Alvarado Skoru için Pediatrik Modifikasyon: Apandisitli Hastaların Görünümü

Year 2024, Volume: 14 Issue: 4, 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

References

• 1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15.5:557-564. doi: 10.1016/S0196-0644(86)80993-3.
• 2. Kollar D, McCartan DP, Bourke M, Cross KS, Dowdall J. Predicting acute appendicitis? A comparison of the Alvarado score, the appendicitis inflammatory response score and clinical assessment. World J Surg. 2015;39(1):104-109. Doi: 10.1007/s00268-014-2794-6.
• 3. Inan M, Tulay SH, Besim H, Karakaya J. The value of ultrasonography and its comparison with Alvarado scoring system in acute appendicitis. Ulus Cerrahi Derg. 2011;27:149-153. doi: 10.5097/1300-0705.UCD.1181-11.04.
• 4. Castro S, Unlu C, Steller E, Van Wagensveld BE, Vrouenraets BC. Evaluation of the appendicitis inflammatory response score for patients with acute appendicitis. World J Surg. 2012;36(7):1540-1545. doi: 10.1007/s00268-012-1521-4.
• 5. Man E, Simonka Z, Varga A, Rárosi F, Lazar G. Impact of the Alvarado score on the diagnosis of acute appendicitis: comparing clinical judgment, Alvarado score and a new modified score in suspected appendicitis: a prospective, randomized clinical trial. Surg Endosc. 2014;28(8):2398-2405. doi: 10.1007/s00464-014-3488-8.
• 6. Kirkil C, Karabulut K, Aygen E, Ilhan Y, YurM, Binnetoglu K, Bulbuller N. Appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain. Ulus Travma Acil Cerrahi Derg. 2013;19(1):13-19. doi: 10.5505/tjtes.2013.88714.
• 7. Blob E, Kohlhober U, Tillawi S. Advancements in the diagnosis of acute appendicitis in children and adolescents. Eur J Pediatr Surg. 2004;14:404-409. doi: 10.1055/s-2004-821152.
• 8. Scholer SJ, Pituch K, Orr DP, Dittus RS. Clinical outcomes of children with acute abdominal pain. Pediatrics. 1996;20:680-685.
• 9. Rotrock SG, Skeoch G, Rush JJ, Johnson NE. Clinical features of misdiagnose appendicitisin children. Ann Emerg Med. 1991;20:45-50.
• 10. Bhatt M, Joseph L, Ducharme FM, Dougherty G, McGillivray D. Prospective validation of the pediatric appendicitis score in a Canadian pediatric emergency department. Acad Emerg Med. 2009;16.7:591-596. doi: 10.1111/j.1553-2712.2009.00445.x.
• 11. Douglas CD, Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000;321:919-922.
• 12. Mentes O, Eryilmaz M, Harlak A, Ozturk E, Tufan T. The value of serum fibrinogen level in the diagnosis of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2012;18:384-388.
• 13. Jo YH, Kim K, Rhee JE, Kim TY, Lee JH, Kang SB, et al. The accuracy of emergency medicine and surgical residents in the diagnosis of acute appendicitis. Am J Emerg Med. 2010;28:766-770. doi: 10.1016/j.ajem.2009.03.017.
• 14. Smink DS, FishmanSJ, Kleinman K, Finkelstein JA. Effects of race insurance status and hospital volume on perforated appendicitis in children. Pediatrics. 2005;115(4):920-925. doi: 10.1542/peds.2004-1363.
• 15. Stephens PL, Mazzucco JJ. Comparison of ultrasound and the Alvarado score for the diagnosis of acute appensicitis. Conn Med. 1999;63(3):137-140.
• 16. Borushok KF, Jeffrey RB Jr, Laing FC. Sonografic diagnosis of perforation in patients with acute appendicitis. AJR Am J Roentgenol. 1990;154(2):275-278. doi: 10.2214/ajr.154.2.2105013.
• 17. Skaane P, Amland PF, Nordshus T, Solheim K. Ultrasonography in patients with suspected acute appendicitis: a prospective study. Br J Radiol. 1990;63(754):787-793 appendicitis. Med Pregl. 2001;54(11-12):557-561.
• 18. Leite PN, Pereira JM, Cunha R, Pinto P, Sirlin C. Computed tomography evaluation of appendicitis and its complications: Imaging techniques and key diagnostic findings. Am J Roentgenol. 2005;185:406-417. doi: 10.2214/ajr.185.2.01850406.
• 19. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004;141:537-546.
• 20. Zakaria O, Sultan TA, Khalil TH, Wahba T. Role of clinical judgment and tissue harmonic imaging ultrasonography in diagnosis of paediatric acute appendicitis. World J Emerg Surg. 2011;6(1):39.
• 21. Baltrak YA, Söğüt SE, Varlıklı O. An Effective Method for Diagnosing Appendicitis in Children: Appendicitis Scoring System. The Anat J of Famil Med. 2020; 3(2): 158-162.
• 22. Dey S, Mohanta PK, Baruah AK, Kharga B, Bhutia KL, Singh SK. Alvarado scoring in acute appendicitis—a clinicopathological correlation. Indian J Surg. 2010;72(4):290-293. doi: 10.1007/s12262-010-0190-5.