediction model was generated with an area under the curve of 72.73%, sensitivity of 100.0%, specificity of 54.5%, and a cut-off value of 151. Conclusion: PAS outperforms USG in the sensitivity of diagnosing appendicitis, whereas USG outperforms PAS in terms of specificity. This study demonstrates the use of PAS in children under 5 years old. Meanwhile, no risk factors were significant in multivariate pediatric acute appendicitis risk factors.
Abstract
Purpose: Pediatric acute appendicitis has a stable incidence rate in Western countries with an annual change of -0.36%. However, a sharp increase was observed in the Asian region. The Indonesian Health Department reveals appendicitis as the fourth most infectious disease, with more than 64,000 patients annually. Hence, there is an urgent need to identify and evaluate the risk factors and diagnostic modalities for accurate diagnosis and early treatment. This study also clarifies the usage of pediatric appendicitis score (PAS) for children <5 years of age. Methods: The current study employed a cross-sectional design with purposive sampling through demographic and PAS questionnaires with ultrasound sonography (USG) results. The analysis was performed using the chi-square and Mann–Whitney tests and logistic regression. Results: This study included 21 qualified patients with an average age of 6.76±4.679 years, weighing 21.72±10.437 kg, and who had been hospitalized for 4.24±1.513 days in Siloam Teaching Hospital. Compared to the surgical gold standard, PAS and USG have moderate sensitivity and specificity. Bodyweight and stay duration were significant for appendicitis (p<0.05); however, all were confounders in the multivariate regression analysis. Incidentally, a risk prediction model was generated with an area under the curve of 72.73%, sensitivity of 100.0%, specificity of 54.5%, and a cut-off value of 151. Conclusion: PAS outperforms USG in the sensitivity of diagnosing appendicitis, whereas USG outperforms PAS in terms of specificity. This study demonstrates the use of PAS in children under 5 years old. Meanwhile, no risk factors were significant in multivariate pediatric acute appendicitis risk factors.
참고문헌 (37)
- Ferris M, "The global incidence of appendicitis : a systematic review of population-based studies", Ann Surg, 266, pp.237~241 (2017)
- Coward S, "Incidence of appendicitis over time : a comparative analysis of an administrative healthcare database and a pathology-proven appendicitis registry", PLoS One, 11, pp.e0165161~ (2016)
- Norsalan NH, (2016), Gadjah Mada University;
- Arifuddin A, "Faktor risiko kejadian apendisitis di bagian rawat inap Rumah Sakit Umum Anutapura Palu", Preventif, 8, pp.26~33 (2017)[DOI]
- Totapally A, "Do racial", ethnic and economic factors affect the rate of complicated appendicitis in children?, 2020, pp.2020, 3268567~
- Taneja V, "Sex hormones determine immune response", Front Immunol, 9, pp.1931~ (2018)
- Rea IM, "Age and age-related diseases : role of inflammation triggers and cytokines", Front Immunol, 9, pp.586~ (2018)
- Obsa MS, "Prevalence of acute appendicitis among patient admitted for acute abdomen in Ethiopia : systematic review and meta-analysis", Int J Surg Open, 26, pp.154~160 (2020)
- Upadhyaya P, "Prevalence of histologically proven acute appendicitis and incidental carcinoid tumour in the practice of surgical pathology at BPKIHS", J BP Koirala Inst Health Sci, 1, pp.73~80 (2018)
- Mukendi AM, "Prostatic cyst : incidental finding on ultrasound", Worldw Med, 1, pp.199~201 (2019)
- Sayed AO, "Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis", Ther Clin Risk Manag, 13, pp.847~854 (2017)
- Reddan T, "Sonographic diagnosis of acute appendicitis in children : a 3-year retrospective", Sonography, 3, pp.87~94 (2016)
