Research Article
BibTex RIS Cite

The Predictive Value of Ultrasound, Alvarado Score, and C-Reactive Protein in Pediatric Appendectomy Outcomes

Year 2022, Volume: 5 Issue: 3, 109 - 115, 30.09.2022
https://doi.org/10.54996/anatolianjem.1058404

Abstract

Aim: This retrospective study aimed to investigate the combined accuracy of appendix diameter, C reactive protein, and Alvarado score in classifying patients with negative appendectomy and acute appendicitis.


Material and Methods: This descriptive observational cohort study research was conducted at the Emergency Department of a Training and Research Hospital between November 2017 and April 2019. We included the data of appendicitis cases aged under 18 years in this restrospective study and gathered data on patients’s demographics, preoperative laboratory values, signs, symptoms, and final pathological diagnosis, restrospectively. Then, cases were divided into acute appendicitis or negative appendectomy groups according to formal pathology reports.


Results: The final study population consisted of 60 patients; the negative appendectomy rate was 25%. The diagnostic accuracy of the multivariate model`s involving CRP, Alvarado score, and appendix diameter was 93.3%, with a sensitivity and specificity of 93.3% for identifying acute appendicitis (+LR: 14 and -LR: 0.07). Applying the model could have prevented 93.3% of negative appendectomy cases (25% to 1.7%) from undergoing unnecessary surgery in our cohort.


Conclusion: In conclusion, CRP, Alvarado score, or appendix diameter should not be used individually to diagnose AA in children. However, combining these variables can increase the accuracy of acute appendicitis diagnosis and may provide a significant reduction in negative appendectomy rates.

References

  • Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet. 2015;386(10000):1278-87.
  • Akbulut S, Koc C, Sahin TT, Sahin E, Tuncer A, Demyati K, et al. Determination of factors predicting acute appendicitis and perforated appendicitis. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2021;27(4):0-. https://doi.org/10.14744/tjtes.2020.60344.
  • Salminen P, Tuominen R, Paajanen H, Rautio T, Nordström P, Aarnio M, et al. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. Jama. 2018;320(12):1259-65.
  • Koberlein GC, Trout AT, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria® Suspected Appendicitis-Child. Journal of the American College of Radiology. 2019;16(5):S252-S63.
  • Ebell MH, Shinholser J. What are the most clinically useful cutoffs for the Alvarado and Pediatric Appendicitis Scores? A systematic review. Annals of emergency medicine. 2014;64(4):365-72. e2.
  • Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ (Clinical research ed). 2015;351:h5527. https://doi.org/10.1136/bmj.h5527.
  • Kim SH, Choi YH, Kim WS, Cheon J-E, Kim I-O. Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases. Pediatric radiology. 2014;44(10):1243-51.
  • Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis. Academic Emergency Medicine. 2017;24(5):523-51.
  • Goldman RD, Carter S, Stephens D, Antoon R, Mounstephen W, Langer JC. Prospective validation of the pediatric appendicitis score. The Journal of pediatrics. 2008;153(2):278-82.
  • Wu H-P, Yang W-C, Wu K-H, Chen C-Y, Fu Y-C. Diagnosing appendicitis at different time points in children with right lower quadrant pain: comparison between Pediatric Appendicitis Score and the Alvarado score. World journal of surgery. 2012;36(1):216-21.
  • Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Medicine. 2011;9(1):139. https://doi.org/10.1186/1741-7015-9-139.
  • Yang J, Liu C, He Y, Cai Z. Laboratory Markers in the Prediction of Acute Perforated Appendicitis in Children. Emergency medicine international. 2019;2019.
  • Sengul S, Guler Y, Calis H, Karabulut Z. The Role of Serum Laboratory Biomarkers for Complicated and Uncomplicated Appendicitis in Adolescents. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2020;30(4):420-4.
  • Chiang JJ, Angus MI, Nah SA, Jacobsen AS, Low Y, Choo CS, et al. Time course response of inflammatory markers in pediatric appendicitis. Pediatric Surgery International. 2020;36(4):493-500.
  • Kabir SA, Kabir SI, Sun R, Jafferbhoy S, Karim A. How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence. International Journal of Surgery. 2017;40:155-62. https://doi.org/https://doi.org/10.1016/j.ijsu.2017.03.013.
  • Gee KM, Jones RE, Babb JL, Preston SC, Beres AL. Clinical and Imaging Correlates of Pediatric Mucosal Appendicitis. The Journal of surgical research. 2019;242:111-7. https://doi.org/10.1016/j.jss.2019.04.039.
  • Lee J, Ko Y, Ahn S, Park JH, Kim HJ, Hwang Ss, et al. Comparison of US and CT on the effect on negative appendectomy and appendiceal perforation in adolescents and adults: A post‐hoc analysis using propensity‐score methods. Journal of Clinical Ultrasound. 2016;44(7):401-10.
  • Toprak H, Kilincaslan H, Ahmad IC, Yildiz S, Bilgin M, Sharifov R, et al. Integration of ultrasound findings with Alvarado score in children with suspected appendicitis. Pediatrics International. 2014;56(1):95-9. https://doi.org/https://doi.org/10.1111/ped.12197.
  • Xu Y, Jeffrey RB, DiMaio MA, Olcott EW. Lymphoid Hyperplasia of the Appendix: A Potential Pitfall in the Sonographic Diagnosis of Appendicitis. AJR American journal of roentgenology. 2016;206(1):189-94. https://doi.org/10.2214/ajr.15.14846.
  • Mittal MK, Dayan PS, Macias CG, Bachur RG, Bennett J, Dudley NC, et al. Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Academic Emergency Medicine. 2013;20(7):697-702.
  • Gurien LA, Smith SD, Dassinger MS, Burford JM, Tepas JJ, Crandall M. Suspected appendicitis pathway continues to lower CT rates in children two years after implementation. The American Journal of Surgery. 2019;218(4):716-21.
  • Alter SM, Walsh B, Lenehan PJ, Shih RD. Ultrasound for diagnosis of appendicitis in a community hospital emergency department has a high rate of nondiagnostic studies. The Journal of emergency medicine. 2017;52(6):833-8.
  • Aydin S, Tek C, Ergun E, Kazci O, Kosar PN. Acute appendicitis or lymphoid hyperplasia: how to distinguish more safely? Canadian Association of Radiologists Journal. 2019;70(4):354-60.
  • Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Annals of internal medicine. 2004;141(7):537-46.
  • Schoel L, Maizlin, II, Koppelmann T, Onwubiko C, Shroyer M, Douglas A, et al. Improving imaging strategies in pediatric appendicitis: a quality improvement initiative. The Journal of surgical research. 2018;230:131-6. https://doi.org/10.1016/j.jss.2018.04.043.

