A scoring system to predict the severity of appendicitis in children

Gorter, Ramon R.; Boom, Anne L oes van den; Heij, Hugo A.; Kneepkens, C. M. F.; Hulsker, Caroline C. C.; Tenhagen, Mark; Dawson, I.; Lee, Johanna H. van der

doi:10.1016/j.jss.2015.08.042

Cited by 27 publications

(44 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These variables were removed from the multivariable model since no relation with SSI was demonstrated. An explanation could be that patients with complex appendicitis have higher inflammatory parameters as a result of peritonitis and there is an interaction between these 2 factors [21]. Shimizu et al [14] showed that CRP levels higher than 65 is a risk factor for the development of an SSI.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Multicenter Study on Risk Factors for Surgical Site Infections after Appendectomy for Acute Appendicitis

et al. 2016

Self Cite

View full text Add to dashboard Cite

Background: Surgical site infections (SSI) are seen in up to 5% of patients after appendectomy for acute appendicitis. SSI are associated with prolonged hospital stay and increased costs. The aim of this multicenter study was to identify factors associated with SSI after appendectomy for acute appendicitis. Methods: Patients who underwent appendectomy for acute appendicitis between June 2014 and January 2015 in 6 teaching hospitals in the southwest of the Netherlands were included. Patient, diagnostic, intra-operative and disease-related factors were collected from the patients' charts. Primary outcome was surgical site infection. Multivariable logistic regression was performed to identify independent risk factors for SSI. Results: Some 637 patients were included. Forty-two patients developed a SSI. In univariable analysis body temperature >38°C, CRP>65 and complex appendicitis were associated with SSI. After multivariable logistic regression with stepwise backwards elimination, complex appendicitis was significantly associated with SSI (OR 4.09; 95% CI 2.04-8.20). Appendiceal stump closure with a stapler device was inversely correlated with SSI (OR 0.40; 95% CI 0.24-0.97) Conclusions: Complex appendicitis is a risk factor for SSI and warrants close monitoring postoperatively. The use of a stapler device for appendiceal stump closure is associated with a reduced risk of SSI.

show abstract

Section: Discussionmentioning

confidence: 99%

Retrospective Multicenter Study on Risk Factors for Surgical Site Infections after Appendectomy for Acute Appendicitis

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…It is the most common abdominal surgical emergency worldwide. Its severity can be classified into two distinct types based on operative findings: simple and complex appendicitis. Around 25–30 percent of all acute appendicitis is considered complex.…”

Section: Introductionmentioning

confidence: 99%

“…It is the most common abdominal surgical emergency worldwide 1 -4 . Its severity can be classified into two distinct types based on operative findings: simple and complex appendicitis 5,6 . Around 25-30 percent of all acute appendicitis is considered complex 7 -12 . A classification to distinguish simple and complex appendicitis was recently provided by Bhangu and colleagues 5 .…”

Section: Introductionmentioning

confidence: 99%

Interobserver variability in the classification of appendicitis during laparoscopy

Boom

Wijkerslooth

Mauff

et al. 2018

British Journal of Surgery

View full text Add to dashboard Cite

BackgroundThe intraoperative classification of appendicitis dictates the patient's postoperative management. Prolonged antibiotic prophylaxis is recommended for complex appendicitis (gangrenous, perforated, abscess), whereas preoperative prophylaxis suffices for simple appendicitis. Distinguishing these two conditions can be challenging. The aim of this study was to assess interobserver variability in the classification of appendicitis during laparoscopy.MethodsShort video recordings taken during laparoscopy for suspected appendicitis were shown to surgeons and surgical residents. They were asked to: classify the appendix as indicative of no, simple or complex appendicitis; categorize the appendix as normal, phlegmonous, gangrenous, perforated and/or abscess; and decide whether they would prescribe postoperative antibiotics. Inter‐rater reliability was evaluated using Fleiss' κ score and the S* statistic.ResultsSome 80 assessors participated in the study. Video recordings of 20 patients were used. Interobserver agreement was minimal for both the classification of appendicitis (κ score 0·398, 95 per cent c.i. 0·385 to 0·410) and the decision to prescribe postoperative antibiotic treatment (κ score 0·378, 0·362 to 0·393). Agreement was slightly higher when published criteria were applied (κ score 0·552, 0·537 to 0·568).ConclusionThere is considerable variability in the intraoperative classification of appendicitis and the decision to prescribe postoperative antibiotic treatment.

show abstract

“…Clinical presentation, ALVARADO score, Pediatric Appendicitis Score (PAS), Computed tomography, ultrasound and blood tests, may be helpful in diagnose of AA, but it is di cult to con rm the type of appendicitis (simple or complicated appendicitis), especially for children younger than ve years of age [3][4][5][6][7] . Been able to diagnose simple vs. complicated appendicitis allows the surgeon to choose the best surgical approach ranging from antibiotics and delayed appendectomy to laparotomy [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

“…At present, several effective methods have been reported for predicting complicated appendicitis in children with AA, but it is malfunctioning in patients younger than ve years of age [6,7,13,14] . Therefore, it is important to predict the type of AA accurately in children younger than ve years of age, in order to choose the optimal treatment strategy and save medical resources.…”

Section: Introductionmentioning

confidence: 99%

A clinical prediction model for complicated appendicitis in children younger than five years of age

Feng

Xing

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: No reliably specific method for complicated appendicitis has been identified in children younger than five years of age. This study aimed to analyze the independent factors for complicated appendicitis in children younger than five years of age, develop and validate a prediction model for the differentiation of simple and complicated appendicitis. Methods: A retrospective study of 382 children younger than five years of age with acute appendicitis from January 2007 to December 2016 was conducted with assessments of demographic data, clinical symptoms and signs, and pre-operative laboratory results. According to intraoperative findings and postoperative pathological results, acute appendicitis were divided into simple and complicated appendicitis. Univariate and multivariate analyses were used to screen out the independent factors of complicated appendicitis, and develop a prediction model for complicated appendicitis. Then 156 such patients from January 2017 to December 2019 were collected as validation sample to validate the prediction model. Test performance of the prediction model was compared with the ALVARADO score and Pediatric Appendicitis Score (PAS). Results: Of the 382 patients, 244 (63.9 %) had complicated appendicitis. Age, white blood cell count, and duration of symptoms were the independent factors for complicated appendicitis in children younger than five years of age. The final predication model for complicated appendicitis included factors above. In validation sample, the prediction model exhibited a high degree of discrimination (area under the curve [AUC]: 0.830; 95% confidence interval [CI]: 0.762 - 0.885) corresponding to a optimal cutoff value of 0.62, and outperformed the PAS (AUC: 0.735; 95% CI: 0.658 - 0.802), ALVARADO score (AUC: 0.733; 95% CI: 0.657 - 0.801). Conclusion : Age, white blood cell count, and duration of symptoms could be used to predict complicated appendicitis in children younger than five years of age with acute appendicitis. The prediction model is a novel but promising method that aids in the differentiation of acute simple and complicated appendicitis.

show abstract

A scoring system to predict the severity of appendicitis in children

Cited by 27 publications

References 36 publications

Retrospective Multicenter Study on Risk Factors for Surgical Site Infections after Appendectomy for Acute Appendicitis

Retrospective Multicenter Study on Risk Factors for Surgical Site Infections after Appendectomy for Acute Appendicitis

Interobserver variability in the classification of appendicitis during laparoscopy

A clinical prediction model for complicated appendicitis in children younger than five years of age

Contact Info

Product

Resources

About