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Abdella Bahta NN, Zeinert P, Rosenberg J, Fonnes S. The Alvarado Score Is the Most Impactful Diagnostic Tool for Appendicitis: A Bibliometric Analysis. J Surg Res 2023; 291:557-566. [PMID: 37540973 DOI: 10.1016/j.jss.2023.06.037] [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: 05/07/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION The objective of this bibliometric analysis was to investigate the citation pattern of studies that have developed a diagnostic tool to diagnose appendicitis. METHODS We investigated characteristics of citations, publication frequency, evolution of citations, and fluctuation of previously highly cited studies. We analyzed which studies had been cited in the method section and identified impactful studies in this research field by a network visualization. We analyzed the differences in citations between diagnostic tools requiring a doctor to be present against the diagnostic tools not requiring doctors to be present, English language studies against non-English studies, and identified diagnostic tools targeting children. RESULTS There was an upward trend in publications in this research field, and between 1999-2021 the Alvarado score has been cited the most. In general, there was a high fluctuation, and 40 studies had been cited in the methods sections. There were significant differences in studies regarding diagnostic tools written in English compared to non-English studies, with more citations in the English-language studies. Furthermore, 22 studies had children as the target population. CONCLUSIONS The Alvarado score was the highest cited study since 1999, with 1086 citations, making it the most impactful study in this research field of diagnostic tools to diagnose appendicitis. Due to the diversity of target populations and settings for which diagnostic tools are developed, there is a need to expand research on diagnostic tools for appendicitis.
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Affiliation(s)
- Nadir Noureldin Abdella Bahta
- Department of Surgery, Herlev and Gentofte Hospital, Center for Perioperative Optimization, University of Copenhagen, Herlev, Denmark.
| | | | - Jacob Rosenberg
- Department of Surgery, Herlev and Gentofte Hospital, Center for Perioperative Optimization, University of Copenhagen, Herlev, Denmark
| | - Siv Fonnes
- Department of Surgery, Herlev and Gentofte Hospital, Center for Perioperative Optimization, University of Copenhagen, Herlev, Denmark
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Raeisi R, Azizi M, Amiri J, Ghorbanpour M, Esna-Ashari F. Accuracy Evaluation of Pediatric Appendicitis Scoring (PAS) Method in Differentiating Nonspecific Abdominal Pain from Appendicitis. Int J Prev Med 2023; 14:40. [PMID: 37351062 PMCID: PMC10284213 DOI: 10.4103/ijpvm.ijpvm_539_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 10/27/2022] [Indexed: 06/24/2023] Open
Abstract
Background This study aimed at evaluating the accuracy of the pediatric appendicitis scoring method in differentiating nonspecific abdominal pain (NSAP) from appendicitis. Methods This cross-sectional study was conducted on 391 children who were hospitalized in the emergency ward due to acute abdominal pain suspected of appendicitis . Pediatric Appendicitis Score (PAS), C-reactive protein (CRP), and appendicitis pathology results of patients undergoing surgery were recorded. Results The results showed that the no significant difference was found among patients in the three experimental groups (appendicitis, specific abdominal pain except appendicitis, and NSAP) with respect to temperature (p = 0.212), but the other variables were significantly different. Findings showed that high CRP frequency, pain migration to right lower quadrant (RLQ), tenderness in right iliac fossa (RIF), anorexia, leukocytosis, high neutrophil, and mean tenderness in RLQ in the appendicitis group were higher than those in the other two groups (p = 0.001). The PAS questionnaire can also be used as a reliable questionnaire with appropriate sensitivity (0.929) and specificity (0.993), and this questionnaire along with detailed clinical examinations could reduce the rate of negative appendectomy to less than 1%. Conclusions This study showed high accuracy of PAS in diagnosing children with appendicitis and differentiating appendicitis from cases of NSAP and specific abdominal pain other than appendicitis. The PAS system could also significantly reduce cases of negative appendicitis. Although high CRP had an excellent ability to diagnose appendicitis, its accuracy was lower than PAS.
