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Poličnik R, Hristov H, Lavriša Ž, Farkaš J, Smole Možina S, Koroušić Seljak B, Blaznik U, Gregorič M, Pravst I. Dietary Intake of Adolescents and Alignment with Recommendations for Healthy and Sustainable Diets: Results of the SI.Menu Study. Nutrients 2024; 16:1912. [PMID: 38931267 PMCID: PMC11206795 DOI: 10.3390/nu16121912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The SI.Menu study offers the latest data on the dietary intake of Slovenian adolescents aged 10 to 17. The purpose of this study is to comprehensively assess their dietary intake (energy and nutrients) and compare their food intakes with dietary recommendations for healthy and sustainable diets. METHODS The cross-sectional epidemiological dietary study SI.Menu (March 2017-April 2018) was conducted on a representative sample of Slovenian adolescents aged 10 to 17 years (n = 468) (230 males and 238 females). Data on dietary intake were gathered through two non-consecutive 24 h recalls, in line with the European Food Safety Authority (EFSA) EU Menu methodology. The repeated 24 h Dietary Recall (HDR) and Food Propensity Questionnaire (FPQ) data were combined to determine the usual intakes of nutrients and food groups, using the Multiple Source Method (MSM) program. RESULTS Adolescents' diets significantly deviate from dietary recommendations, lacking vegetables, milk and dairy products, nuts and seeds, legumes, and water, while containing excessive meat (especially red meat) and high-sugar foods. This results in insufficient intake of dietary fibre, and nutrients such as vitamin D, folate, and calcium. CONCLUSIONS The dietary intake of Slovenian adolescents does not meet healthy and sustainable diet recommendations. This study provides an important insight into the dietary habits of Slovenian adolescents that could be useful for future public health strategies.
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Affiliation(s)
- Rok Poličnik
- National Institute of Public Health, Trubarjeva Cesta 2, SI-1000 Ljubljana, Slovenia; (J.F.); (U.B.); (M.G.)
| | - Hristo Hristov
- Nutrition Institute, Koprska Ulica 98, SI-1000 Ljubljana, Slovenia; (H.H.); (Ž.L.); (I.P.)
| | - Živa Lavriša
- Nutrition Institute, Koprska Ulica 98, SI-1000 Ljubljana, Slovenia; (H.H.); (Ž.L.); (I.P.)
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva Ulica 101, SI-1000 Ljubljana, Slovenia;
| | - Jerneja Farkaš
- National Institute of Public Health, Trubarjeva Cesta 2, SI-1000 Ljubljana, Slovenia; (J.F.); (U.B.); (M.G.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000 Ljubljana, Slovenia
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakičan, Sl-9000 Murska Sobota, Slovenia
| | - Sonja Smole Možina
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva Ulica 101, SI-1000 Ljubljana, Slovenia;
| | - Barbara Koroušić Seljak
- Computer System Department, Jožef Stefan Institute, Jamova Cesta 39, SI-1000 Ljubljana, Slovenia;
| | - Urška Blaznik
- National Institute of Public Health, Trubarjeva Cesta 2, SI-1000 Ljubljana, Slovenia; (J.F.); (U.B.); (M.G.)
| | - Matej Gregorič
- National Institute of Public Health, Trubarjeva Cesta 2, SI-1000 Ljubljana, Slovenia; (J.F.); (U.B.); (M.G.)
| | - Igor Pravst
- Nutrition Institute, Koprska Ulica 98, SI-1000 Ljubljana, Slovenia; (H.H.); (Ž.L.); (I.P.)
