Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study

Pogorelić, Zenon; Lukšić, Bruna; Ninčević, Stipe; Lukšić, Bruno; Polašek, Ozren

doi:10.1016/j.jpedsurg.2020.09.066

Cited by 38 publications

(76 citation statements)

References 16 publications

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“…In this context, hyponatremia has been hypothesized to have predictive value in detection of perforation in sigmoid diverticulitis in older patients undergoing emergency surgery [29] and anastomotic leakage in patients following colorectal surgery [30]. Compared to the results of a prospective study by Pogorelić et al [13], the discriminatory accuracy of our data on sodium was lower regarding differentiation of a PA from AA. Noteworthy, cutoff was set at a lower level and also mean levels of their PA group were markedly lower.…”

Section: Discussioncontrasting

confidence: 79%

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Levels of C-Reactive Protein and Sodium May Differentiate a Perforated Appendix from a Nonperforated Appendix in Children

Nissen

Tröbs

2021

BioMed Research International

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Background. Acute appendicitis (AA) might be amenable to conservative antibiotic treatment, whereas a perforated appendix (PA) necessitates surgery. We investigated the value of clinical–laboratory markers in distinguishing AA from a PA. Methods. Retrospectively obtained preoperative parameters for 306 consecutive patients (<18 years) with histologically confirmed appendicitis (AA ( n = 237 ) vs. PA ( n = 69 )), treated at our institution between January 2014 and December 2017. Results. A PA was associated with male preponderance, younger age, decreased sodium level and increased white blood cell count, Tzanakis score, C-reactive protein (CRP) level, and CRP-to-lymphocyte ratio (CLR). Upon discrimination analysis, CLR and CRP displayed the highest accuracy in differentiating a PA from AA. Regression analysis identified levels of CRP, sodium, and the Tzanakis score as independent predictors for a PA. Conclusion. Levels of CLR, CRP, sodium, and Tzanakis score might support decision-making regarding treatment options for pediatric appendicitis.

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Section: Discussioncontrasting

confidence: 79%

“…Recently, hyponatremia has been reported as a very sensitive marker of advanced acute appendicitis in children with sensitivity and specificity of 94.7% and 88.5%, respectively [13].…”

Section: Introductionmentioning

confidence: 99%

Levels of C-Reactive Protein and Sodium May Differentiate a Perforated Appendix from a Nonperforated Appendix in Children

Nissen

Tröbs

2021

BioMed Research International

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“…It uses a special mathematical model to select patients with an advanced stage of the disease. In contrast to the scales mentioned above, C-reactive protein is used as one of the variables, which has been documented in several studies as a sensitive laboratory marker in the diagnosis of acute appendicitis [ 13 , 15 , 17 , 24 , 25 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children

et al. 2021

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Background: This prospective observational study aimed to evaluate the validity of appendicitis inflammatory response (AIR) score in differentiating advanced (perforated) from simple (non-perforated) appendicitis in pediatric patients. Methods: A single-center prospective cross-sectional study was conducted between 1 January 2019 until 1 May 2020 including 184 pediatric patients who underwent appendectomy. Based on the intraoperative finding of advanced (n = 38) or simple (n = 146) appendicitis the patients were divided into two groups. Recipient-operator curve (ROC), with calculation of sensitivity and specificity of best cutoff and the area under the curve (AUC), were used to measure the diagnostic value and the potential for risk stratification of the AIR score, among the patients with simple or advanced acute appendicitis. Results: The median value of the AIR score in the perforated and non-perforated groups was 10 (interquartile range, IQR 9, 11), and was 7 (IQR 6, 9), respectively (p < 0.001). Based on the calculated value of AIR score, the patients were classified with a high precision into low, indeterminate and high risk groups for acute appendicitis (p < 0.001). A cutoff value of ≥9 was demonstrated to serve as a reliable indicator of perforated appendicitis with a sensitivity and a specificity of 89.5% and 71.9%, respectively (AUC = 0.80; 95% CI: 0.719–0.871; p < 0.001). Conclusions: Acute appendicitis can be detected with a high level of sensitivity and specificity using the AIR score. Also, the AIR score may differentiate perforated from non-perforated appendicitis in pediatric patients with a high level of accuracy.

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“…However, hyponatremia was studied only in the pediatric population, whereas hyperbilirubinemia was studied in both pediatric and adult patients. 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

“…However, hyponatremia was studied only in the pediatric population, whereas hyperbilirubinemia was studied in both pediatric and adult patients. 12,13 Ultrasonography and abdominal computed tomography (CT) are currently used to help diagnose appendicitis.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors to Diagnose Appendicitis in Children in the Emergency Department

Dadeh¹,

Puitong²

2021

OAEM

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Introduction The most common surgical condition in children is appendicitis. However, making a diagnosis can be difficult due to poor communication and difficulty in the physical examination. Objective This study aimed to determine the accurate clinical predictive factors for the diagnosis of appendicitis in children in the emergency department (ED). Methods A retrospective cohort study was conducted from January 2015 to December 2019. The electronic medical records were reviewed from 1043 pediatric patients younger than 15 years with the chief complaint of abdominal pain and were admitted to the ED during the study period. The patients were divided into either the appendicitis group or non-appendicitis group. The two groups were compared in terms of baseline characteristics, abdominal symptoms and signs, symptom durations, laboratory results, final diagnosis, treatment in the ED, ED disposition, morbidity, and mortality. The significant predictive factors for the diagnosis of appendicitis were examined using univariate and multivariate analyses by logistic regression. Results Predictive factors for the diagnosis of appendicitis in pediatric patients with abdominal pain were gradual increase in abdominal pain (odds ratio (OR) 3.38, 95% confidence interval (CI) 1.51–7.58), right lower quadrant abdominal tenderness (OR 21.07, 95% CI 9.12–48.67), presentation of peritoneal irritation signs (OR 12.57, 95% CI 5.28–29.92), and an absolute neutrophil count >75% (OR 4.68, 95% CI 2.3–9.51). The significant variables were used to develop a diagnostic predictive probability scoring system that ranged from 0.05 to 0.95. The receiver operating characteristic curve indicated a cut-off point of 0.089 to predict pediatric appendicitis with an area under the curve of 0.963. Conclusion The predictive factors for diagnosing appendicitis in children are useful in determining which children require surgical intervention. However, the clinical symptoms and physical examination of the abdomen continue to be the most important diagnostic tools for the diagnosis of appendicitis in children.

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Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study

Cited by 38 publications

References 16 publications

Levels of C-Reactive Protein and Sodium May Differentiate a Perforated Appendix from a Nonperforated Appendix in Children

Levels of C-Reactive Protein and Sodium May Differentiate a Perforated Appendix from a Nonperforated Appendix in Children

Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children

Predictive Factors to Diagnose Appendicitis in Children in the Emergency Department

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