Alvarado Skoru için Pediatrik Modifikasyon: Apandisitli Hastaların Görünümü

Year 2024, , 189 - 192, 31.07.2024

Burhan Beger , Cihan Etgul , Metin Şimşek , Bülent Sönmez , Sevgi Ulusoy Tangül

https://doi.org/10.16899/jcm.1496012

Abstract

İngilizce - Algılandı

Türkçe

İngilizce

Rusça

Türkçe

İngilizce

Rusça
Objective: This study, with the purpose of decreasing the morbidity rate in emergency pediatric surgery clinics, evaluates the reliability of an acute appendicitis diagnosis score we define as “appearance of the patient with appendicitis (APA)”, which is a new modification of Alvarado Score (AS).

Methods: One hundred eighty patients, that admitted to Van Training and Research Hospital between February 2018 and June 2018 and were consulted to pediatric surgery with acute appendicitis suspicion; were analyzed as a randomized prospective study. In the new scoring system which we define as APA, instead of a left shift of neutrophils – a state of the patients lying still in the bed, reluctant to speak, with dry lips, with tired eyes, upset and with a troubled expression at the face is placed. For all the patients, AS (AS 1-4, AS 5-6 and AS 7-10) and APA (APA 1-4, APA 5-6 and APA 7-10) scores were independently calculated as three groups and were compared to each other.

Results: 180 children (108 males – 72 female) with an average age of 11 (range, 6 – 15) were included in the study. Distribution of patients in the three groups of AS was determined as 1-4: 90 (50%), AS 5-7: 48 (26.7%) and AS 8-10: 42 (23.3%) respectively. Distribution of patients with respect to APA score were as APA 1-4: 72 (40%), APA 5-7: 69 (38.3%) and APA 8-10: 39 (21.7%). Appendectomy was performed on 3 patients from the AS 1-4 group, on 15 patients from AS 5-6 group and on 33 patients from AS 7-10 group. Whereas none of the patients from the APA 1-4 group had an appendectomy, 18 patients from APA 5-6 group and 33 patients from APA 7-10 group had an appendectomy.

Conclusion: By means of the APA which we define as a combination of AS and clinical judgment (CJ), the number of pediatric cases with appendicitis suspicion to be kept under observation was increased and unnecessary –too early or too late- surgical intervention incidence was decreased. Our study shows CJ and scoring systems are not alternative methods for each other and collective use of both can decrease morbidity and mortality in acute appendicitis treatment.

2.126 / 5.000
Amaç: Bu çalışma, acil çocuk cerrahisi kliniklerinde morbidite oranının azaltılması amacıyla Alvarado'nun yeni bir modifikasyonu olan ve “apandisitli hastanın görünümü (APA)” olarak tanımladığımız akut apandisit tanı skorunun güvenilirliğini değerlendirmektedir. Puan (AS).

Yöntemler: Şubat 2018 ile Haziran 2018 tarihleri ​​arasında Van Eğitim ve Araştırma Hastanesi'ne başvuran ve akut apandisit şüphesiyle çocuk cerrahisine başvuran 180 hasta; randomize prospektif bir çalışma olarak analiz edildi. APA olarak tanımladığımız yeni puanlama sisteminde nötrofillerin sola kayması yerine hastaların yatakta hareketsiz yatması, konuşmak istememesi, dudakları kuru, gözleri yorgun, üzgün ve yüzünde sıkıntılı bir ifade olması durumu. yüz yerleştirilir. Tüm hastaların AS (AS 1-4, AS 5-6 ve AS 7-10) ve APA (APA 1-4, APA 5-6 ve APA 7-10) skorları üç grup halinde bağımsız olarak hesaplandı ve karşılaştırıldı. birbirlerine.

Bulgular: Araştırmaya yaş ortalaması 11 (6-15 yaş aralığı) olan 180 çocuk (108 erkek – 72 kız) dahil edildi. AS'nin üç gruba göre dağılımı sırasıyla 1-4: 90 (%50), AS 5-7: 48 (%26,7) ve AS 8-10: 42 (%23,3) olarak belirlendi. Hastaların APA skoruna göre dağılımı APA 1-4:72 (%40), APA 5-7:69 (%38,3) ve APA 8-10:39 (%21,7) şeklindeydi. AS 1-4 grubundan 3 hastaya, AS 5-6 grubundan 15 hastaya ve AS 7-10 grubundan 33 hastaya apendektomi yapıldı. APA 1-4 grubundaki hastaların hiçbirinde apendektomi yapılmazken, APA 5-6 grubunda 18, APA 7-10 grubunda ise 33 hastaya apendektomi uygulandı.

Sonuç: AS ve klinik yargının (CJ) birleşimi olarak tanımladığımız APA sayesinde, apandisit şüphesi ile gözlem altında tutulması gereken pediatrik olguların sayısı artırılmış ve gereksiz -çok erken veya çok geç- cerrahi müdahale sıklığı azaltılmıştır. azaldı. Çalışmamız CJ ve skorlama sistemlerinin birbirine alternatif yöntemler olmadığını ve her ikisinin birlikte kullanımının akut apandisit tedavisinde morbidite ve mortaliteyi azaltabileceğini göstermektedir.
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Keywords

Alvarado skoru, Apandisit, Pediatri.

Pediatric Modification For Alvarado Score: Appearance Of Patients With Apandisitis

Abstract

ABSTRACT
Objective: This study, with the purpose of decreasing the morbidity rate in emergency pediatric surgery clinics, evaluates the reliability of an acute appendicitis diagnosis score we define as “appearance of the patient with appendicitis (APA)”, which is a new modification of Alvarado Score (AS).

Methods: One hundred eighty patients, that admitted to Van Training and Research Hospital between February 2018 and June 2018 and were consulted to pediatric surgery with acute appendicitis suspicion; were analyzed as a randomized prospective study. In the new scoring system which we define as APA, instead of a left shift of neutrophils – a state of the patients lying still in the bed, reluctant to speak, with dry lips, with tired eyes, upset and with a troubled expression at the face is placed. For all the patients, AS (AS 1-4, AS 5-6 and AS 7-10) and APA (APA 1-4, APA 5-6 and APA 7-10) scores were independently calculated as three groups and were compared to each other.

Results: 180 children (108 males – 72 female) with an average age of 11 (range, 6 – 15) were included in the study. Distribution of patients in the three groups of AS was determined as 1-4: 90 (50%), AS 5-7: 48 (26.7%) and AS 8-10: 42 (23.3%) respectively. Distribution of patients with respect to APA score were as APA 1-4: 72 (40%), APA 5-7: 69 (38.3%) and APA 8-10: 39 (21.7%). Appendectomy was performed on 3 patients from the AS 1-4 group, on 15 patients from AS 5-6 group and on 33 patients from AS 7-10 group. Whereas none of the patients from the APA 1-4 group had an appendectomy, 18 patients from APA 5-6 group and 33 patients from APA 7-10 group had an appendectomy.

Conclusion: By means of the APA which we define as a combination of AS and clinical judgment (CJ), the number of pediatric cases with appendicitis suspicion to be kept under observation was increased and unnecessary –too early or too late- surgical intervention incidence was decreased. Our study shows CJ and scoring systems are not alternative methods for each other and collective use of both can decrease morbidity and mortality in acute appendicitis treatment.

Keywords

Acute appendicitis, pediatrics, alvarado score.

Ethical Statement

Van Training and Research Hospital 03,05,2018 number: 2018/08

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