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Determining Surgeon's Accuracy in Predicting the Severity of Appendicitis in Children: A Comparison Between Clinical
Somya Bhatt1, Rahul Saxena1, Manish Pathak1
1Department of Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Insights
Surgeon clinical assessment accurately predicts appendicitis severity in children, aiding in reduced complications. This study highlights the surgeon's vital role in diagnosing pediatric appendicitis effectively.
Area of Science:
- Pediatric Surgery
- Surgical Diagnostics
- Clinical Assessment
Background:
- Appendicitis is a common pediatric surgical emergency.
- Diagnosing acute appendicitis in young children remains challenging despite advanced imaging.
- Accurate diagnosis is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To compare surgeon's clinical diagnosis with intraoperative findings in pediatric appendectomy.
- To evaluate the accuracy of surgeon's assessment in differentiating complicated from uncomplicated appendicitis.
- To identify clinical and laboratory predictors of appendicitis severity in children.
Main Methods:
- Prospective observational study of 78 children undergoing laparoscopic appendectomy.
- Surgeons completed a pro forma after clinical evaluation.
- Comparison of surgeon's diagnosis with intraoperative findings.
Main Results:
- Loose stools and vomiting were significant predictors of appendicitis severity (P=0.04, P=0.01).
- Elevated leukocyte count (above 11,425) and neutrophils (above 74.4%) indicated complicated appendicitis.
- High-sensitivity C-reactive protein (above 71.20 mg/dl) and Appendicitis Inflammatory Response score (above 7) were significant indicators (P=0.001, P=0.002).
- Ultrasound findings showed statistical significance (P=0.0004) in identifying complicated appendicitis.
Conclusions:
- Surgeon's prediction of appendicitis severity showed high statistical significance (P=0.0004) compared to intraoperative findings.
- Surgeon's clinical assessment achieved 82.05% accuracy, with a positive predictive value of 81.24% and negative predictive value of 84.72%.
- Surgeons play a critical role in predicting appendicitis severity, potentially reducing morbidity and mortality associated with complicated cases.
Background:
Appendicitis is one of the most common surgical emergencies in children. Despite the availability of a plethora of advanced diagnostic imaging, diagnosis of acute appendicitis in young children remains a challenge.
Materials And Methods:
This prospective observational study compared the surgeon's diagnosis with the intraoperative findings in the 78 children who underwent a laparoscopic appendectomy at a tertiary center over a duration of 18 months. After the clinical evaluation of the child, the surgeon was asked to fill out a pro forma. The delineation of complicated from uncomplicated appendicitis by a surgeon's clinical assessment was taken into consideration for the purpose of this study.
Results:
Symptoms such as loose stools and vomiting were statistically significant in predicting the severity of appendicitis (P = 0.04 and P = 0.01). A value of total leukocyte count above 11,425 was found to be predictive of complicated appendicitis (sensitivity - 70.6% and specificity - 51.2% and area under the receiver operating characteristic curve [AUROC] - 0.67) with differential leukocyte count (neutrophils) above 74.4% (sensitivity - 80.6% and specificity - 62.5%). Similarly, on comparing the uncomplicated and complicated groups, the high-sensitivity C-reactive protein value was found to be significant (P = 0.001, sensitivity - 80%, specificity - 76.5%, and cutoff >71.20 mg/dl). Appendicitis Inflammatory Response score above 7 indicated complicated appendicitis (sensitivity - 73.5%, specificity - 61.4%, AUROC - 0.744, P = 0.002). Ultrasound findings help identify complicated appendicitis cases (P = 0.0004, sensitivity: 59%, specificity: 60%, and AUROC: 0.67).
Conclusion:
Surgeon prediction was compared with intraoperative findings which were statistically significant with P = 0.0004, a sensitivity of 70.59%, and a specificity of 90.91% (accuracy - 82.05%, positive predictive value - 81.24%, and negative predictive value - 84.72%). Hence, a surgeon can play a crucial role in predicting the severity of the disease and can reduce the morbidity and mortality rates associated with complicated appendicitis.
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