Veerle A B van den Bogaard1, Sjoerd M Euser2, Tjeerd van der Ploeg3, Niels de Korte4, Dave G M Sanders5, Derek de Winter6, Diederik Vergroesen6, Krijn van Groningen7, Peter de Winter6. 1. Department of Pediatrics, Spaarne Hospital, Hoofddorp, the Netherlands. Electronic address: appendicitis.studie@gmail.com. 2. Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands. 3. Foreest Medical School, Alkmaar Medical Centre, Alkmaar, the Netherlands. 4. Department of Surgery, Spaarne Hospital, Hoofddorp, the Netherlands. 5. Department of Radiology, Spaarne Hospital, Hoofddorp, the Netherlands. 6. Department of Pediatrics, Spaarne Hospital, Hoofddorp, the Netherlands. 7. Department of Pathology, Spaarne Hospital, Hoofddorp, the Netherlands.
Abstract
OBJECTIVE: Studies have investigated sensitivity and specificity of symptoms and tests for diagnosing appendicitis in children. Less is known with regard to the predictive value of these symptoms and tests with respect to the severity of appendicitis. The aim of this study was to determine the predictive value of patient's characteristics and tests for discriminating between perforated and nonperforated appendicitis in children. PATIENTS AND METHODS: Pediatric patients who underwent an appendectomy at Spaarne Hospital Hoofddorp, the Netherlands, between January 1, 2009 and December 31, 2013, were included. Baseline patient's characteristics, history, physical examination, laboratory data and results of ultrasounds were collected. Univariate and multivariate logistic regressions were used to determine predictors of perforation. RESULTS: In total, 375 patients were included in this study of which 97 children (25.9%) had significant signs of perforation. Univariate analysis showed that age, duration of complaints, temperature, vomiting, CRP, WBC, different findings on ultrasound and the diameter of the appendix were good predictors of a perforated appendicitis. The final multivariate prediction model included temperature, CRP, clearly visible appendix and free fluids on ultrasound and diameter of the appendix and resulted in an area under the curve (AUC) of 0.91 showing sensitivity and specificity of respectively 85.2% and 81.2%. CONCLUSION: This prediction model can be used for identification of 'high-risk' children for a perforated appendicitis and might be helpful to prevent complications and longer hospitalization by bringing these children to theater earlier.
OBJECTIVE: Studies have investigated sensitivity and specificity of symptoms and tests for diagnosing appendicitis in children. Less is known with regard to the predictive value of these symptoms and tests with respect to the severity of appendicitis. The aim of this study was to determine the predictive value of patient's characteristics and tests for discriminating between perforated and nonperforated appendicitis in children. PATIENTS AND METHODS: Pediatric patients who underwent an appendectomy at Spaarne Hospital Hoofddorp, the Netherlands, between January 1, 2009 and December 31, 2013, were included. Baseline patient's characteristics, history, physical examination, laboratory data and results of ultrasounds were collected. Univariate and multivariate logistic regressions were used to determine predictors of perforation. RESULTS: In total, 375 patients were included in this study of which 97 children (25.9%) had significant signs of perforation. Univariate analysis showed that age, duration of complaints, temperature, vomiting, CRP, WBC, different findings on ultrasound and the diameter of the appendix were good predictors of a perforated appendicitis. The final multivariate prediction model included temperature, CRP, clearly visible appendix and free fluids on ultrasound and diameter of the appendix and resulted in an area under the curve (AUC) of 0.91 showing sensitivity and specificity of respectively 85.2% and 81.2%. CONCLUSION: This prediction model can be used for identification of 'high-risk' children for a perforated appendicitis and might be helpful to prevent complications and longer hospitalization by bringing these children to theater earlier.
Authors: Nusrat S Shommu; Craig N Jenne; Jaime Blackwood; Dori-Ann Martin; Ari R Joffe; Robin Eccles; Mary Brindle; Ijab Khanafer; Hans J Vogel; Graham C Thompson Journal: Sci Rep Date: 2018-03-06 Impact factor: 4.379