Diagnosing Ruptured Appendicitis Preoperatively in Pediatric Patients

Williams, Regan F.; Blakely, Martin L.; Fischer, Peter; Streck, Christian J.; Dassinger, Melvin S.; Gupta, Himesh; Renaud, Elizabeth; Eubanks, James W.; Huang, Eunice Y.; Hixson, S. Douglas; Langham, Max R.

doi:10.1016/j.jamcollsurg.2009.01.029

Cited by 75 publications

(67 citation statements)

References 26 publications

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“…Most studies in literature defined their perforated appendicitis group based on surgical reports. Fewer studies defined this group based on the histology report [10,13] and some combined the surgical report with the histology report [11]. Based on the literature and the ICD10 we chose to use the surgical report.…”

Section: Discussionmentioning

confidence: 99%

“…In children CRP values aid in the diagnosis of perforated appendicitis. Whether LC may discriminate simple from perforated appendicitis in the pediatric population remains uncertain [9][10][11][12][13]. Despite previous investigations it remains unclear whether LC, CRP levels and Erythrocyte Sedimentation Rate (ESR) levels combined with body temperature and duration of abdominal pain have a predictive value in diagnosing a perforated appendicitis in unselected patient groups.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Study of Acute and Perforated Appendicitis

Akhil¹

2017

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Introduction: The aim of this study was to create a model for the identification of a perforated appendicitis. Patients and Method:All consecutive patients who have undergone an appendectomy in the DY Patil Medical Hospital, Pune between January 1, 2015 and July 31, 2017 were included in a retrospective cohort study. Baseline patient characteristics, history and laboratory data were collected. Variables discriminating perforated from non-perforated appendicitis were identified using univariate and multivariable analyses. These items were used to create a model to predict perforation.Results: A total of 498 patients were included in the study. In the univariate analysis leukocyte count (LC), C-Reactive Protein levels (CRP), Erythrocyte Sedimentation Rate levels (ESR), days of symptoms and temperature were identified as predictors of perforated appendicitis. A predictive model was created using CRP, LC, ESR, duration of abdominal pain, and temperature. The predicted probability (P) of a perforated appendicitis can be calculated from the following model: (P) = 1 / (1+e (-(-2.788 + 0.012* CRP + 0.207* days with complaints))). Conclusion:Perforation of appendicitis can be predicted from the CRP level and the duration of abdominal pain. These findings might influence the choice between conservative or surgical treatment of appendicitis, and could provide guidance in the early start of antibiotics. Keywords:

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative Study of Acute and Perforated Appendicitis

Akhil¹

2017

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“…19,27,28 Nevertheless, despite judicious use of diagnostic imaging and the development of protocols for diagnosis of appendicitis, negative appendectomy rates in children remain high, ranging from 4.4% to 13%. 4,21,29,30 Few studies have systematically examined the performance characteristics of using a clinical pathway combining an objective appendicitis grading score with selective diagnostic imaging for children with suspected appendicitis. 31,32 Our study has shown that use of a clinical pathway that combines a clinical grading score and selective use of US can…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of a Clinical Pathway for Suspected Appendicitis

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Although appendicitis is the most common surgical cause of abdominal pain in pediatrics, its diagnosis remains elusive. When evaluated independently, clinical scoring systems and ultrasonography have been shown to have low to moderate sensitivity in the diagnosis of appendicitis.WHAT THIS STUDY ADDS: Our study evaluated the accuracy of a clinical practice guideline combining the Samuel' s pediatric appendicitis score and selective ultrasonography as the primary imaging modality for children with suspected appendicitis. Our clinical pathway demonstrated high sensitivity and specificity. abstract OBJECTIVE: To evaluate the diagnostic accuracy of a clinical pathway for suspected appendicitis combining the Samuel' s pediatric appendicitis score (PAS) and selective use of ultrasonography (US) as the primary imaging modality.METHODS: Prospective, observational cohort study conducted at an urban, academic pediatric emergency department. After initial evaluation, patients were determined to be at low (PAS 1-3), intermediate (PAS 4-7), or high (PAS 8-10) risk for appendicitis. Low-risk patients were discharged with telephone follow-up. High-risk patients received immediate surgical consultation. Patients at intermediate risk for appendicitis underwent US. RESULTS:Of the 196 patients enrolled, 65 (33.2%) had appendicitis. An initial PAS of 1-3 was noted in 44 (22.4%), 4-7 in 119 (60.7%), and 8-10 in 33 (16.9%) patients. Ultrasonography was performed in 128 (65.3%) patients, and 48 (37.5%) were positive. An abdominal computed tomography scan was requested by the surgical consultants in 13 (6.6%) patients. The negative appendectomy rate was 3 of 68 (4.4%). Follow-up was established on 190 of 196 (96.9%) patients. Overall diagnostic accuracy of the pathway was 94% (95% confidence interval [CI] 91%-97%) with a sensitivity of 92.3% (95% CI 83.0%-97.5%), specificity of 94.7% (95% CI 89.3%-97.8%), likelihood ratio (+) ) and likelihood ratio (2) 0.08 (95% CI 0.04-0.19).CONCLUSIONS: Our protocol demonstrates high sensitivity and specificity for diagnosis of appendicitis in children. Institutions should consider investing in resources that increase the availability of expertise in pediatric US. Standardization of care may decrease radiation exposure associated with use of computed tomography scans. Pediatrics 2014;133:e88-e95 AUTHORS:

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“…We have recently reported that the accuracy of distinguishing acute nonperforated appendicitis from perforated appendicitis is approximately 90% in our center. 13 A limitation of this trial is the single-center design, which may affect the generalizability of our findings. Other centers use different antibiotic regimens in their interval appendectomy treatment plans, as well as various criteria for discontinuing antibiotics, and these may compare differently with early appendectomy.…”

Section: Commentmentioning

confidence: 95%

Early vs Interval Appendectomy for Children With Perforated Appendicitis

Blakely¹,

Williams²,

Dassinger³

et al. 2011

Arch Surg

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Setting: A tertiary-referral urban children's hospital.Patients: A total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis.Interventions: Early appendectomy (within 24 hours of admission) vs interval appendectomy (6-8 weeks after diagnosis).Main Outcome Measures: Time away from normal activities (days). Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (eg, intra-abdominal abscess, surgical site infection, unplanned readmission).Results: Early appendectomy, compared with interval appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; PϽ.001). The overall adverse event rate was 30% for early appendectomy vs 55% for interval appendectomy (relative risk with interval appendectomy, 1.86; 95% confidence interval, 1.21-2.87; P=.003). Of the patients randomized to interval appendectomy, 23 (34%) had an appendectomy earlier than planned owing to failure to improve (n=17), recurrent appendicitis (n=5), or other reasons (n=1). Conclusions:Early appendectomy significantly reduced the time away from normal activities. The overall adverse event rate after early appendectomy was significantly lower compared with interval appendectomy.

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Diagnosing Ruptured Appendicitis Preoperatively in Pediatric Patients

Cited by 75 publications

References 26 publications

Comparative Study of Acute and Perforated Appendicitis

Comparative Study of Acute and Perforated Appendicitis

Prospective Evaluation of a Clinical Pathway for Suspected Appendicitis

Early vs Interval Appendectomy for Children With Perforated Appendicitis

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