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

Yıl 2022, Cilt: 5 Sayı: 3, 109 - 115, 30.09.2022

Ali Çelik Mehmet Altuntaş

https://doi.org/10.54996/anatolianjem.1058404

Cited By: 1

Öz

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.

Anahtar Kelimeler

Appendicitis, Alvarado score, appendix diameter, Creactive protein, lymphoid hyperplasia, negative appendectomy

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

Öz

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.

Anahtar Kelimeler

Akut apandisit, Alvarado skoru, apandiks çapı, C-reaktif protein, lenfoid hiperplazi, negatif apendektomi

Kaynakça

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