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva Ulica 101, SI-1000 Ljubljana, Slovenia;
- VIST-Faculty of Applied Sciences, Gerbičeva Cesta 51A, SI-1000 Ljubljana, Slovenia
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Sogbodjor LA, Razavi C, Williams K, Selman A, Pereira SMP, Davenport M, Moonesinghe SR. Risk factors for complications after emergency surgery for paediatric appendicitis: a national prospective observational cohort study. Anaesthesia 2024; 79:524-534. [PMID: 38387160 DOI: 10.1111/anae.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 02/24/2024]
Abstract
Appendicectomy is a common procedure in children with a low risk of mortality, however, complication rates and risk factors are largely unknown. This study aimed to characterise the incidence and epidemiology of postoperative complications in children undergoing appendicectomy in the UK. This multicentre prospective observational cohort study, which included children aged 1-16 y who underwent surgery for suspected appendicitis, was conducted between November 2019 and January 2022. The primary outcome was 30-day postoperative morbidity. Data collected included: patient characteristics; comorbidities; and physiological status. Multivariable regression analysis was used to identify independent risk factors for poor outcomes. Data from 2799 children recruited from 80 hospitals were analysed, of which 185 (7%) developed postoperative complications. Children from black and 'other' minority ethnic groups were at significantly higher risk of poor outcomes: OR (95%CI) 4.13 (1.87-9.08), p < 0.001 and 2.08 (1.12-3.87), p = 0.021, respectively. This finding was independent of socio-economic status and type of appendicitis found on histology. Other risk factors for complications included: ASA physical status ≥ 3 (OR (95%CI) 4.05 (1.70-9.67), p = 0.002); raised C-reactive protein (OR 95%CI 1.01 (1.00-1.01), p < 0.001); pyrexia (OR (95%CI) 1.77(1.20-2.63), p = 0.004); and peri-operative oxygen supplementation (OR (95%CI) 4.20 (1.44-12.24), p = 0.009). In the UK NHS, which is a universally accessible healthcare system, ethnicity, but not socio-economic status, was associated with an increased risk of postoperative complications in children having surgery for acute appendicitis. Further evaluations and interventions are required to address this health inequality in keeping with NHS and international priorities.
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Affiliation(s)
- L A Sogbodjor
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Centre for Research and Improvement, Royal College of Anaesthetists, London, UK
| | - C Razavi
- Centre for Research and Improvement, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Williams
- Centre for Research and Improvement, Royal College of Anaesthetists, London, UK
| | - A Selman
- Department of Anaesthesia, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S M Pinto Pereira
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK
| | - M Davenport
- Department of Paediatric Surgery, King's College London NHS Foundation Trust, London, UK
| | - S R Moonesinghe
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK
- Central London National Institute for Health Research Patient Safety Research Collaboration, London, UK
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Hebballi NB, DeSantis S, Brown EL, Markham C, Tsao K. Body Mass Index Is Associated With Pediatric Complicated Appendicitis and Postoperative Complications. Ann Surg 2023; 278:337-346. [PMID: 37317845 DOI: 10.1097/sla.0000000000005965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the association between body mass index (BMI) spectrum and complicated appendicitis and postoperative complications in pediatric patients. BACKGROUND Despite the impact of being overweight and obese on complicated appendicitis and postoperative complications, the implications of being underweight are unknown. METHODS A retrospective review of pediatric patients was conducted using NSQIP (2016-2020) data. Patient's BMI percentiles were categorized into underweight, normal weight, overweight, and obese. The 30-day postoperative complications were grouped into minor, major, and any. Univariate and multivariable logistic regression models were performed. RESULTS Among 23,153 patients, the odds of complicated appendicitis were 66% higher in underweight patients [odds ratio (OR)=1.66; 95% CI: 1.06-2.59] and 28% lower in overweight patients (OR=0.72; 95% CI: 0.54-0.95) than normal-weight patients. A statistically significant interaction between overweight and preoperative white blood cells (WBCs) increased the odds of complicated appendicitis (OR=1.02; 95% CI: 1.00-1.03). Compared to normal-weight patients, obese patients had 52% higher odds of minor (OR=1.52; 95% CI: 1.18-1.96) and underweight patients had 3 times the odds of major (OR=2.77; 95% CI: 1.22-6.27) and any (OR=2.82; 95% CI: 1.31-6.10) complications. A statistically significant interaction between underweight and preoperative WBC lowered the odds of major (OR=0.94; 95% CI: 0.89-0.99) and any complications (OR=0.94; 95% CI: 0.89-0.98). CONCLUSIONS Underweight, overweight, and interaction between overweight and preoperative WBC were associated with complicated appendicitis. Obesity, underweight, and interaction between underweight and preoperative WBC were associated with minor, major, and any complications. Thus, personalized clinical pathways and parental education targeting at-risk patients can minimize postoperative complications.