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Affiliation(s)
- Roya Raeisi
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mona Azizi
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalaleddin Amiri
- Department of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Farzaneh Esna-Ashari
- Community Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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3
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Many diagnostic tools for appendicitis: a scoping review. Surg Endosc 2023; 37:3419-3429. [PMID: 36735050 DOI: 10.1007/s00464-023-09890-2] [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: 08/08/2022] [Accepted: 01/15/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to provide an overview of all diagnostic tools developed to diagnose appendicitis with their reported accuracy and to further characterize these including their need for diagnostic equipment. METHODS This scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews and a protocol was registered at Open Science Framework. We performed a systematic literature search in PubMed, Embase, China National Knowledge Infrastructure, Índice Bibliográfico Espanhol de Ciências da Saúde, and Latin American and Caribbean Health Sciences Literature. We included original articles of all languages with the purpose to derive an accessible diagnostic tool. We extracted data regarding study- and diagnostic tool characteristics, and the accuracy of each diagnostic tool. RESULTS The search led to 6419 records, where 74 studies were included, yielding 82 diagnostic tools reported in seven different languages. Among these tools, 35% included patient characteristics, 85% symptoms, 93% physical examinations, 37% vital signs, 78% laboratory values, and 16% imaging. Among the diagnostic tools, 35% relied on a medical doctor/surgeon with access to a laboratory, and six diagnostic tools did not require a bedside medical doctor/surgeon. The median positive predictive value, negative predictive value, sensitivity, and specificity across diagnostic tools were 91%, 94%, 89%, and 86%, respectively. CONCLUSIONS We identified 82 diagnostic tools that most frequently were based on symptoms and physical examinations. Most diagnostic tools relied on a medical doctor/surgeon with access to laboratory values. The accuracy was high across the diagnostic tools.
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Alemrajabi M, Zadeh MK, Davani SZN, Nasiri F, Riazi S, Nasiri M. Comparison of Appendicitis Inflammatory Response (AIR) and Lintula scoring systems in diagnosing acute appendicitis among children. J Med Life 2022; 15:443-447. [PMID: 35646183 PMCID: PMC9126464 DOI: 10.25122/jml-2021-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 11/28/2021] [Indexed: 11/18/2022] Open
Abstract
Appendectomy is still the best treatment for acute appendicitis in pediatric patients. Given the problems of early and immediate diagnosis of acute appendicitis, defining the best diagnostic protocol for this condition is of utmost importance. Different diagnostic methods, such as Lintula and appendicitis inflammatory response (AIR) scoring systems, are used for this purpose. This study aims to compare Lintula and AIR scoring systems among children with suspicion of acute appendicitis regarding their postoperative outcomes. During two years, a prospective multicentric study was carried out in the selected hospitals of Iran. Pediatric patients admitted with the diagnosis of acute appendicitis were enrolled in the study. Before decision making, each patient's score was calculated according to two appendicitis scoring systems of Lintula and AIR. The clinical outcomes and diagnosis of patients were then compared to the results of each scoring system. For those patients who were a candidate to undergo surgery, the final diagnosis of acute appendicitis was made by histopathology. Patients were divided into high and low-risk groups according to scoring systems outcomes. Among the patients with lower scoring for appendicitis, the AIR scoring system had a sensitivity and specificity of 95%, which was more promising than that of the Lintula system (19%); however, the specificity was comparable between the two models (74% vs. 83%). For patients at higher risk of acute appendicitis, although the AIR scoring systems did not provide reliable results (sen: 45% and spe: 25%), the Lintula scoring showed remarkable sensitivity (87%), accompanied by a high diagnostic accuracy (87%). AIR and Lintula scoring systems are not accurate models to predict the risk of acute appendicitis among children; therefore, they can serve as an adjacent modality for other diagnostic methods.