Ultrason, Alvarado Skoru ve C-Reaktif Proteinin Pediatrik Appendektomilerdeki Prediktör Değeri

Year 2022, Volume: 5 Issue: 3, 109 - 115, 30.09.2022
https://doi.org/10.54996/anatolianjem.1058404

Abstract

Amaç: Bu retrospektif çalışma, negatif apendektomili ve akut apandisitli hastaları sınıflandırmada apendiks çapı, C reaktif protein ve Alvarado skorunun birleşik doğruluğunu araştırmayı amaçladı.


Gereç ve Yöntemler: Bu tanımlayıcı gözlemsel kohort çalışması, Kasım 2017 ile Nisan 2019 tarihleri arasında bir Eğitim ve Araştırma Hastanesi Acil Servisinde yürütülmüştür. Çalışmaya 18 yaş altı apandisit olguları dahil edilmiş ve hastaların demografik özellikleri, laboratuvar ölçümleri, semptom, bulgu ve nihai patoloji raporlarına ilişkin veriler retrospektif olarak toplanmıştır. Daha sonra olgular resmi patoloji raporlarına göre akut apandisit veya negatif apendektomi gruplarına ayrılmıştır.


Bulgular: Nihai çalışma popülasyonu 60 hastadan oluşuyordu ve negatif apendektomi oranı %25 idi. CRP, Alvarado skoru ve apendiks çapı verilerini içeren çok değişkenli modelin tanısal doğruluğu %93.3, akut apandisit tanımlamada duyarlılık ve özgüllüğü %93.3 idi (+LR: 14 ve -LR: 0.07). Modeli uygulamanın, kohortumuzdaki negatif apendektomi vakalarının %93,3'ünü (%25 ila %1,7) gereksiz cerrahiden kurtarabileceği görülmüştür.


Sonuç: Sonuç olarak, CRP, Alvarado skoru veya apendiks çapı çocuklarda AA tanısında tek başına kullanılmamalıdır. Ancak bu değişkenlerin birlikte kullanımı apandisit tanısının doğruluğunu artırabilir ve negatif apendektomi oranlarında önemli bir azalma sağlayabilir.

