Making a Decision between Acute Appendicitis and Acute Gastroenteritis

Area of Science:

• Pediatric Emergency Medicine
• Gastroenterology
• Surgical Diagnostics

Background:

• Acute appendicitis is a common pediatric surgical emergency requiring timely diagnosis.
• Symptoms like diarrhea and vomiting can mimic acute gastroenteritis, delaying appendicitis treatment.
• Accurate differentiation between appendicitis and gastroenteritis in children is clinically challenging.

Purpose of the Study:

• To identify independent predictors distinguishing acute appendicitis from acute gastroenteritis in pediatric patients presenting with abdominal pain and diarrhea.
• To develop and validate a predictive model for acute appendicitis in this cohort.
• To compare the performance of the new model against the established Pediatric Appendicitis Score (PAS).

Main Methods:

• Retrospective case-control study involving children admitted with abdominal pain and diarrhea.
• Patients were categorized into acute appendicitis and acute gastroenteritis groups.
• Multiple logistic regression and ROC curve analysis were used to identify predictors and assess model performance.

Main Results:

• The study included 32 appendicitis cases and 82 gastroenteritis cases.
• Key predictors for appendicitis were identified as vomiting, right lower quadrant (RLQ) pain, stool occult blood (OB), elevated white blood cell (WBC) count, and elevated C-reactive protein (CRP).
• A revised combined model demonstrated superior discrimination compared to the PAS model.

Conclusions:

• Vomiting, RLQ pain, OB, WBC, and CRP are significant predictors for differentiating pediatric appendicitis from gastroenteritis.
• The developed predictive model aids in timely and accurate diagnosis of appendicitis in children presenting with diarrhea.
• This approach can improve clinical decision-making and potentially reduce delays in surgical intervention for appendicitis.