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Affiliation(s)
- Mehdi Alemrajabi
- Department of Colorectal Surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Khavanin Zadeh
- Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sam Zeraatian-Nejad Davani
- Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fazil Nasiri
- Department of Obstetrics & Gynecology, Istanbul University, Istanbul, Turkey
| | - Sevda Riazi
- South Health Center of Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nasiri
- Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran,Corresponding Author: Mohammad Nasiri, Department of General Surgery, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. E-mail:
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Postuma R, Vajcner G, Postuma RB, Keijzer R. Bedside pressure-pain threshold algometry to measure abdominal tenderness in childhood appendicitis: A retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vaziri M, Nafissi N, Jahangiri F, Nasiri M. Comparison of the appendicitis inflammatory response and Alvarado scoring systems in the diagnosis of acute appendicitis in children. J Med Life 2021; 14:75-80. [PMID: 33767789 PMCID: PMC7982267 DOI: 10.25122/jml-2020-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Our objective was to compare the diagnostic accuracy of Alvarado and appendicitis inflammatory response (AIR) scoring systems among children suspected of acute appendicitis concerning their postoperative outcomes. During a two-year period, a prospective multicentric study was carried in the selected hospitals of Iran. All children who were admitted with the diagnosis of acute appendicitis were enrolled in the study. However, patients suffering from generalized peritonitis or those who had a history of abdominal surgery were excluded. Before decision-making, each patient’s score according to two appendicitis scoring systems was calculated. The clinical outcomes and diagnosis of patients were then compared to the results of each scoring system. For those patients who were a candidate for surgery, the final diagnosis of acute appendicitis was made by histopathology. Patients were divided into a high- and low-risk group according to scoring systems outcomes. Among the patients with a low score for appendicitis, the AIR scoring system had a sensitivity and specificity of 95% and 74%, respectively, which was more promising in comparison to that of the Alvarado system (90% and 70%, respectively). Regarding the patients at higher risk of acute appendicitis, none of the scoring systems provided reliable results since both systems showed sensitivity and specificity of less than 50%, which was not sufficient to distinguish patients who are a candidate for surgery. AIR and Alvarado scoring systems are not accurate models to predict the risk of acute appendicitis among children; however, the AIR system could be used as a reliable material to rule out the acute appendicitis diagnosis.
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Affiliation(s)
- Mohammad Vaziri
- Department of Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Nafissi
- Department of Breast Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Jahangiri
- Department of Pediatric Surgery, Ali-Asghar children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nasiri
- Department of Surgery, Hazrat-e Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Tzortzopoulou AK, Giamarelou P, Tsolia M, Spyridis N, Vakaki M, Passalides A, Zavras N. The Jumping Up (J-Up) Test: Making the Diagnosis of Acute Appendicitis Easier in Children. Glob Pediatr Health 2019; 6:2333794X19884824. [PMID: 31763374 PMCID: PMC6851606 DOI: 10.1177/2333794x19884824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/16/2019] [Indexed: 12/05/2022] Open
Abstract
We evaluate a new clinical test, jumping up (J-up) test, to diagnose easier
appendicitis in children. A total of 407 patients, aged 5 to16 years, with right
lower quadrant abdominal pain were asked to jump rising both hands and trying to
reach a toy hanging down from the ceiling of the examination room. Bieri
pediatric Face Pain Scale was used for recording the pain response. J-up test
has sensitivity of 87% and specificity of 70%. A positive J-up test combined
with leukocytosis (white blood cells count >12 000/mm3),
neutrophilia >75%, neutrophil/lymphocyte >2, and C-reactive protein >5
mg/dL, achieved a posttest probability of appendicitis of 85%. A negative J-up
test combined with the aforementioned blood markers within normal range had a
posttest probability for non-appendicitis of 92%. J-up test is a reliable
clinical test, which could be used even by an inexperienced doctor. Combined
with classical blood markers, it could successfully predict which child is in
urgent need or not of surgery.
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Affiliation(s)
- Adelais K Tzortzopoulou
- "P & A Kyriakou" Children's Hospital, Athens, Greece.,National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mariza Tsolia
- "P & A Kyriakou" Children's Hospital, Athens, Greece
| | | | - Marina Vakaki
- "P & A Kyriakou" Children's Hospital, Athens, Greece
| | | | - Nikolaos Zavras
- National and Kapodistrian University of Athens, Athens, Greece
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van Amstel P, Gorter RR, van der Lee JH, Cense HA, Bakx R, Heij HA. Ruling out Appendicitis in Children: Can We Use Clinical Prediction Rules? J Gastrointest Surg 2019; 23:2027-2048. [PMID: 30374814 PMCID: PMC6773677 DOI: 10.1007/s11605-018-3997-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 09/23/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE To identify available clinical prediction rules (CPRs) and investigate their ability to rule out appendicitis in children presenting with abdominal pain at the emergency department, and accordingly select CPRs that could be useful in a future prospective cohort study. METHODS A literature search was conducted to identify available CPRs. These were subsequently tested in a historical cohort from a general teaching hospital, comprising all children (< 18 years) that visited the emergency department between 2012 and 2015 with abdominal pain. Data were extracted from the electronic patient files and scores of the identified CPRs were calculated for each patient. The negative likelihood ratios were only calculated for those CPRs that could be calculated for at least 50% of patients. RESULTS Twelve CPRs were tested in a cohort of 291 patients, of whom 87 (29.9%) suffered from acute appendicitis. The Ohmann score, Alvarado score, modified Alvarado score, Pediatric Appendicitis score, Low-Risk Appendicitis Rule Refinement, Christian score, and Low Risk Appendicitis Rule had a negative likelihood ratio < 0.1. The Modified Alvarado Scoring System and Lintula score had a negative likelihood ratio > 0.1. Three CPRs were excluded because the score could not be calculated for at least 50% of patients. CONCLUSION This study identified seven CPRs that could be used in a prospective cohort study to compare their ability to rule out appendicitis in children and investigate if clinical monitoring and re-evaluation instead of performing additional investigations (i.e., ultrasound) is a safe treatment strategy in case there is low suspicion of appendicitis.
