Clinical predictors of acute appendicitis: in a Portuguese Paediatric Department

Abstract

Background and aims: Acute appendicitis (AA) is a challenging diagnosis in children because the symptoms can mimic other common causes of abdominal pain. Clinical scoring systems, as the Alvarado score (AS), are tools that can predict the risk of AA in children and evaluated signs, symptoms and blood exams.

Material and methods: A retrospective study of children between the ages of 4 and 18 years referred to the emergency department for abdominal pain and submitted to appendectomy. Two groups were defined: those with histology-confirmed appendicitis and those without appendicitis. Univariate analysis was performed with logistic regression to compute odds ratio [CIs]c for each possible predictor. Results: The univariate analysis showed that six of the variables were significant predictors of appendicitis. These were leucocytes (OR=3.2 [2-5.1]), neutrophil (OR=3.6 [1.3-10.1]), AS (continuous variable) (OR=1.6 [1.3-2.1]), ASa‰¥5 (OR=7.6 [2.9-19.9]), ASa‰¥6 (OR=6.9 [2.5-18.7]) and ASa‰¥7 (OR=5.6 [1.6-19.7]). All other recorded findings were not statistically significant. The negative appendectomy rate was estimated in 18%. It was an expected rate according to the information from other studies which reported a rate of 15-30%. Clinical findings when associated in a score, as the AS, can predict the risk of this clinical situation. Using three different cut-points (5, 6 and 7 points) of AS we observed positive and significantly associations, that remains even after adjustment for age and gender.

Conclusion: Individually high leucocytes and neutrophil counts are associated with AA. Clinical story, signs and symptoms, as well, laboratory exams when grouped on a score can predict the risk of AA.

Keywords

• acute appendicitis
• negative appendicitis rate
• Alvarado score

Kaynakça

1. von Suchodoletz H, Volzer H. [Distinctive features of appendicitis in childhood]. Zentralbl Chir 2008,133:554-558.
2. Brekke M, Eilertsen RK. Acute abdominal pain in general handling. A descriptive study. Scand J Prim Health Care 2009,27:137-140. diagnoses and
3. Ramarajan N, Krishnamoorthi R, Barth R, Ghanouni P, Mueller C, Dannenburg B, et al. An interdisciplinary initiative to reduce radiation exposure: evaluation of appendicitis in a pediatric emergency department with clinical assessment supported by a staged ultrasound and computed tomography 2009,16:1258-1265. Acad Emerg Med
4. Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med 2000,36:39-51.
5. Karabulut R, Sonmez K, Turkyilmaz Z, Demirogullari B, Ozen IO, Demirtola A, et al. Negative appendectomy experience in children. Ir J Med Sci 2011,180:55-58.
6. Douglas CD, Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography appendicitis, incorporating the Alvarado score. BMJ 2000,321:919-922. diagnosis of acute
7. Abdeldaim Y, Mahmood S, Mc Avinchey D. The Alvarado score as a tool for diagnosis of acute appendicitis. Ir Med J 2007,100:342.
8. Dado G, Anania G, Baccarani U, Marcotti E, Donini A, Risaliti A, et al. Application of a clinical score for the diagnosis of acute appendicitis in childhood: a retrospective analysis of 197 patients. J Pediatr Surg 2000,35:1320- 1322.

9. Khan I, ur Rehman A. Application of alvarado scoring system in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2005,17:41-44.
10. Impellizzeri P, Centonze A, Antonuccio P, Turiaco N, Cifala S, Basile M, et al. Utility of a scoring system in the diagnosis of acute appendicitis in pediatric age. A retrospective study. Minerva Chir 2002,57:341-346.
11. Sitter H, Hoffmann S, Hassan I, Zielke A. Diagnostic score in appendicitis. Validation of a diagnostic score (Eskelinen score) in patients in whom Langenbecks Arch Surg 2004,389:213-218.
12. Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002,37:877-881.
13. 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 2009,16:591-596.
14. Benjamin IS, Patel AG. Managing acute appendicitis. BMJ 2002,325:505-506.
15. Aarnio P, Salonen IS. Abdominal disorders arising from 71 Meckel's diverticulum. Ann Chir Gynaecol 2000,89:281-284.
16. Humes DJ, Simpson J. Acute appendicitis. BMJ 2006,333:530-534.
17. Jang SO, Kim BS, Moon DJ. [Application of alvarado score in patients with suspected appendicitis]. Korean J Gastroenterol 2008,52:27- 31.
18. Allister L, Bachur R, Glickman J, Horwitz B. Serum Markers in Acute Appendicitis. J Surg Res 2009.
19. Groselj-Grenc M, Repse S, Vidmar D, Derganc M. Clinical and laboratory methods in diagnosis of acute appendicitis in children. Croat Med J 2007,48:353-361.
20. Guraya SY, Al-Tuwaijri TA, Khairy GA, Murshid KR. Validity of leukocyte count to predict the severity of acute appendicitis. Saudi Med J 2005,26:1945-1947.
21. Agrawal CS, Adhikari S, Kumar M. Role of serum C-reactive protein and leukocyte count in the diagnosis of acute appendicitis in Nepalese population. Nepal Med Coll J 2008,10:11-15.
22. Kim E, Subhas G, Mittal VK, Golladay ES. C- reactive protein estimation does not improve accuracy in the diagnosis of acute appendicitis in pediatric patients. Int J Surg 2009,7:74-77.
23. Vignault F, Filiatrault D, Brandt ML, Garel L, Grignon A, Ouimet A. Acute appendicitis in children: 1990,176:501-504. with US. Radiology
24. Rettenbacher T, Hollerweger A, Macheiner P, Rettenbacher L, Tomaselli F, Schneider B, et al. Outer diameter of the vermiform appendix as a sign of acute appendicitis: evaluation at US. Radiology 2001,218:757-762.
25. Sivit CJ, Siegel MJ, Applegate KE, Newman KD. When appendicitis is suspected in children. Radiographics 2001,21:247-262; questionnaire 288-294.