Prediction Model for Failure of Nonoperative Management of Uncomplicated Appendicitis in Adults

Kobayashi, Toshimichi; Hidaka, Eiji; Koganezawa, Itsuki; Nakagawa, Masashi; Yokozuka, Kei; Ochiai, Sigeto; Gunji, Takahiro; Ozawa, Yosuke; Hikita, Kosuke; Sano, Tsuyoshi; Tomita, Koichi; Tabuchi, Satoshi; Chiba, Naokazu; Kawachi, Sigeyuki

doi:10.1007/s00268-021-06213-1

Cited by 6 publications

(6 citation statements)

References 34 publications

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“…Previously, we reported that the maximal outer diameter of the appendix and presence of appendiceal fecalith were associated with failure of non-operative management in UA [22]. We considered that the presence of fecalith leads to an ongoing obstruction with subsequent out ow obstruction of the lumen of the appendix.…”

Section: Discussionmentioning

confidence: 99%

Development of a scoring model for the prediction of gangrenous/perforated appendicitis

Kobayashi

Hidaka

Koganezawa

et al. 2023

Preprint

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Background: The mortality rate of gangrenous/perforated appendicitis is higher than that of uncomplicate appendicitis. However, non-operative management of such patients is ineffective. This necessitates their careful exam at presentation to identify gangrenous/perforated appendicitis and aid surgical decision-making. Therefore, this study aimed to develop a new scoring model for predicting gangrenous/perforated appendicitis in adults based on objective findings. Methods: We retrospectively analyzed 151 patients with acute appendicitis who underwent emergency surgery between January 2014 and June 2021. We performed univariate and multivariate analyses to identify independent predictors of gangrenous/perforated appendicitis, and a new scoring model was developed based on logistic regression coefficients for independent predictors. Receiver operating characteristic (ROC) curve analysis and the Hosmer–Lemeshow test were performed to assess the discrimination and calibration of the model. Finally, the scores were classified into three categories based on the probability of gangrenous/perforated appendicitis. Results: Among the 151 patients, 85 and 66 patients were diagnosed with gangrenous/perforated appendicitis and uncomplicated appendicitis, respectively. Using the multivariate analysis, c-reactive protein level, maximal outer diameter of the appendix, and presence of appendiceal fecalith were identified as independent predictors for developing gangrenous/perforated appendicitis. Our novel scoring model was developed based on three independent predictors and ranged from 0 to 3. The area under the ROC curve was 0.792 (95% confidence interval, 0.721—0.863), and the Hosmer–Lemeshow test showed a good calibration of the novel scoring model (P = 0.716). Three risk categories were classified: low, moderate, and high risk with probabilities of 30.9%, 63.8%, and 94.4%, respectively. Conclusions: Our scoring model can objectively and reproducibly identify gangrenous/perforated appendicitis with good diagnostic accuracy and help in determining the degree of urgency and in making decisions about appendicitis management.

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Section: Discussionmentioning

confidence: 99%

Development of a scoring model for the prediction of gangrenous/perforated appendicitis

Kobayashi

Hidaka

Koganezawa

et al. 2023

Preprint

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“…Previous studies have reported various indicators associated with GPA [20][21][22][23][24][25][26][27][28][29][30][31][32]. WBC is commonly used as a blood marker for diagnosing appendicitis [21,22], while lymphocyte levels are inversely correlated with the severity of appendicitis in ammation, typically reduced in cases of gangrenous appendicitis [23,24].…”

Section: Discussionmentioning

confidence: 99%

Predictive Model for Gangrenous/Perforated Appendicitis Identification in Adults: A Multicenter Retrospective Study

Liang,

Sailai,

Ding

et al. 2024

Preprint

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Background Gangrenous or perforated appendicitis (GPA) is a severe form of appendicitis with a higher mortality rate than uncomplicated appendicitis. Accurate preoperative identification of GPA is crucial for timely surgical intervention. Methods This retrospective multicenter study included 796 patients who underwent appendectomy. Univariate and multivariate logistic regression analyses were used to develop a nomogram model for predicting GPA based on laboratory tests and computed tomography (CT) findings. The model was validated using an external dataset. Results Seven independent predictors were included in the nomogram: white blood cell count, lymphocyte count, D-dimer, serum glucose, albumin, maximum outer diameter of the appendix, and presence of appendiceal fecalith. The nomogram achieved good discrimination and calibration in both the training and testing sets. In the training set, the AUC was 0.806 (95%CI: 0.763–0.849), and the sensitivity and specificity were 82.1% and 66.9%, respectively. The Hosmer-Lemeshow test showed good calibration (P = 0.7378). In the testing set, the AUC was 0.799 (95%CI: 0.741–0.856), and the sensitivity and specificity were 70.5% and 75.3%, respectively. Decision curve analysis confirmed the clinical utility of the nomogram. Conclusions The laboratory test-CT nomogram model can effectively identify GPA patients, aiding in surgical decision-making and improving patient outcomes.

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“…Previously, we reported that the maximal outer diameter of the appendix and presence of appendiceal fecalith were associated with failure of non-operative management in UA [ 22 ]. We considered that the presence of fecalith leads to an ongoing obstruction with subsequent outflow obstruction of the lumen of the appendix.…”

Section: Discussionmentioning

confidence: 99%

Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background The mortality rate of gangrenous/perforated appendicitis is higher than that of uncomplicated appendicitis. However, non-operative management of such patients is ineffective. This necessitates their careful exam at presentation to identify gangrenous/perforated appendicitis and aid surgical decision-making. Therefore, this study aimed to develop a new scoring model based on objective findings to predict gangrenous/perforated appendicitis in adults. Methods We retrospectively analyzed 151 patients with acute appendicitis who underwent emergency surgery between January 2014 and June 2021. We performed univariate and multivariate analyses to identify independent objective predictors of gangrenous/perforated appendicitis, and a new scoring model was developed based on logistic regression coefficients for independent predictors. Receiver operating characteristic (ROC) curve analysis and the Hosmer–Lemeshow test were performed to assess the discrimination and calibration of the model. Finally, the scores were classified into three categories based on the probability of gangrenous/perforated appendicitis. Results Among the 151 patients, 85 and 66 patients were diagnosed with gangrenous/perforated appendicitis and uncomplicated appendicitis, respectively. Using the multivariate analysis, C-reactive protein level, maximal outer diameter of the appendix, and presence of appendiceal fecalith were identified as independent predictors for developing gangrenous/perforated appendicitis. Our novel scoring model was developed based on three independent predictors and ranged from 0 to 3. The area under the ROC curve was 0.792 (95% confidence interval, 0.721—0.863), and the Hosmer–Lemeshow test showed a good calibration of the novel scoring model (P = 0.716). Three risk categories were classified: low, moderate, and high risk with probabilities of 30.9%, 63.8%, and 94.4%, respectively. Conclusions Our scoring model can objectively and reproducibly identify gangrenous/perforated appendicitis with good diagnostic accuracy and help in determining the degree of urgency and in making decisions about appendicitis management.

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Prediction Model for Failure of Nonoperative Management of Uncomplicated Appendicitis in Adults

Cited by 6 publications

References 34 publications

Development of a scoring model for the prediction of gangrenous/perforated appendicitis

Development of a scoring model for the prediction of gangrenous/perforated appendicitis

Predictive Model for Gangrenous/Perforated Appendicitis Identification in Adults: A Multicenter Retrospective Study

Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis

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