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Affiliation(s)
- Paul van Amstel
- Paediatric Surgical Centre of Amsterdam, Emma Children’s Hospital Amsterdam University Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Ramon R. Gorter
- Paediatric Surgical Centre of Amsterdam, Emma Children’s Hospital Amsterdam University Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Johanna H. van der Lee
- Division Woman and Child, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Huib A. Cense
- Division of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, The Netherlands
| | - Roel Bakx
- Paediatric Surgical Centre of Amsterdam, Emma Children’s Hospital Amsterdam University Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Hugo A. Heij
- Paediatric Surgical Centre of Amsterdam, Emma Children’s Hospital Amsterdam University Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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Dokumcu Z, Toker Kurtmen B, Divarci E, Tamay PB, Kose T, Sezak M, Ozok G, Ergun O, Celik A. Retrospective Multivariate Analysis of Data from Children with Suspected Appendicitis: A New Tool for Diagnosis. Emerg Med Int 2018; 2018:4810730. [PMID: 30275991 PMCID: PMC6157147 DOI: 10.1155/2018/4810730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/17/2018] [Accepted: 08/12/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Decision-making for management may sometimes be difficult in acute appendicitis (AA). Various diagnostic scoring systems exist, but their sensitivity and specificity rates are far from ideal. In this study, the determination of the predictors and the effect of radiological data and developing a new scoring system were aimed. METHODS Medical records of patients who were hospitalized for AA between February 2012 and October 2016 were retrospectively reviewed. All data were compared between patients with and without appendicitis. The multivariate analysis was performed to define significant variables and to examine the sensitivity and specificity of each group of predictors including radiological data. A new scoring system (NSS) was formed and was compared with two existing scoring systems: pediatric appendicitis score (PAS) and Alvarado scoring system (ASS) by using reclassification method. RESULTS Negative appendectomy rate was 11.3%. Statistical analysis identified 21 independently significant variables. The heel drop test had the highest odds ratio. Sensitivity and specificity rates of clinical predictors were 84.6% and 94.8%, respectively. Radiological predictors increased the sensitivity rate to 86.9%. Sensitivity and specificity rates for PAS, ASS, and NSS were 86.8% and 83.9%, 84.7% and 81.6%, and 96.8% and 95.6%, respectively. The "re-assessed negative appendectomy rate" was 6.2% and false positive results were remarkably more common in patients with duration of symptoms less than 24 hours. CONCLUSION Radiological data improves the accuracy of diagnosis. Containing detailed clinical and radiological data, NSS performs superiorly to PAS and ASS, regarding sensitivity and specificity without any age limitation. The efficiency of NSS may be enhanced by determining different predictors for different phases of the inflammatory process.
