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[Appendicitis predictive score for children younger than 4 years]
Ricardo Rassi1, Florencia Muse2, Eduardo Cuestas3
1Hospital Privado Universitario de Córdoba. Córdoba, Argentina.. ricardorassi@hotmail.com.
Insights
This study developed a novel risk score to aid in the early diagnosis of acute appendicitis in children under four years old. The scale demonstrated high accuracy, improving diagnostic timeliness and potentially reducing perforation rates in young patients.
Area of Science:
- Pediatric Surgery
- Diagnostic Accuracy
- Clinical Decision Support
Context:
- Acute appendicitis in young children presents non-specifically, often leading to delayed diagnosis and high perforation rates.
- Early and accurate diagnosis is crucial to prevent complications in pediatric patients.
- Existing diagnostic methods may lack sufficient sensitivity or specificity in this age group.
Purpose:
- To develop and validate an early diagnostic risk score for acute appendicitis in children under four years of age.
- To improve the accuracy and timeliness of appendicitis diagnosis in a vulnerable pediatric population.
- To identify key clinical, laboratory, and ultrasound variables predictive of acute appendicitis in young children.
Summary:
- A retrospective study of 100 children under four years old with suspected appendicitis was conducted.
- A predictive risk score was constructed using variables including Blumberg's sign, C-reactive protein, neutrophil-lymphocyte index, and ultrasound findings.
- The developed scale achieved an area under the ROC curve of 0.96, with high sensitivity (95.1%) and specificity (90.0%).
Impact:
- The validated risk score can assist clinicians in making earlier and more accurate diagnoses of acute appendicitis in children under four.
- Implementation of this tool may lead to reduced diagnostic delays, fewer appendiceal perforations, and improved patient outcomes.
- This risk score offers a valuable adjunct to clinical judgment and diagnostic imaging in pediatric appendicitis evaluation.
Introduction:
The clinical presentation of acute appendicitis in infants and young children is nonspecific. The diagnosis is often delayed and is accompanied by high rates of appendiceal perforation. The aim of the present study was to develop an early diagnostic scale for acute appendicitis in children less than 4 years of age. Results: The scale had a high discrimination index area under the ROC curve of 0.96 (95%CI 0.88-0.99), sensitivity of 95.1% (95%CI 86.3-99.0%), specificity of 90.0% (95%CI 55.7-89.5%), positive predictive value of 98.3% (95%CI 90.0-99.7%) and negative predictive value of 75.0% (95%CI 49.4-90.2). Conclusions: In this study, a risk score based on characteristics of children less than 4 years with abdominal pain was developed that may help predict a patient’s risk of developing acute appendicitis.
Patients And Methods:
100 children less than 4 years of age with a presumptive diagnosis of acute appendicitis were retrospectively evaluated in 4 hospitals. The case group comprised 90 patients with histopathological diagnosis of positive appendicitis (with inflammation in the appendiceal wall) while the control group comprised 10 patients with a histopathological diagnosis of negative appendicitis (without inflammation). Epidemiological, clinical, laboratory, and ultrasound variables were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score. Accuracy of the score was measured by the area under the receiver operating characteristic curve. Final model comprised 4 variables (Blumberg's sign, C-reactive protein, neutrophil-lymphocyte index and positive ultrasound).
Results:
The scale had a high discrimination index area under the ROC curve of 0.96 (95%CI 0.88-0.99), sensitivity of 95.1% (95%CI 86.3-99.0%), specificity of 90.0% (95%CI 55.7-89.5%), positive predictive value of 98.3% (95%CI 90.0-99.7%) and negative predictive value of 75.0% (95%CI 49.4-90.2).
Conclusions:
In this study, a risk score based on characteristics of children less than 4 years with abdominal pain was developed that may help predict a patient’s risk of developing acute appendicitis.
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