References

  • Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet. 2015;386(10000):1278-87.
  • Akbulut S, Koc C, Sahin TT, Sahin E, Tuncer A, Demyati K, et al. Determination of factors predicting acute appendicitis and perforated appendicitis. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2021;27(4):0-. https://doi.org/10.14744/tjtes.2020.60344.
  • Salminen P, Tuominen R, Paajanen H, Rautio T, Nordström P, Aarnio M, et al. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. Jama. 2018;320(12):1259-65.
  • Koberlein GC, Trout AT, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria® Suspected Appendicitis-Child. Journal of the American College of Radiology. 2019;16(5):S252-S63.
  • Ebell MH, Shinholser J. What are the most clinically useful cutoffs for the Alvarado and Pediatric Appendicitis Scores? A systematic review. Annals of emergency medicine. 2014;64(4):365-72. e2.
  • Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ (Clinical research ed). 2015;351:h5527. https://doi.org/10.1136/bmj.h5527.
  • Kim SH, Choi YH, Kim WS, Cheon J-E, Kim I-O. Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases. Pediatric radiology. 2014;44(10):1243-51.
  • Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis. Academic Emergency Medicine. 2017;24(5):523-51.
  • Goldman RD, Carter S, Stephens D, Antoon R, Mounstephen W, Langer JC. Prospective validation of the pediatric appendicitis score. The Journal of pediatrics. 2008;153(2):278-82.
  • Wu H-P, Yang W-C, Wu K-H, Chen C-Y, Fu Y-C. Diagnosing appendicitis at different time points in children with right lower quadrant pain: comparison between Pediatric Appendicitis Score and the Alvarado score. World journal of surgery. 2012;36(1):216-21.
  • Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Medicine. 2011;9(1):139. https://doi.org/10.1186/1741-7015-9-139.
  • Yang J, Liu C, He Y, Cai Z. Laboratory Markers in the Prediction of Acute Perforated Appendicitis in Children. Emergency medicine international. 2019;2019.
  • Sengul S, Guler Y, Calis H, Karabulut Z. The Role of Serum Laboratory Biomarkers for Complicated and Uncomplicated Appendicitis in Adolescents. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2020;30(4):420-4.
  • Chiang JJ, Angus MI, Nah SA, Jacobsen AS, Low Y, Choo CS, et al. Time course response of inflammatory markers in pediatric appendicitis. Pediatric Surgery International. 2020;36(4):493-500.
  • Kabir SA, Kabir SI, Sun R, Jafferbhoy S, Karim A. How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence. International Journal of Surgery. 2017;40:155-62. https://doi.org/https://doi.org/10.1016/j.ijsu.2017.03.013.
  • Gee KM, Jones RE, Babb JL, Preston SC, Beres AL. Clinical and Imaging Correlates of Pediatric Mucosal Appendicitis. The Journal of surgical research. 2019;242:111-7. https://doi.org/10.1016/j.jss.2019.04.039.
  • Lee J, Ko Y, Ahn S, Park JH, Kim HJ, Hwang Ss, et al. Comparison of US and CT on the effect on negative appendectomy and appendiceal perforation in adolescents and adults: A post‐hoc analysis using propensity‐score methods. Journal of Clinical Ultrasound. 2016;44(7):401-10.
  • Toprak H, Kilincaslan H, Ahmad IC, Yildiz S, Bilgin M, Sharifov R, et al. Integration of ultrasound findings with Alvarado score in children with suspected appendicitis. Pediatrics International. 2014;56(1):95-9. https://doi.org/https://doi.org/10.1111/ped.12197.
  • Xu Y, Jeffrey RB, DiMaio MA, Olcott EW. Lymphoid Hyperplasia of the Appendix: A Potential Pitfall in the Sonographic Diagnosis of Appendicitis. AJR American journal of roentgenology. 2016;206(1):189-94. https://doi.org/10.2214/ajr.15.14846.
  • Mittal MK, Dayan PS, Macias CG, Bachur RG, Bennett J, Dudley NC, et al. Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Academic Emergency Medicine. 2013;20(7):697-702.
  • Gurien LA, Smith SD, Dassinger MS, Burford JM, Tepas JJ, Crandall M. Suspected appendicitis pathway continues to lower CT rates in children two years after implementation. The American Journal of Surgery. 2019;218(4):716-21.
  • Alter SM, Walsh B, Lenehan PJ, Shih RD. Ultrasound for diagnosis of appendicitis in a community hospital emergency department has a high rate of nondiagnostic studies. The Journal of emergency medicine. 2017;52(6):833-8.
  • Aydin S, Tek C, Ergun E, Kazci O, Kosar PN. Acute appendicitis or lymphoid hyperplasia: how to distinguish more safely? Canadian Association of Radiologists Journal. 2019;70(4):354-60.
  • Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Annals of internal medicine. 2004;141(7):537-46.
  • Schoel L, Maizlin, II, Koppelmann T, Onwubiko C, Shroyer M, Douglas A, et al. Improving imaging strategies in pediatric appendicitis: a quality improvement initiative. The Journal of surgical research. 2018;230:131-6. https://doi.org/10.1016/j.jss.2018.04.043.
There are 25 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Ali Çelik 0000-0003-2363-1844

Mehmet Altuntaş 0000-0001-5624-968X

Publication Date September 30, 2022
Published in Issue Year 2022 Volume: 5 Issue: 3

Cite

AMA Çelik A, Altuntaş M. The Predictive Value of Ultrasound, Alvarado Score, and C-Reactive Protein in Pediatric Appendectomy Outcomes. Anatolian J Emerg Med. September 2022;5(3):109-115. doi:10.54996/anatolianjem.1058404