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A clinical prediction model for complicated appendicitis in children younger than five years of age
Wei Feng1, Xu-Feng Zhao1, Miao-Miao Li2
1Graduate school, Tianjin Medical University, Tianjin, 300070, China.
Insights
A new prediction model using age, white blood cell count, and symptom duration effectively differentiates complicated appendicitis in young children. This tool offers a promising approach for diagnosing acute appendicitis in this vulnerable age group.
Area of Science:
- Pediatric Surgery
- Medical Diagnostics
- Clinical Research
Background:
- Diagnosing complicated appendicitis in children under five remains challenging due to a lack of specific methods.
- Acute appendicitis in young children requires accurate differentiation between simple and complicated forms for appropriate management.
Purpose of the Study:
- To identify independent factors associated with complicated appendicitis in children younger than five years.
- To develop and validate a prediction model for distinguishing simple from complicated appendicitis in this age group.
Main Methods:
- A retrospective analysis of 382 children under five with acute appendicitis was performed.
- Independent factors were identified using univariate and multivariate analyses.
- A prediction model was developed and validated on a separate cohort of 156 patients, comparing its performance against the ALVARADO score and Pediatric Appendicitis Score (PAS).
Main Results:
- Complicated appendicitis was observed in 63.9% of the patients.
- Age, white blood cell count, and symptom duration were identified as independent predictors.
- The developed model demonstrated high discrimination (AUC: 0.830) and outperformed PAS and the ALVARADO score.
Conclusions:
- Age, white blood cell count, and symptom duration are key predictors for complicated appendicitis in young children.
- The novel prediction model shows promise in differentiating simple and complicated appendicitis, aiding clinical decision-making.
Background:
No reliably specific method for complicated appendicitis has been identified in children younger than five years of age. This study aimed to analyze the independent factors for complicated appendicitis in children younger than five years of age, develop and validate a prediction model for the differentiation of simple and complicated appendicitis.
Methods:
A retrospective study of 382 children younger than five years of age with acute appendicitis from January 2007 to December 2016 was conducted with assessments of demographic data, clinical symptoms and signs, and pre-operative laboratory results. According to intraoperative findings and postoperative pathological results, acute appendicitis was divided into simple and complicated appendicitis. Univariate and multivariate analyses were used to screen out the independent factors of complicated appendicitis, and develop a prediction model for complicated appendicitis. Then 156 such patients from January 2017 to December 2019 were collected as validation sample to validate the prediction model. Test performance of the prediction model was compared with the ALVARADO score and Pediatric Appendicitis Score (PAS).
Results:
Of the 382 patients, 244 (63.9%) had complicated appendicitis. Age, white blood cell count, and duration of symptoms were the independent factors for complicated appendicitis in children younger than five years of age. The final predication model for complicated appendicitis included factors above. In validation sample, the prediction model exhibited a high degree of discrimination (area under the curve [AUC]: 0.830; 95% confidence interval [CI]: 0.762-0.885) corresponding to a optimal cutoff value of 0.62, and outperformed the PAS (AUC: 0.735; 95% CI: 0.658-0.802), ALVARADO score (AUC: 0.733; 95% CI: 0.657-0.801).
Conclusion:
Age, white blood cell count, and duration of symptoms could be used to predict complicated appendicitis in children younger than five years of age with acute appendicitis. The prediction model is a novel but promising method that aids in the differentiation of acute simple and complicated appendicitis.
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