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Pre-Coronavirus Disease 2019 Pediatric Acute Appendicitis: Risk Factors Model and Diagnosis Modality in a Developing
Jonathan Salim1, Flora Agustina1,2, Julian Johozua Roberth Maker1
1Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.
Insights
The pediatric appendicitis score (PAS) shows higher sensitivity than ultrasound sonography (USG) for diagnosing appendicitis in children. USG offers better specificity, and PAS is effective for children under five.
Area of Science:
- Pediatric surgery
- Diagnostic imaging
- Epidemiology
Background:
- Pediatric acute appendicitis incidence is stable in Western countries but increasing in Asia.
- Appendicitis is a significant health concern in Indonesia, ranking as the fourth most common infectious disease.
- Accurate diagnosis and early treatment are crucial due to rising appendicitis rates in Asian regions.
Purpose of the Study:
- To evaluate risk factors and diagnostic methods for pediatric acute appendicitis.
- To assess the utility of the pediatric appendicitis score (PAS) in children under five years old.
- To compare the diagnostic performance of PAS and ultrasound sonography (USG).
Main Methods:
- Cross-sectional study design with purposive sampling.
- Data collection via demographic and PAS questionnaires, and ultrasound sonography (USG) results.
- Statistical analysis included chi-square, Mann-Whitney tests, and logistic regression.
Main Results:
- The study included 21 pediatric patients with acute appendicitis.
- Both PAS and USG demonstrated moderate sensitivity and specificity compared to surgical outcomes.
- A risk prediction model showed 72.73% AUC, 100% sensitivity, and 54.5% specificity.
Conclusions:
- PAS exhibits higher sensitivity, while USG shows greater specificity in diagnosing appendicitis.
- The study confirms the applicability of PAS for diagnosing appendicitis in children under five.
- No significant risk factors for pediatric acute appendicitis were identified in the multivariate analysis.
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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