Hong Zhou1, Yi-Chen Chen, Jin-Zhe Zhang. 1. Department of Pediatric Surgery, Beijing Children's Hospital, Capital University of Medical Sciences, Beijing 100045, China. hzhou@163bj.com
Abstract
AIM: To re-evaluate the algorithm that has been used for over 40 years for diagnosis of acute abdominal pain among children. METHODS: Among the 937 cases admitted to the surgical emergency ward in 2000, 656 cases of acute appendicitis were studied to evaluate the usefulness of the present algorithm for its calculated accuracy, false positive and false negative rates, the sensitivity and specificity in the instant diagnosis of various types of acute appendicitis in different age groups. The algorithm used was established in 1958 and revised for this study in 1999. It includes a 3-step analysis of clinical presentations, i.e.: firstly, a diagnosis of surgical pain by definite organic abdominal signs; then a diagnosis of the subgroup of surgical condition by special signs; and finally the diagnosis of the present disease by specific signs. A footnote describes a "comparative technique" of abdominal examination in non-cooperative children. RESULTS: The general accuracy of diagnosis was 92.8 %, overall mortality 0.1 % among 973 cases of abdominal pain in 2000. 373 attending surgeons and 241 residents including trainees joined the diagnosis and treatment with no remarkable difference in the results. The incidence of acute appendicitis, 656 in 973 cases, was 67.4 % representing the majority of abdominal pain. In the series of 656 cases, the accuracy of diagnosis of acute appendicitis was 93.6 %, false positive 6.4 %, false negative 0.9 %, sensitivity at first visit 82.7 %, specificity for appendicitis 98.0 %, no death or documentary complication. CONCLUSION: The present algorithm used for diagnosis of acute abdominal pain is effective and preferable in reducing misdiagnosis and maltreatment at emergency. The use of some modern technology should be further explored.
AIM: To re-evaluate the algorithm that has been used for over 40 years for diagnosis of acute abdominal pain among children. METHODS: Among the 937 cases admitted to the surgical emergency ward in 2000, 656 cases of acute appendicitis were studied to evaluate the usefulness of the present algorithm for its calculated accuracy, false positive and false negative rates, the sensitivity and specificity in the instant diagnosis of various types of acute appendicitis in different age groups. The algorithm used was established in 1958 and revised for this study in 1999. It includes a 3-step analysis of clinical presentations, i.e.: firstly, a diagnosis of surgical pain by definite organic abdominal signs; then a diagnosis of the subgroup of surgical condition by special signs; and finally the diagnosis of the present disease by specific signs. A footnote describes a "comparative technique" of abdominal examination in non-cooperative children. RESULTS: The general accuracy of diagnosis was 92.8 %, overall mortality 0.1 % among 973 cases of abdominal pain in 2000. 373 attending surgeons and 241 residents including trainees joined the diagnosis and treatment with no remarkable difference in the results. The incidence of acute appendicitis, 656 in 973 cases, was 67.4 % representing the majority of abdominal pain. In the series of 656 cases, the accuracy of diagnosis of acute appendicitis was 93.6 %, false positive 6.4 %, false negative 0.9 %, sensitivity at first visit 82.7 %, specificity for appendicitis 98.0 %, no death or documentary complication. CONCLUSION: The present algorithm used for diagnosis of acute abdominal pain is effective and preferable in reducing misdiagnosis and maltreatment at emergency. The use of some modern technology should be further explored.
Authors: M D Klein; A B Rabbani; K D Rood; T Durham; N M Rosenberg; M J Bahr; R L Thomas; S E Langenburg; L R Kuhns Journal: J Pediatr Surg Date: 2001-09 Impact factor: 2.545