Anupam B Kharbanda1, Michael C Monuteaux2, Richard G Bachur2, Nanette C Dudley3, Lalit Bajaj4, Michelle D Stevenson5, Charles G Macias6, Manoj K Mittal7, Jonathan E Bennett8, Kelly Sinclair9, Peter S Dayan10. 1. Department of Pediatrics Emergency Medicine, Children's Minnesota, Minneapolis. Electronic address: Anupam.kharbanda@childrensmn.org. 2. Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass. 3. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City. 4. Department of Pediatrics, University of Colorado School of Medicine, Denver. 5. Department of Pediatrics, University of Louisville, Louisville, Ky. 6. Department of Pediatrics, Baylor College of Medicine, Houston, Texas. 7. Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia. 8. Department of Pediatrics, Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, Del. 9. Department of Pediatrics, University of Missouri, Kansas City. 10. Department of Pediatrics, Columbia University, New York, NY.
Abstract
OBJECTIVE: To develop a clinical score to predict appendicitis among older, male children who present to the emergency department with suspected appendicitis. METHODS: Patients with suspected appendicitis were prospectively enrolled at 9 pediatric emergency departments. A total of 2625 patients enrolled; a subset of 961 male patients, age 8-18 were analyzed in this secondary analysis. Outcomes were determined using pathology, operative reports, and follow-up calls. Clinical and laboratory predictors with <10% missing data and kappa > 0.4 were entered into a multivariable model. Resultant β-coefficients were used to develop a clinical score. Test performance was assessed by calculating the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios. RESULTS: The mean age was 12.2 years; 49.9% (480) had appendicitis, 22.3% (107) had perforation, and the negative appendectomy rate was 3%. In patients with and without appendicitis, overall imaging rates were 68.6% (329) and 84.4% (406), respectively. Variables retained in the model included maximum tenderness in the right lower quadrant, pain with walking/coughing or hopping, and the absolute neutrophil count. A score ≥8.1 had a sensitivity of 25% (95% confidence interval [CI], 20%-29%), specificity of 98% (95% CI, 96%-99%), and positive predictive value of 93% (95% CI, 86%-97%) for ruling in appendicitis. CONCLUSIONS: We developed an accurate scoring system for predicting appendicitis in older boys. If validated, the score might allow clinicians to manage a proportion of male patients without diagnostic imaging.
OBJECTIVE: To develop a clinical score to predict appendicitis among older, male children who present to the emergency department with suspected appendicitis. METHODS:Patients with suspected appendicitis were prospectively enrolled at 9 pediatric emergency departments. A total of 2625 patients enrolled; a subset of 961 male patients, age 8-18 were analyzed in this secondary analysis. Outcomes were determined using pathology, operative reports, and follow-up calls. Clinical and laboratory predictors with <10% missing data and kappa > 0.4 were entered into a multivariable model. Resultant β-coefficients were used to develop a clinical score. Test performance was assessed by calculating the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios. RESULTS: The mean age was 12.2 years; 49.9% (480) had appendicitis, 22.3% (107) had perforation, and the negative appendectomy rate was 3%. In patients with and without appendicitis, overall imaging rates were 68.6% (329) and 84.4% (406), respectively. Variables retained in the model included maximum tenderness in the right lower quadrant, pain with walking/coughing or hopping, and the absolute neutrophil count. A score ≥8.1 had a sensitivity of 25% (95% confidence interval [CI], 20%-29%), specificity of 98% (95% CI, 96%-99%), and positive predictive value of 93% (95% CI, 86%-97%) for ruling in appendicitis. CONCLUSIONS: We developed an accurate scoring system for predicting appendicitis in older boys. If validated, the score might allow clinicians to manage a proportion of male patients without diagnostic imaging.
Authors: Anupam B Kharbanda; Michelle D Stevenson; Charles G Macias; Kelly Sinclair; Nanette C Dudley; Jonathan Bennett; Lalit Bajaj; Manoj K Mittal; Craig Huang; Richard G Bachur; Peter S Dayan Journal: Pediatrics Date: 2012-03-05 Impact factor: 7.124
Authors: Ross J Fleischman; Miranda K Devine; Marie-Annick N Yagapen; Angela J Steichen; Matthew L Hansen; Andrew F Zigman; David M Spiro Journal: Pediatr Emerg Care Date: 2013-10 Impact factor: 1.454
Authors: Anupam B Kharbanda; Nanette C Dudley; Lalit Bajaj; Michelle D Stevenson; Charles G Macias; Manoj K Mittal; Richard G Bachur; Jonathan E Bennett; Kelly Sinclair; Craig Huang; Peter S Dayan Journal: Arch Pediatr Adolesc Med Date: 2012-08
Authors: Anupam B Kharbanda; Gabriela Vazquez-Benitez; Dustin W Ballard; David R Vinson; Uli K Chettipally; Mamata V Kene; Steven P Dehmer; Richard G Bachur; Peter S Dayan; Nathan Kuppermann; Patrick J O'Connor; Elyse O Kharbanda Journal: Pediatrics Date: 2018-03-13 Impact factor: 7.124
Authors: Mehdi Alemrajabi; Morteza Khavanin Zadeh; Sam Zeraatian-Nejad Davani; Fazil Nasiri; Sevda Riazi; Mohammad Nasiri Journal: J Med Life Date: 2022-04
Authors: Paul van Amstel; Ramon R Gorter; Johanna H van der Lee; Huib A Cense; Roel Bakx; Hugo A Heij Journal: J Gastrointest Surg Date: 2018-10-29 Impact factor: 3.452