Pediatric appendicitis: state of the art review

Rentea, Rebecca M.; Peter, Shawn D. St.; Snyder, Charles L.

doi:10.1007/s00383-016-3990-2

Cited by 111 publications

(98 citation statements)

References 152 publications

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“…From the present study and other studies evaluating integration of US with PAS [20, 21], or with Alvarado score [20, 22–24], and from recent guidelines on pediatric appendicitis [27, 28], it seems that patients should be categorized into three different groups based on the clinical prediction score: one group with low probability (0–3 points), one with intermediate probability (4–6 points), and one group with high probability of appendicitis (8–10 points). It seems that children in the low probability group could safely be sent home without US.…”

Section: Discussionmentioning

confidence: 94%

“…Children in the high probability group may not benefit from an US since the rate of false-negative results seems to increase which may mislead the surgeon. Hence, in presence of a high clinical prediction, the physician has different options, where the two most accurate seem to be active observation or diagnostic laparoscopy according to the most recent published guidelines [27, 28]. …”

Section: Discussionmentioning

confidence: 99%

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Ultrasound for Appendicitis: Performance and Integration with Clinical Parameters

Löfvenberg

Salö

2016

BioMed Research International

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Objective. To evaluate the performance of ultrasound in pediatric appendicitis and the integration of US with the pediatric appendicitis score (PAS) and C-reactive protein (CRP). Method. An institution-based, retrospective study of children who underwent abdominal US for suspected appendicitis between 2012 and 2015 at a tertiary pediatric surgery center. US results were dichotomized, with a nonvisualized appendix considered as a negative examination. Results. In total, 438 children were included (mean 8.5 years, 54% boys), with an appendicitis rate of 29%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for US were 82%, 97%, 92%, and 93%, respectively, without significant age or gender differences. Pediatric radiologists had significantly higher sensitivity compared to general radiologists, 88% and 71%, respectively (p < 0.01), but no differences were seen for specificity, PPV, and NPV. The sensitivity, NPV, and negative likelihood ratio for the combination of negative US, PAS < 5, and CRP < 5 mg/L were 98%, 98%, and 0.05 (95% CI 0.03–0.15). Conclusion. US may be a useful tool for evaluating children with suspected appendicitis, regardless of age or gender, and should be the first choice of imaging modalities. Combining US with PAS and CRP may reduce several unnecessary admissions for in-hospital observation.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Ultrasound for Appendicitis: Performance and Integration with Clinical Parameters

Löfvenberg

Salö

2016

BioMed Research International

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“…However, for such a common disease, its etiology is not yet fully understood. Several hypotheses have been proposed, including luminal obstruction, infection, innate immunity, and adaptive immunity related to hygiene [3,4,5,6]. In the 1980s, Barker et al reported that improvement in household amenities and piped water supply was followed by an increased rate of acute appendicitis, suggesting a ‘hygiene hypothesis’ that reduced early exposure to gut pathogens in children possibly altered the adaptive immunity with inappropriate or excessive inflammatory response leading to appendicitis [7,8].…”

Section: Introductionmentioning

confidence: 99%

Risk of Appendicitis among Children with Different Piped Water Supply: A Nationwide Population-Based Study

Liu

Huang

et al. 2018

IJERPH

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Appendicitis is a common surgical condition for children. However, environmental effects, such as piped water supply, on pediatric appendicitis risk remain unclear. This longitudinal, nationwide, cohort study aimed to compare the risk of appendicitis among children with different levels of piped water supply. Using data from Taiwan Water Resource Agency and National Health Insurance Research Database, we identified 119,128 children born in 1996–2010 from areas of the lowest piped water supply (prevalence 51.21% to 63.06%) as the study cohort; additional 119,128 children of the same period in areas of the highest piped water supply (prevalence 98.97% to 99.63%) were selected as the controls. Both cohorts were propensity-score matched by baseline variables. We calculated the hazard ratios (HRs) and 95% confidence intervals (CIs) of appendicitis in the study cohort compared to the controls by Cox proportional hazards regression. The study cohort had a raised overall incidence rates of appendicitis compared to the control cohort (12.8 vs. 8.7 per 10,000 person-years). After covariate adjustment, the risk of appendicitis was significantly increased in the study cohort (adjusted HR = 1.46, 95% CI: 1.35, 1.58, p < 0.001). Subgroup and sensitivity analyses showed consistent results that children with low piped water supply had a higher risk of appendicitis than those with high piped water supply. This study demonstrated that children with low piped water supply were at an increased risk of appendicitis. Enhancement of piped water availability in areas lacking adequate, secure, and sanitized water supply may protect children against appendicitis.

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“…Отдельные эндохирургические методики, прежде все-го, лапароскопическая аппендэктомия, получили широ-кое распространение в практике детской хирургии, дока-зали свою эффективность [4][5][6][7], однако даже в этом случае далеко не всеми авторами лапароскопическая аппендэктомия признается безусловным методом выбо-ра при лечении детей с деструктивным аппендицитом и аппендикулярным перитонитом [8].…”

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“…Наиболее разработаны алгоритмы ведения детей с острым аппендицитом [4,7,34]; А. Дроновым и соавт. [4] разработаны алгоритмы применения лапа-роскопии при большинстве экстренных состояний (таких как острый аппендицит, кишечная инвагинация, спаеч-ная болезнь, дивертикул Меккеля), предложена хирур-гическая тактика при ургентных заболеваниях органов малого таза у девочек, описан алгоритм эндоскопиче-ского и лапароскопического этапа при кишечной инва-гинации у детей.…”

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