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Affiliation(s)
- Nutan B Hebballi
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
| | - Stacia DeSantis
- Department of Biostatistics and Data Science, The University of Texas School of Public Health, Houston, Texas
| | - Eric L Brown
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas
| | - Christine Markham
- Department of Health Promotion & Behavioral Sciences The University of Texas School of Public Health, Houston, Texas
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
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Zavras N, Vaou N, Zouganeli S, Kasti A, Dimitrios P, Vaos G. The Impact of Obesity on Perioperative Outcomes for Children Undergoing Appendectomy for Acute Appendicitis: A Systematic Review. J Clin Med 2023; 12:4811. [PMID: 37510927 PMCID: PMC10381702 DOI: 10.3390/jcm12144811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Today, the prevalence of obesity in the pediatric population has increased dramatically. Acute appendicitis (AA) is the most common surgical condition among pediatric patients. We aimed to investigate the impact of obesity on postoperative outcomes in terms of operative time (OT), length of stay (LOS), surgical site infection (SSI), overall complications, adverse events, and mortality in children undergoing appendectomy for acute appendicitis. An extensive search of the literature in PubMed and Google Scholar was conducted to evaluate the outcomes of normal weight (NW), overweight (OW), and obese (OB) children who underwent appendectomy. Although no statistically significant differences were noted in perioperative outcomes and overall postoperative complications between OW/OB and NW children in the majority of the included studies, prolonged OT and LOS and SSI were found in some studies. Moreover, no differences in terms of readmissions and ED visits were recorded. We conclude that the impact of obesity on postoperative outcomes for children undergoing appendectomy for AA is unclear, and, therefore, no safe conclusions can be drawn with the currently available data. Due to the lack of high-quality studies, further research is required to optimize the surgical approach and prevent unwarranted complications.
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Affiliation(s)
- Nikolaos Zavras
- Department of Pediatric Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece
| | - Natalia Vaou
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Sofia Zouganeli
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Arezina Kasti
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | | | - George Vaos
- Department of Pediatric Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece
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Paul ME, Wallace JG, Coakley BA. An Assessment of the Relationship Between BMI and Children Undergoing Surgical Procedures: A Retrospective Study. Child Obes 2023; 19:249-257. [PMID: 35776521 PMCID: PMC10398724 DOI: 10.1089/chi.2022.0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: While multiple studies have documented that obesity increases the risk of operative complications among adults, little data exist on how obesity impacts surgical outcomes among children. We aimed to determine if children with obesity have different postoperative outcomes than their peers. Methods: A retrospective chart review was conducted of 875 patients aged between 2 and 18 years who underwent surgery during 2018. Patients were stratified, based on BMI percentile for age, as having less than healthy weight (<5th percentile), healthy weight (5th-84th percentile), excess weight (85th-94th percentile), or obesity (≥95th percentile). Demographic information and data on medical comorbidities and postoperative complications were collected. All analyses were conducted using chi-square or Kruskal-Wallis testing. Results: Eighty-two patients were excluded due to lack of BMI data and 56 were excluded as they had below healthy weight. Of the remaining 737 patients, 475 (64.4%) had healthy weight, 124 (16.8%) had excess weight, and 138 (18.70%) had obesity. Children with obesity had more tonsillectomy/adenoidectomy (p < 0.01) and vascular access (p = 0.04) procedures compared with peers. Additionally, patients with obesity were more likely to have a pre-existing history of liver disease (p < 0.01) and more frequently developed postoperative wound dehiscence (p < 0.01). No other complications occurred more frequently among children with obesity. Conclusions: Children with obesity required more tonsillectomy/adenoidectomy and vascular access procedures. Wound dehiscence was the only complication that was associated with obesity. This suggests that children with obesity are not inherently more prone to experience surgical complications and therefore elective procedures should likely not be deferred until preoperative weight loss is achieved.
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Affiliation(s)
- Megan E. Paul
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Brian A. Coakley
- Departments of Pediatrics and Surgery, Mount Sinai Health System, New York, NY, USA
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Maret-Ouda J, Ström JC, Roelstraete B, Emilsson L, Joshi AD, Khalili H, Ludvigsson JF. Appendectomy and Future Risk of Microscopic Colitis: A Population-Based Case-Control Study in Sweden. Clin Gastroenterol Hepatol 2023; 21:467-475.e2. [PMID: 35716902 DOI: 10.1016/j.cgh.2022.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Microscopic colitis (MC) is an inflammatory bowel disease and a common cause of chronic diarrhea. Appendectomy has been suggested to have immunomodulating effects in the colon, influencing the risk of gastrointestinal disease. The relationship between appendectomy and MC has only been sparsely studied. METHODS This was a case-control study based on the nationwide ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort, consisting of histopathological examinations in Sweden, linked to national registers. Patients with MC were matched to population controls by age, sex, calendar year of biopsy, and county of residence. Data on antecedent appendectomy and comorbidities were retrieved from the Patient Register. Unconditional logistic regression models were conducted presenting odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for country of birth and matching factors. Further subanalyses were made based on MC subtypes (lymphocytic colitis and collagenous colitis), follow-up time postappendectomy and severity of appendicitis. RESULTS The study included 14,520 cases of MC and 69,491 controls, among these 7.6% (n = 1103) and 5.1% (n = 3510), respectively, had a previous appendectomy ≥1 year prior to MC or matching date. Patients with a previous appendectomy had an increased risk of MC in total (OR, 1.50; 95% CI, 1.40-1.61) and per the collagenous colitis subtype (OR, 1.67; 95% CI, 1.48-1.88) or lymphocytic colitis subtype (OR, 1.42; 95% CI, 1.30-1.55). The risk remained elevated throughout follow-up, and the highest risk was observed in noncomplicated appendicitis. CONCLUSIONS This nationwide case-control study found a modestly increased risk of developing MC following appendectomy.