- Hajalioghli P, "Ultrasonography in diagnosis of appendicitis and its complications in pediatric patients : a cross-sectional study", Ann Pediatr Surg, 16, pp.12~ (2020)
- Abo A, "The influence of body mass index on the accuracy of ultrasound and computed tomography in diagnosing appendicitis in children", Pediatr Emerg Care, 27, pp.731~736 (2011)
- Trout AT, "A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting : how can we improve the diagnostic value of sonography?", Pediatr Radiol, 42, pp.813~823 (2012)
- Srinivasan A, "Utility of CT after sonography for suspected appendicitis in children : integration of a clinical scoring system with a staged imaging protocol", Emerg Radiol, 22, pp.31~42 (2015)
- Lin W, "Anatomic reasons for failure to visualize the appendix with graded compression sonography : insights from contemporaneous CT", AJR Am J Roentgenol, 209, pp.W128~38 (2017)
- Junewick J, "Rate of and factors affecting sonographic visualization of the appendix in asymptomatic children", Emerg Radiol, 20, pp.135~138 (2013)
- Kim MS, "Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis", Br J Radiol, 91, pp.20170529~ (2018)
- Mostbeck G, "How to diagnose acute appendicitis : ultrasound first", Insights Imaging, 7, pp.255~263 (2016)
- Jennings R, "Cost-effectiveness of imaging protocols for suspected appendicitis", Pediatrics, 145, pp.e20191352~ (2020)
- Whitt B, "Systematic review of the accuracy of magnetic resonance imaging in the diagnosis of acute appendicitis in children : comparison with computed tomography", Med Student Res J, 4, pp.54~58 (2015)
- Menteri Kesehatan Republik Indonesia, "Standar tarif pelayanan kesehatan pada fasilitas kesehatan tingkat pertama dan fasilitas kesehatan tingkat lanjutan dalam penyelenggaraan program jaminan kesehatan" (2013), Menteri Kesehatan Republik Indonesia
- BPS-Statistics Indonesia, "Statistik pendapatan = Income statistics", BPS-Statistics Indonesia, ~ (2021)
- Goldman RD, "Prospective validation of the pediatric appendicitis score", J Pediatr, 153, pp.278~282 (2008)
- Salö M, "Appendicitis in children : evaluation of the pediatric appendicitis score in younger and older children", Surg Res Pract, 2014, pp.438076~ (2014)
- Timmerman ME, "The influence of underweight and obesity on the diagnosis and treatment of appendicitis in children", Int J Colorectal Dis, 31, pp.1467~1473 (2016)
- 강민재, "The adiposity rebound in the 21st century children: meaning for what?", Clinical and Experimental Pediatrics, 61(12), pp.375~380 (2018), 대한소아청소년과학회
- Vollrath ME, "Child temperament predicts the adiposity rebound. A 9-year prospective sibling control study", PLoS One, 13, pp.e0207279~ (2018)
- Direktorat Pencegahan dan Pengendalian Penyakit Tidak Menular, "Tiga periode kritis dalam perkembangan jaringan lemak di tubuh-bagian kedua, periode adiposity rebound", Direktorat Pencegahan dan Pengendalian Penyakit Tidak Menular, Kementerian Kesehatan Republik Indonesia, ~ (2018)
- Childs CE, "Diet and immune function", Nutrients, 11, pp.1933~ (2019)
- Kim DY, "Use of the pediatric appendicitis score in a community hospital", Indian Pediatr, 53, pp.217~220 (2016)
- Khan D, "The immune system is a natural target for estrogen action : opposing effects of estrogen in two prototypical autoimmune diseases", Front Immunol, 6, pp.635~ (2016)
- Walędziak M, "Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy-results from Pol-LA(Polish Laparoscopic Appendectomy)multicenter large cohort study", Sci Rep, 9, pp.14793~ (2019)
- Kuamr A, "Acute appendicitis : correlation between ultrasonographic and surgical findings", Int J Health Clin Res, 4, pp.170~172 (2021)
- Monajemzadeh M, "Pathologic evaluation of appendectomy specimens in children : is routine histopatholgic examination indicated?", Iran J Pediatr, 21, pp.485~490 (2011)
- Howell EC, "Perforation risk in pediatric appendicitis : assessment and management", Pediatric Health Med Ther, 9, pp.135~145 (2018)