Evaluation of the Reliability of Pediatric Appendicitis Score and Ultrasonography Findings in the Diagnosis of Acute Appendicitis in Children

Year 2020, Volume: 14 Issue: 5, 445 - 451, 29.09.2020

Yasemin Günal , Dilek Polat Erkan Gökçe , Serap Yörübulut

https://doi.org/10.12956/tchd.761649

Abstract

Objective: Acute appendicitis is the most common surgical emergency in childhood. Early diagnosis is essential to prevent perforation-related morbidity. In this study, we aimed to evaluate the effectiveness of pediatric appendicitis score (PAS) and ultrasonography (USG) findings in the diagnosis of acute appendicitis.
Materials and Methods: Patients who presented with acute abdominal pain and who were followed up or operated with a pre-diagnosis of appendicitis were analyzed retrospectively. The patients were divided into two groups as operated (n = 288) and non-operated (n = 161). PAS value of all patients was calculated and 1-4 negative (low risk), 5-6 suspect (moderate risk), 7 and above were considered positive (high risk). Patients who underwent USG were included in the study. The definitive diagnosis of the patients undergoing surgery was confirmed by histopathological evaluation.
Results: With the pre-diagnosis of acute appendicitis, 449 patients (171 girls, 278 boys) were hospitalized. Appendectomy was performed in 288 (64 %) of the patients. The remaining 161 patients (36 %) who recovered after the observation were discharged without any surgery. Histopathological diagnosis of patients undergoing appendectomy was acute appendicitis in 217 patients (75.3 %), perforated appendicitis in 67 patients (23.2 %) and normal appendix in 4 patients (1.4 %). Patients undergoing appendectomy had a significantly higher PAS value (p < 0.001). PAS value was significantly higher in the patients diagnosed with perforated appendicitis (p < 0.05). The sensitivity of USG and PAS were 81.59 % and 82.98 %, and their specificity was 88.81 % and 95.03 %, respectively, in the diagnosis of appendicitis. The sensitivity decreased significantly (67.70 %), and the specificity increased (100 %) when the patients with appendicitis in USG and PAS 7 and above were evaluated together. The sensitivity was 32.29 % and the specificity was 83.85 % when USG positivity or high-risk PAS value was used alone.
Conclusion: PAS is a useful clinical guide in determining the risk group for appendicitis and the use of additional imaging, and supports the diagnosis even in the high-risk group without additional imaging. However, in cases of incompatibility between USG and PAS values, we believe that close observation, repeated physical examination and, if necessary, further imaging are necessary to reduce the rate of negative appendectomy.

Keywords

Acute appendicitis, ultrasonography, clinical score, children

Çocuklarda Akut Apandisit Tanısında Pediatrik Apandisit Skoru ve Ultrasonografi Bulgularının Güvenilirliğinin Değerlendirilmesi

Abstract

Amaç: Akut apandisit, çocukluk çağında en sık görülen cerrahi acil durumdur. Perforasyonla ilişkili morbiditeyi önlemek için erken tanı şarttır. Bu çalışmada, pediatrik apandisit skoru (PAS) ve ultrasonografi (USG) bulgularının apandisit tanısı koymadaki etkinliklerinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Akut karın ağrısı şikayeti ile başvuran ve apandisit ön tanısı ile yatırılarak takip veya ameliyat edilen hastalar geriye dönük olarak değerlendirildi. Hastalar cerrahi uygulanan (n=288) ve cerrahi uygulanmayan (n=161) olarak iki gruba ayrıldı. Tüm hastaların PAS değeri hesaplandı ve 1-4 arası negatif (düşük risk), 5-6 arası şüpheli (orta risk), 7 ve üzeri olanlar pozitif (yüksek risk) olarak kabul edildi. Çalışmaya USG yapılmış olan hastalar dahil edildi. Cerrahi uygulanan hastaların kesin tanısı histopatolojik değerlendirme ile doğrulandı.
Bulgular: Akut apandisit ön tanısıyla 449 hasta (171 kız, 278 erkek) yatırıldı. Hastaların 288’ine (% 64) apendektomi uygulandı. Gözlem sonrası iyileşen 161 hasta (% 36) ise herhangi bir cerrahi uygulanmadan taburcu edildi. Apendektomi uygulanan hastaların histopatolojik tanıları 217 hastada (% 75,3) akut apandisit, 67 hastada (% 23,2) perfore apandisit ve 4 hastada (% 1,4) normal apendiks idi. Apendektomi yapılan hastaların PAS değeri anlamlı olarak yüksekti (p <0,001). Perfore apandisit tanısı alan hastalarda PAS değeri anlamlı olarak yüksek saptandı (p <0,05). Apandisit tanısında USG ve PAS’ın sırası ile duyarlılıkları % 81,59 ve % 82,98, seçicilikleri % 88,81 ve % 95,03 olarak bulundu. Ameliyat kararı verilirken doğru tanıya ulaşabilmek için USG de apandisit saptanan ve PAS 7 ve üzeri olan hastalar birlikte değerlendirildiğinde duyarlılık belirgin düştü (% 67,70), seçicilik ise arttı (% 100). USG pozitifliği veya yüksek riskli PAS değerlerinden yalnızca birinin olması durumunda duyarlılık % 32,29, seçicilik ise % 83,85 olarak saptandı.
Sonuç: PAS apandisit risk grubunun belirlenmesinde ve ek görüntüleme kullanımıyla ilgili karar vermede yararlı bir klinik rehberdir ve yüksek risk grubunda olan vakalarda ek görüntüleme yapılmadan bile tanıyı desteklemektedir. Bununla birlikte USG ve PAS değerleri arasında uyumsuzluk olan vakalarda negatif apendektomi oranını azaltmak için yakın gözlem, tekrarlayan fizik muayene ve gerekirse daha ileri görüntülemenin gerekli olduğuna inanıyoruz.

Keywords

Akut apandisit, Ultrasonografi, clinical score, children

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