Evaluating Appendicitis Scoring Systems Using a Prospective Pediatric Cohort

Schneider, Carisa; Kharbanda, Anupam B.; Bachur, Richard G.

doi:10.1016/j.annemergmed.2006.12.016

Cited by 150 publications

(142 citation statements)

References 15 publications

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“…[9][10][11][12] Several scoring systems, including the pediatric appendicitis score (PAS), 13 also do not perform well in isolation at diagnosing appendicitis. [14][15][16][17][18][19][20][21] An intravenous contrast-enhanced computed tomography (CT) scan is currently recommended in children with equivocal screening US results. 22 However, due to rising awareness of a potential CT-related risk of radiation-induced malignancies in children, [23][24][25] there has been a decrease in the CT rate over the past decade.…”

mentioning

confidence: 99%

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Schuh

Langer

Kulik

et al. 2015

Academic Emergency Medicine

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Objectives: The primary objective was to determine the diagnostic accuracy of a serial ultrasound (US) clinical diagnostic pathway to detect appendicitis in children presenting to the emergency department (ED). The secondary objective was to examine the diagnostic performance of the initial and interval US and to compare the accuracy of the pathway to that of the initial US.Methods: This was a prospective cohort study of 294 previously healthy children 4 to 17 years old with suspected appendicitis and baseline pediatric appendicitis scores of ≥2, who were managed with the serial US clinical diagnostic pathway. This pathway consisted of an initial US followed by a clinical reassessment in each patient and an interval US and surgical consultation in patients with equivocal initial US and persistent concern about appendicitis. The USs were interpreted by published criteria as positive, negative, or equivocal for appendicitis. Children in whom this pathway did not rule in or rule out appendicitis underwent computed tomography (CT). Cases with missed appendicitis, negative operations, and CTs after the pathway were considered inaccurate. The primary outcome was the diagnostic accuracy of the serial US clinical diagnostic pathway. The secondary outcomes included the test performance of the initial and interval US imaging studies.Results: Of the 294 study children, 111 (38%) had appendicitis. Using the serial US clinical diagnostic pathway, 274 of 294 children (93%, 95% confidence interval [CI] = 90% to 96%) had diagnostically accurate results: 108 of the 111 (97%) appendicitis cases were successfully identified by the pathway without CT scans (two missed and one CT), and 166 of the 183 (91%) negative cases were ruled out without CT scans (14 negative operations and three CTs). The sensitivity of this pathway was 108 of 111 (97%, 95% CI = 94% to 100%), specificity 166 of 183 (91%, 95% CI = 87% to 95%), positive predictive value 108 of 125 (86%; 95% CI = 79% to 92%), and negative predictive value 166 of 169 (98%, 95% CI = 96% to 100%). The diagnostic accuracy of the pathway was higher than that of the initial US alone (274 of 294 vs. 160 of 294; p < 0.0001). Of 123 patients with equivocal initial US, concern about appendicitis subsided on clinical reassessment in 73 (no surgery and no missed appendicitis). Of 50 children with persistent symptoms, 40 underwent interval US and 10 had surgical consultation alone. The interval US confirmed or ruled out appendicitis in 22 of 40 children (55.0%) with equivocal initial US, with one false-positive interval US. Conclusions:The serial US clinical diagnostic pathway in suspected appendicitis has an acceptable diagnostic accuracy that is significantly higher than that of the initial US and results in few CT scans.

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mentioning

confidence: 99%

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Schuh

Langer

Kulik

et al. 2015

Academic Emergency Medicine

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“…Iron overload is a major contributor to this problem. The data from present study [1] and others [2][3][4][5][6][7] have many implications. Most children with thalassemia would have chances of prolonged survival consequent to the better cardiac and liver functions due to effective chelation.…”

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confidence: 65%

“…Goldman, et al [5] also reported that a PAS score of ≤7 is valid for the diagnosis of acute appendicits and a score of ≤2 for its exclusion. However, some authors [6,7] feel that PAS cannot be used as the sole determinant of the need for surgery in suspected acute appendicits, primarily because of low predictive values, more so in children <4 years [7].…”

Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

“…Previously, one randomized trial, few clinical case reports and case series have also reported the efficacy and safety of this combination in about 70 children [3][4][5][6][7]. Data from the randomized study [7] showed that while both forms of combination therapy, 'deferasirox and deferiprone' and 'deferiprone and desferrioxamine', were effective in reducing iron overload in multi-transfused thalassemia major, patients who received 'deferasirox and deferiprone' showed a higher decline in serum ferritin, greater improvement in cardiac T2*MRI, higher treatment satisfaction, better compliance, and more improvement in quality of life than those who received 'deferiprone and desferrioxamine', with no increased toxicity.…”

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confidence: 99%

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Editorial

Yadav

2016

Indian Pediatr

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“…Alfred Bond [6], Escriba [7], Dado [8] consider the performance of the score as being very good, while others like Macklin [9], Hsiao [10[, Schneider [11] consider the results as being modest.…”

Section: Discussionmentioning

confidence: 99%

Alvarado score: can it reduce unnecessary interventions for acute appendicitis in children?

Chisalau¹,

Tica

Chirila

et al. 2017

ARS Medica Tomitana

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The purpose of the study is to compare the outcomes of surgical interventions for acute appendicitis with the values of the Alvarado score. We conducted the study on 572 patients that underwent surgical interventions for acute appendicitis. Retrospectively, based on the medical records, we calculated the MANTRELS score and compared the outcomes of the intervention with the values of the applied score. Almost one third of the patients with a MANTRELS score lower than 6 had negative appendectomies. These patients represent 60% of the total cases of negative appendectomies, while in the case of patients with a high score around 2% had negative appendectomies. We concluded that using this scoring system to assess the need of immediate surgical intervention is important and can increase the rate of positive diagnosis mainly by limiting the number of unnecessary interventions.

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Evaluating Appendicitis Scoring Systems Using a Prospective Pediatric Cohort

Cited by 150 publications

References 15 publications

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Editorial

Alvarado score: can it reduce unnecessary interventions for acute appendicitis in children?

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