A pre-operative clinical scoring system to distinguish perforation risk with pediatric appendicitis

Bonadio, William A.; Shahid, Syeda; Vardi, Lior; Buckingham, Carly; Kornblatt, Allison; Free, Chloe; Homel, Peter

doi:10.1016/j.jpedsurg.2017.05.017

Cited by 12 publications

(25 citation statements)

References 34 publications

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“…The preoperative clinical scoring system to distinguish perforation risk with pediatric AA proposed by Bonadio et al, based on the duration of symptoms (> 1 day), fever (> 38.0 C), and WBC absolute count (> 13,000/mm 3 ), resulted in a multivariate ROC curve of 89% for perforation (P < 0.001), and the risk for perforation was additive with each additional predictive variable exceeding its threshold value, linearly increasing from 7% with no variable present to 85% when all 3 variables are present [49].…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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“…The rapid review is reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines 15 . The cohort study is reported according to Standards for Reporting Diagnostic Accuracy (STARD) guidelines 16 for diagnostic accuracy studies and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines 17 .…”

Section: Methodsmentioning

confidence: 99%

Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study

Nepogodiev¹,

Wilkin²,

Bradshaw³

et al. 2020

The Lancet Child & Adolescent Health

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Evidence before this study: Acute appendicitis is the most common general surgical emergency in children. Its diagnosis remains challenging and children presenting with acute right iliac fossa (RIF) pain may be admitted for clinical observation or undergo normal appendicectomy (removal of a histologically normal appendix). A search for external validation studies of risk prediction models for acute appendicitis in children was performed on MEDLINE and Web of Science on 12 January 2017 using the search terms ["appendicitis" OR "appendectomy" OR "appendicectomy"] AND ["score" OR "model" OR "nomogram" OR "scoring"]. Studies validating prediction models aimed at differentiating acute appendicitis from all other causes of RIF pain were included. No date restrictions were applied. Validation studies were most commonly performed for the Alvarado, Appendicitis Inflammatory Response Score (AIRS), and Paediatric Appendicitis Score (PAS) models. Most validation studies were based on retrospective, single centre, or small cohorts, and findings regarding model performance were inconsistent. There was no high quality evidence to guide selection of the optimum model and threshold cutoff for identification of low-risk children in the UK and Ireland. Added value of this study: Most children admitted to hospital with RIF pain do not undergo surgery. When children do undergo appendicectomy, removal of a normal appendix (normal appendicectomy) is common, occurring in around 1 in 6 children. The Shera score is able to identify a large low-risk group of children who present with acute RIF pain but do not have acute appendicitis (specificity 44%). This low-risk group has an overall 1 in 30 risk of acute appendicitis and a 1 in 270 risk of perforated appendicitis. The Shera score is unable to achieve a sufficiently high positive predictive value to select a high-risk group who should proceed directly to surgery. Current diagnostic performance of ultrasound is also too poor to select children for surgery. Implications of all the available evidence: Routine pre-operative risk scoring could inform shared decision making by doctors, children, and parents by supporting safe selection of lowrisk patients for ambulatory management, reducing unnecessary admissions and normal appendicectomy. Hospitals should ensure seven-day-a-week availability of ultrasound for medium and high-risk patients. Ultrasound should be performed by operators trained to assess for acute appendicitis in children. For children in whom diagnostic uncertainty remains following ultrasound, magnetic resonance imaging (MRI) or low-dose computed tomography (CT) are second-line investigations.

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“…This study aimed not to diagnose acute appendicitis in patients with acute abdominal pain, but to develop a new scoring system to help predict the prognosis and plan treatment for acute appendicitis diagnosed after a radiographic examination. The new scoring system consisted of 5 risk factors, including fever 7 , 9 , 10 , 12 , 17 , 18 and CRP levels, 12 , 17 , 19 , 20 found to be predictors of complicated appendicitis in many previous studies. CRP is generally recognized as a useful biomarker for predicting acute appendicitis in children.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have revealed risk factors for complicated appendicitis in pediatric patients. 6 - 13 In addition, although some studies have suggested scoring systems to differentiate complicated and uncomplicated appendicitis, 7 , 10 , 13 no scoring system has been widely accepted to date. Therefore, this study aimed to investigate preoperative factors associated with complicated appendicitis and to develop a scoring system that distinguishes complicated appendicitis in children aged <10 years.…”

Section: Introductionmentioning

confidence: 99%

Scoring System for Differentiation of Complicated Appendicitis in Pediatric Patients: Appendicitis Scoring System in Children

Lee

Cho

Gwak

et al. 2021

Global Pediatric Health

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Although several scoring systems have been used to differentiate simple acute appendicitis from perforated appendicitis, no particular system has been widely accepted. Therefore, this study aimed to investigate preoperative factors associated with complicated appendicitis and to develop a scoring system that distinguishes complicated appendicitis in children aged <10 years. Patients aged <10 years who underwent surgical treatment for acute appendicitis between 2011 and 2019 were included in this study, after excluding those with insufficient medical records, with other diseases that affect the length of hospitalization, or without formal reports of abdominal computed tomography (CT) or ultrasonography (US). Complicated appendicitis was defined as hospitalization for ≥5 days postoperatively or readmission within 30 days postoperatively. Patient characteristics, symptoms, physical examination, laboratory data, and radiographic results were collected to determine predictors of complicated appendicitis. The mean age of 279 patients was 7.3 years. Among them, 57 patients had complicated appendicitis. A scoring system was developed based on the following 5 independent risk factors derived from multiple logistic regression analysis: body temperature, anorexia, diarrhea, C-reactive protein (CRP) level, and presence of periappendiceal free fluid on CT or US. The scoring system resulted in an area under the curve of .898 ( P < .001). For patients aged <10 years, a new model that includes objective factors, such as body temperature, CRP levels, and radiography results, might help predict complicated appendicitis and determine treatment plans.

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A pre-operative clinical scoring system to distinguish perforation risk with pediatric appendicitis

Cited by 12 publications

References 34 publications

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study

Scoring System for Differentiation of Complicated Appendicitis in Pediatric Patients: Appendicitis Scoring System in Children

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