Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort

Zouari, Mohamed; Jallouli, Mohamed; Louati, Hamdi; Kchaou, Rim; Chtourou, Rahma; Ahmed, Kawsar; Dhaou, Mahdi Ben; Zitouni, Hayet; Mhiri, Riadh

doi:10.1016/j.ajem.2015.10.004

Cited by 30 publications

(29 citation statements)

References 31 publications

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“…The classification of US results is not consistent among studies; a nonvisualized appendix can be categorized as equivocal or negative. The binary categorization in the present study, with a nonvisualized appendix without secondary signs of appendicitis classified as a negative examination, is in conjunction with some of the previous studies [12, 21, 24]. Conversely, Schuh et al [17], classified a partly or nonvisualized appendix without secondary signs, as equivocal.…”

Section: Discussionsupporting

confidence: 79%

“…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: Discussionsupporting

confidence: 62%

“…No study has evaluated CRP integrated with US. Zouari et al did not find it helpful when integrating CRP with the Alvarado score [24]. In the present study, integrating a negative US and CRP < 15 mg/L improved sensitivity (82% to 92%) and slightly increased the NPV (93% to 95%).…”

Section: Discussioncontrasting

confidence: 62%

“…In addition, only a few studies have considered the possibility of combining US with a clinical prediction score (Table 1) [20–23]. Furthermore, studies have evaluated the combination of routine blood tests such as C-reactive protein (CRP) and white blood cell (WBC) count, with US (Table 1) [24, 25]. …”

Section: Introductionmentioning

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: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 62%

Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

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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“…Pediatric emergency POCUS has been part of this movement, with published scanning protocols describing its use in the evaluation of trauma, abdominal pain [4, 5], dyspnea [6], and musculoskeletal complaints [7, 8], among others. This is much the same range of complaints that are the focus of adult emergency and critical care ultrasound.…”

mentioning

confidence: 99%

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

et al. 2016

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The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

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