Juan González Del Castillo1,2, Francisco Javier Ayuso1, Victoria Trenchs3, Mikel Martinez Ortiz de Zarate4, Carmen Navarro5, Kinda Altali6, Cristina Fernandez7, David Huckins8, Francisco Javier Martín-Sánchez1,2. 1. Emergency Department, Hospital Universitario Clínico San Carlos, Madrid, Spain. 2. Health Research Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain. 3. Emergency Department, Hospital Universitario Sant Joan de Deu, Barcelona, Spain. 4. Emergency Department, Hospital Universitario de Basurto, Bilbao, Spain. 5. Emergency Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain. 6. Pediatric Department, Hospital Universitario Clínico San Carlos, Madrid, Spain. 7. Research Unit, Preventive Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Spain. 8. Division of Emergency Medicine, Newton-Wellesley Hospital, Newton, Massachusetts, USA.
Abstract
OBJECTIVE: Evaluate the diagnostic accuracy of the APPY1 Test alone and in combination with the Alvarado score (AS) to rule out acute appendicitis (AA) in patients presenting to EDs with abdominal pain suspicious for AA. METHODOLOGY: Observational study in a prospective consecutive cohort including all patients from 2 to 20 years with abdominal pain suggestive of AA in four EDs. The APPY1 Test was performed and AS was calculated to determine risk stratification for each patient. RESULTS: 321 patients enrolled (mean age 11.8 (SD 3.8) years, 52.0% male), with 32.4% low risk, 23.7% intermediate risk and 43.9% high risk according to the AS. 111 (34.6%) had AA, of whom 1 (0.9%) had a false-negative APPY1 Test result. The APPY1 Test had a sensitivity (Se) of 99.1% (95% CI 94.4% to 99.9%), specificity (Sp) of 32.9% (95% CI 26.6% to 39.7%), negative predictive value (NPV) of 98.6% (95% CI 91.2% to 99.9%) and negative likelihood ratio (LHR-) of 0.03 (0.00 to 0.19) in this population. For patients at low risk by AS, the APPY1 Test had a Se of 100% (95% CI 62.9% to 100%), NPV of 100% (95% CI 91.1% to 100%) and LHR- of 0.0 (not calculable), and for patients at intermediate risk by AS, the APPY1 Test had a Se of 94.4% (95% CI 70.6% to 99.7%), NPV of 94.7% (95% CI 71.9% to 99.7%) and LHR- of 0.18 (0.0 to 1.2), respectively. CONCLUSIONS: APPY1 Test is a potentially useful diagnostic tool to rule out AA in this population, with clinical utility primarily in those patients classified as having low clinical risk of appendicitis according to the AS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: Evaluate the diagnostic accuracy of the APPY1 Test alone and in combination with the Alvarado score (AS) to rule out acute appendicitis (AA) in patients presenting to EDs with abdominal pain suspicious for AA. METHODOLOGY: Observational study in a prospective consecutive cohort including all patients from 2 to 20 years with abdominal pain suggestive of AA in four EDs. The APPY1 Test was performed and AS was calculated to determine risk stratification for each patient. RESULTS: 321 patients enrolled (mean age 11.8 (SD 3.8) years, 52.0% male), with 32.4% low risk, 23.7% intermediate risk and 43.9% high risk according to the AS. 111 (34.6%) had AA, of whom 1 (0.9%) had a false-negative APPY1 Test result. The APPY1 Test had a sensitivity (Se) of 99.1% (95% CI 94.4% to 99.9%), specificity (Sp) of 32.9% (95% CI 26.6% to 39.7%), negative predictive value (NPV) of 98.6% (95% CI 91.2% to 99.9%) and negative likelihood ratio (LHR-) of 0.03 (0.00 to 0.19) in this population. For patients at low risk by AS, the APPY1 Test had a Se of 100% (95% CI 62.9% to 100%), NPV of 100% (95% CI 91.1% to 100%) and LHR- of 0.0 (not calculable), and for patients at intermediate risk by AS, the APPY1 Test had a Se of 94.4% (95% CI 70.6% to 99.7%), NPV of 94.7% (95% CI 71.9% to 99.7%) and LHR- of 0.18 (0.0 to 1.2), respectively. CONCLUSIONS: APPY1 Test is a potentially useful diagnostic tool to rule out AA in this population, with clinical utility primarily in those patients classified as having low clinical risk of appendicitis according to the AS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: K Altali Alhames; F J Martín-Sánchez; P Ruiz-Artacho; F J Ayuso; V Trenchs; M Martínez Ortiz de Zarate; C Navarro; M Fuentes Ferrer; C Fernández; J González Del Castillo; A Bodas Journal: Rev Esp Quimioter Date: 2021-04-30 Impact factor: 1.553