A new approach to the management of acute appendicitis: Decision tree method

Erkent, Murathan; Karakaya, Emre; Yücebaş, Sait Can

doi:10.1016/j.ajem.2022.01.034

Cited by 6 publications

(6 citation statements)

References 21 publications

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Section: Discussionmentioning

confidence: 99%

“…NLR provides information about two separate inflammatory pathways, making it a potential marker to predict AA and its severity. The NEU count highlights the active and ongoing inflammatory state, while the LYM count highlights the regulatory pathway [ 15 ]. According to Hajibandeh et al, NLR is a promising marker that can predict the diagnosis and severity of AA with a cutoff value of 4.7, AUC of 0.96, sensitivity of 88.89%, and specificity of 90.91% [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Duyan¹,

VURAL²

2022

Cureus

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BackgroundAcute appendicitis (AA) is one of the most frequent causes of abdominal pain requiring emergency intervention in adults. Approximately one-third of cases present with atypical clinical symptoms. This study aims to compare the monocyte-to-lymphocyte ratio (MLR), red cell distribution width (RDW) to lymphocyte ratio (RLR), and systemic immune inflammation index (SII) with other biomarkers in distinguishing patients with and without AA. MethodologyA total of 347 patients (AA 125, nonspecific abdominal pain 90, and control group 132) were enrolled in the study according to the cross-sectional study design. Receiver operating characteristic (ROC) analysis was used to determine the cutoff in diagnostic value measurements. Statistical significance was determined by the statistics of sensitivity, specificity, positive predictive value, and negative predictive value. Comparison of ROC curves of C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), neutrophil-tolymphocyte ratio (NLR), MLR, and SII was evaluated with the pairwise comparison of ROC curves and 95% confidence interval. ResultsIn detecting AA, CRP, WBC, NEU, NLR, MLR, and SII have excellent diagnostic power (area under the curve [AUC] 0.80-0.88), while RDW, lymphocyte count, monocyte (MON) count, and RLR had acceptable diagnostic power (AUC 0.70-0.77). When the power in the diagnosis of AA was compared, a significant difference was found between CRP and NEU, CRP and SII, WBC and NEU, and WBC and SII. ConclusionsThe diagnosis of AA remains dependent on many factors. Inflammatory biomarkers assist this process. MLR and SII may be recommended to use in diagnosing AA in adults, along with other clinical findings. RLR is adequate but not superior.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Duyan¹,

VURAL²

2022

Cureus

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“…With its strong interpretability and decision process visualization, Decision Tree has been applied to support the clinical decision of AA. Erkent et al, 36 Aydin et al 11 have developed a Decision Tree to distinguish CA from UCA for adults and children, respectively. However, this was the first study applying Decision Tree to develop a decision flow chart for pregnant patients.…”

Section: Discussionmentioning

confidence: 99%

Establishment of predictive models for acute complicated appendicitis during pregnancy—A retrospective case–control study

Zhang

Weng³

et al. 2023

Intl J Gynecology & Obste

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Objective To develop a scoring system based on clinical and imaging features to distinguish complicated appendicitis (CA) from uncomplicated appendicitis (UCA) during pregnancy. Method This was a retrospective case–control study. Patients diagnosed with acute appendicitis during pregnancy were included, and they were divided into a CA group and a UCA group based on the intraoperative findings and the biopsy results. Multivariate logistic regression and machine learning were employed to establish a predictive model. Results A total of 342 patients were included in this study. Among them, 141 (41.23%) patients were diagnosed with CA. The predictive model contained six indices, including symptom duration time more than 24 h, fever, heart rate at least 98 beats/minute, monocyte count at least 0.72 × 109/L, lymphocyte count at least 1 × 109/L and direct bilirubin at least 4.75 μmol/L. The total score was 31 points, and a score of more than 15.5 points predicted the development of CA during pregnancy with area under the curve (AUC) of 0.80 (95% confidence interval 0.75–0.84) and specificity of 0.84. A decision flow chart for distinguishing CA from UCA during pregnancy was developed by Decision Tree with an AUC of 0.78. Conclusion The models combining clinical findings and laboratory tests, developed by two methods, can distinguish CA from UCA in pregnancy in a convenient and visualized way. Trial Registration The research has been registered in Chinese Clinical Trial Registry on January 7, 2022 with registration ID ChiCTR2200055339.

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“…For example, Yamashita et al [ 32 ] divided appendiceal tissue into groups based on mural architecture, which directly correlates to the level of inflammation. This is useful because there are different levels of acute appendicitis patients presenting with UAA or CAA [ 37 ].…”

Section: Reviewmentioning

confidence: 99%

The Use of Procalcitonin in the Diagnosis of Acute Appendicitis: A Systematic Review

Dale¹

2022

Cureus

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Background: Acute appendicitis (AA) is one of the most common surgical pathologies. Its diagnosis is often carried out based on clinical signs and symptoms, with additional minimally invasive tests (i.e., blood testing) done to support the diagnosis. Procalcitonin (PCT) is a relatively novel biomarker that is starting to be used by clinicians for patients admitted into hospitals with a variety of infections. Its level can be used to identify the presence of infection. The aim of this review is to assess how useful PCT is as a biomarker in supporting clinicians' assessment of patients with suspected appendicitis.Methods: A systematic literature search was carried out, yielding a total of 16 primary research papers deemed appropriate for appraisal.Results: The usefulness of PCT in aiding the diagnosis of AA depends on the severity of appendicitis. Patients who experience complicated appendicitis (CAA) such as perforation, gangrene, or necrosis have a significantly raised PCT level (p<0.05) compared to those with uncomplicated appendicitis (UAA) and a variety of other non-appendiceal intra-abdominal pathologies.Conclusions: The use of PCT in UAA is weak, however, PCT was deemed useful in helping predict CAA, thus helping portray the severity of infection. This, in turn, will help ensure patients are taken to the operating theatre in a timely and safe manner for subsequent appendicectomy.

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A new approach to the management of acute appendicitis: Decision tree method

Cited by 6 publications

References 21 publications

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Assessment of the Diagnostic Value of Novel Biomarkers in Adult Patients With Acute Appendicitis: A Cross-Sectional Study

Establishment of predictive models for acute complicated appendicitis during pregnancy—A retrospective case–control study

The Use of Procalcitonin in the Diagnosis of Acute Appendicitis: A Systematic Review

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