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Affiliation(s)
- Zafer Dokumcu
- Ege University Faculty of Medicine Department of Pediatric Surgery, Izmir, Turkey
| | - Bade Toker Kurtmen
- Ege University Faculty of Medicine Department of Pediatric Surgery, Izmir, Turkey
| | - Emre Divarci
- Ege University Faculty of Medicine Department of Pediatric Surgery, Izmir, Turkey
| | - Petek Bayindir Tamay
- Ege University Faculty of Medicine Department of Radiology, Division of Pediatric Radiology, Izmir, Turkey
| | - Timur Kose
- Ege University Faculty of Medicine Department of Biostatistics and Medical Informatics, Izmir, Turkey
| | - Murat Sezak
- Ege University Faculty of Medicine Department of Pathology, Izmir, Turkey
| | - Geylani Ozok
- Ege University Faculty of Medicine Department of Pediatric Surgery, Izmir, Turkey
| | - Orkan Ergun
- Ege University Faculty of Medicine Department of Pediatric Surgery, Izmir, Turkey
| | - Ahmet Celik
- Ege University Faculty of Medicine Department of Pediatric Surgery, Izmir, Turkey
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Kharbanda AB, Vazquez-Benitez G, Ballard DW, Vinson DR, Chettipally UK, Kene MV, Dehmer SP, Bachur RG, Dayan PS, Kuppermann N, O’Connor PJ, Kharbanda EO. Development and Validation of a Novel Pediatric Appendicitis Risk Calculator (pARC). Pediatrics 2018; 141:e20172699. [PMID: 29535251 PMCID: PMC5869337 DOI: 10.1542/peds.2017-2699] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We sought to develop and validate a clinical calculator that can be used to quantify risk for appendicitis on a continuous scale for patients with acute abdominal pain. METHODS The pediatric appendicitis risk calculator (pARC) was developed and validated through secondary analyses of 3 distinct cohorts. The derivation sample included visits to 9 pediatric emergency departments between March 2009 and April 2010. The validation sample included visits to a single pediatric emergency department from 2003 to 2004 and 2013 to 2015. Variables evaluated were as follows: age, sex, temperature, nausea and/or vomiting, pain duration, pain location, pain with walking, pain migration, guarding, white blood cell count, and absolute neutrophil count. We used stepwise regression to develop and select the best model. Test performance of the pARC was compared with the Pediatric Appendicitis Score (PAS). RESULTS The derivation sample included 2423 children, 40% of whom had appendicitis. The validation sample included 1426 children, 35% of whom had appendicitis. The final pARC model included the following variables: sex, age, duration of pain, guarding, pain migration, maximal tenderness in the right-lower quadrant, and absolute neutrophil count. In the validation sample, the pARC exhibited near perfect calibration and a high degree of discrimination (area under the curve: 0.85; 95% confidence interval: 0.83 to 0.87) and outperformed the PAS (area under the curve: 0.77; 95% confidence interval: 0.75 to 0.80). By using the pARC, almost half of patients in the validation cohort could be accurately classified as at <15% risk or ≥85% risk for appendicitis, whereas only 23% would be identified as having a comparable PAS of <3 or >8. CONCLUSIONS In our validation cohort of patients with acute abdominal pain, the pARC accurately quantified risk for appendicitis.
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Affiliation(s)
- Anupam B. Kharbanda
- Department of Pediatric Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota
| | | | - Dustin W. Ballard
- The Permanente Medical Group, Inc and Division of Research, Kaiser Permanente, Oakland, California
| | - David R. Vinson
- The Permanente Medical Group, Inc and Division of Research, Kaiser Permanente, Oakland, California
| | - Uli K. Chettipally
- The Permanente Medical Group, Inc and Division of Research, Kaiser Permanente, Oakland, California
| | - Mamata V. Kene
- The Permanente Medical Group, Inc and Division of Research, Kaiser Permanente, Oakland, California
| | - Steven P. Dehmer
- Division of Research, HealthPartners Institute, Bloomington, Minnesota
| | - Richard G. Bachur
- Division of Emergency Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter S. Dayan
- Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; and
| | - Nathan Kuppermann
- Emergency Medicine and Pediatrics, University of California Davis Health, Sacramento, California
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Karami MY, Niakan H, Zadebagheri N, Mardani P, Shayan Z, Deilami I. Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems. Ann Coloproctol 2017; 33:227-231. [PMID: 29354605 PMCID: PMC5768477 DOI: 10.3393/ac.2017.33.6.227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose Acute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population. Methods We prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined. Results The sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores. Conclusion The RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.
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Affiliation(s)
- Mohammad Yasin Karami
- Student Research Committee, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Niakan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Fars Province, Shiraz, Iran
| | - Navid Zadebagheri
- Student Research Committee, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mardani
- Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shayan
- Trauma Research Center, Department of Community Medicine, The Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Deilami
- Student Research Committee, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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