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Affiliation(s)
- John Maret-Ouda
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
| | - Jennifer C Ström
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Bjorn Roelstraete
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Louise Emilsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Science, University of Örebro, Örebro, Sweden; Värmlands Nysäter Health Care Center and Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Amit D Joshi
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussets
| | - Hamed Khalili
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachussets; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachussets
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
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Perez NP, Ahmad H, Alemayehu H, Newman EA, Reyes-Ferral C. The impact of social determinants of health on the overall wellbeing of children: A review for the pediatric surgeon. J Pediatr Surg 2022; 57:587-597. [PMID: 34893308 DOI: 10.1016/j.jpedsurg.2021.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 01/10/2023]
Abstract
Disparities in health care access, quality, and outcomes for pediatric patients, and their relationship to race and socioeconomic status (SES) have been extensively documented. The underlying causes behind such disparities have been less carefully studied, as clinicians and researchers often fail to look past immutable features such as race, into modifiable factors like social determinants of health (SDOH). A child's environment affects their patterns of social engagement, sense of security, and overall well-being. Resources such as affordable housing, access to education, public safety, and availability of healthy foods and safe play spaces impact and enhance quality of life, and have significant influence on both health and health care outcomes. These upstream indicators are often unrecognized or misidentified as health concerns. Few pediatric surgery publications discuss SDOH and their effects on children. This paper aims to introduce the five domains of SDOH (economic stability, education, social and community context, health and healthcare, and neighborhood and built environment) along with strategies to identify and address needs in these domains from a provider, hospital, and health system's perspective. It is anticipated that this information will serve as a foundation for pediatric surgeons to understand and develop processes that ameliorate disparities related to SDOH and improve surgical outcomes and the well-being of all children.
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Affiliation(s)
- Numa P Perez
- Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St GRB-425, Boston, MA 02114, United States.
| | - Hira Ahmad
- Department of Surgery, Nationwide Children's Hospital, Columbus, The Ohio State University College of Medicine, OH, United States
| | - Hanna Alemayehu
- Department of Surgery, Children's and Women's Hospital, University of South Alabama Health System, Mobile, AL, United States
| | - Erika A Newman
- Department of Surgery, CS Mott Children's Hospital, The University of Michigan, Ann Arbor, MI, United States
| | - Cynthia Reyes-Ferral
- Department of Surgery, St. Joseph's Children's Hospital, Tampa, FL, United States
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Salim J, Agustina F, Maker JJR. Pre-Coronavirus Disease 2019 Pediatric Acute Appendicitis: Risk Factors Model and Diagnosis Modality in a Developing Low-Income Country. Pediatr Gastroenterol Hepatol Nutr 2022; 25:30-40. [PMID: 35087731 PMCID: PMC8762600 DOI: 10.5223/pghn.2022.25.1.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Pediatric acute appendicitis has a stable incidence rate in Western countries with an annual change of -0.36%. However, a sharp increase was observed in the Asian region. The Indonesian Health Department reveals appendicitis as the fourth most infectious disease, with more than 64,000 patients annually. Hence, there is an urgent need to identify and evaluate the risk factors and diagnostic modalities for accurate diagnosis and early treatment. This study also clarifies the usage of pediatric appendicitis score (PAS) for children <5 years of age. METHODS The current study employed a cross-sectional design with purposive sampling through demographic and PAS questionnaires with ultrasound sonography (USG) results. The analysis was performed using the chi-square and Mann-Whitney tests and logistic regression. RESULTS This study included 21 qualified patients with an average age of 6.76±4.679 years, weighing 21.72±10.437 kg, and who had been hospitalized for 4.24±1.513 days in Siloam Teaching Hospital. Compared to the surgical gold standard, PAS and USG have moderate sensitivity and specificity. Bodyweight and stay duration were significant for appendicitis (p<0.05); however, all were confounders in the multivariate regression analysis. Incidentally, a risk prediction model was generated with an area under the curve of 72.73%, sensitivity of 100.0%, specificity of 54.5%, and a cut-off value of 151. CONCLUSION PAS outperforms USG in the sensitivity of diagnosing appendicitis, whereas USG outperforms PAS in terms of specificity. This study demonstrates the use of PAS in children under 5 years old. Meanwhile, no risk factors were significant in multivariate pediatric acute appendicitis risk factors.
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Affiliation(s)
- Jonathan Salim
- Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
| | - Flora Agustina
- Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.,Pediatric Surgery Department, Siloam Hospitals Lippo Village, Tangerang, Indonesia
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Determining the impact of body mass index on ultrasound accuracy for diagnosing appendicitis: Is it less useful in obese children? J Pediatr Surg 2021; 56:2010-2015. [PMID: 33573804 DOI: 10.1016/j.jpedsurg.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ultrasonography (US) is the preferred imaging for suspected pediatric appendicitis. We hypothesize that children with elevated Body-Mass-Index-for-age percentile (BMIP) may be more likely to have an inaccurate or equivocal (IE) US. METHODS After IRB approval, a four-year review was performed on pediatric patients evaluated for appendicitis by US. The CDC BMIP Calculator was used. IE subgroups were analyzed together for comparison against the accurate group. RESULTS 1059 patients were included: median age 11.3 years (IQR: 8.2, 14.6), 506 (47.8%) males. Median BMIP was 65.9 (IQR: 33.9, 89.6). US accurately diagnosed 857 (80.9%), incorrectly diagnosed 76 (7.2%), 126 (11.9%) were equivocal. Overall sensitivity was 0.85, specificity 0.96, PPV 0.93 and NPV 0.91. Obese children (BMIP ≥95%), had higher odds of IE US (OR: 1.86, 95% CI: 1.28, 2.70; p = 0.001). When analyzed by sex, risk increased in obese males (OR: 2.55, 95% CI:1.53, 4.24; p = 0.0003) but normalized in obese females (OR: 1.30, 95% CI:0.74, 2.28; p = 0.35). CONCLUSIONS An elevated BMIP may increase difficulty in visualizing the appendix, resulting in inaccurate or equivocal findings. This risk is seen specifically in obese males. If US findings do not correlate with clinical assessment in obese children with abdominal pain, further evaluation may be warranted.
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Leung B, Madhuripan N, Bittner K, Rastegar V, Banever G, Tashjian D, Moriarty K, Polansky S, Tirabassi M. Clinical outcomes following identification of tip appendicitis on ultrasonography and CT scan. J Pediatr Surg 2019; 54:108-111. [PMID: 30401497 DOI: 10.1016/j.jpedsurg.2018.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE With recent improvements in imaging technology, subtler variations in the anatomy of the appendix can be appreciated. We hypothesized that radiographic findings of tip appendicitis may not correlate strongly with a pathologic diagnosis of appendicitis. METHODS Our radiology database was searched for reports of a diagnosis of tip appendicitis between January 2013 and June 2017 for patients between the ages of 2 and 17. Retrospective chart review was performed for demographic and clinical data, including outcomes. For patients managed operatively, the pathology results were reviewed for evidence of acute appendicitis. Patients managed nonoperatively and those with negative pathology were considered to not have appendicitis. RESULTS Fifty-five patients met inclusion criteria (31 boys and 24 girls); 46/55 patients with tip appendicitis on imaging ultimately did not have appendicitis. Twenty-one patients underwent appendectomy, and 9/21 had pathologic evidence of appendicitis. One patient had a ruptured appendix. No other pathology was identified in the negative appendectomies. Two patients managed nonoperatively required readmission, but not secondary to missed diagnosis of appendicitis. CONCLUSIONS Ultrasound and CT findings of tip appendicitis may not accurately associate with a final diagnosis of acute appendicitis. Clinical judgment should ultimately dictate appropriate initial management, follow-up tests, and imaging. TYPE OF STUDY Diagnostic Study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Briana Leung
- Department of Surgery, Pediatric Surgery Division, Baystate Health, Springfield, MA.
| | | | - Katharine Bittner
- Department of Surgery, Pediatric Surgery Division, Baystate Health, Springfield, MA
| | - Vida Rastegar
- Epidemiology and Biostatistics Research Core, Baystate Health, Springfield, MA
| | - Gregory Banever
- Department of Surgery, Pediatric Surgery Division, Baystate Health, Springfield, MA
| | - David Tashjian
- Department of Surgery, Pediatric Surgery Division, Baystate Health, Springfield, MA
| | - Kevin Moriarty
- Department of Surgery, Pediatric Surgery Division, Baystate Health, Springfield, MA
| | | | - Michael Tirabassi
- Department of Surgery, Pediatric Surgery Division, Baystate Health, Springfield, MA
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