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Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis
BACKGROUND: The mortality rate of gangrenous/perforated appendicitis is higher than that of uncomplicated appendicitis. However, non-operative management of such patients is ineffective. This necessitates their careful exam at presentation to identify gangrenous/perforated appendicitis and aid surgi...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10249254/ https://www.ncbi.nlm.nih.gov/pubmed/37286951 http://dx.doi.org/10.1186/s12876-023-02767-7 |
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author | Kobayashi, Toshimichi Hidaka, Eiji Koganezawa, Itsuki Nakagawa, Masashi Yokozuka, Kei Ochiai, Shigeto Gunji, Takahiro Sano, Toru Tomita, Koichi Tabuchi, Satoshi Chiba, Naokazu Kawachi, Shigeyuki |
author_facet | Kobayashi, Toshimichi Hidaka, Eiji Koganezawa, Itsuki Nakagawa, Masashi Yokozuka, Kei Ochiai, Shigeto Gunji, Takahiro Sano, Toru Tomita, Koichi Tabuchi, Satoshi Chiba, Naokazu Kawachi, Shigeyuki |
author_sort | Kobayashi, Toshimichi |
collection | PubMed |
description | BACKGROUND: The mortality rate of gangrenous/perforated appendicitis is higher than that of uncomplicated appendicitis. However, non-operative management of such patients is ineffective. This necessitates their careful exam at presentation to identify gangrenous/perforated appendicitis and aid surgical decision-making. Therefore, this study aimed to develop a new scoring model based on objective findings to predict gangrenous/perforated appendicitis in adults. METHODS: We retrospectively analyzed 151 patients with acute appendicitis who underwent emergency surgery between January 2014 and June 2021. We performed univariate and multivariate analyses to identify independent objective predictors of gangrenous/perforated appendicitis, and a new scoring model was developed based on logistic regression coefficients for independent predictors. Receiver operating characteristic (ROC) curve analysis and the Hosmer–Lemeshow test were performed to assess the discrimination and calibration of the model. Finally, the scores were classified into three categories based on the probability of gangrenous/perforated appendicitis. RESULTS: Among the 151 patients, 85 and 66 patients were diagnosed with gangrenous/perforated appendicitis and uncomplicated appendicitis, respectively. Using the multivariate analysis, C-reactive protein level, maximal outer diameter of the appendix, and presence of appendiceal fecalith were identified as independent predictors for developing gangrenous/perforated appendicitis. Our novel scoring model was developed based on three independent predictors and ranged from 0 to 3. The area under the ROC curve was 0.792 (95% confidence interval, 0.721—0.863), and the Hosmer–Lemeshow test showed a good calibration of the novel scoring model (P = 0.716). Three risk categories were classified: low, moderate, and high risk with probabilities of 30.9%, 63.8%, and 94.4%, respectively. CONCLUSIONS: Our scoring model can objectively and reproducibly identify gangrenous/perforated appendicitis with good diagnostic accuracy and help in determining the degree of urgency and in making decisions about appendicitis management. |
format | Online Article Text |
id | pubmed-10249254 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-102492542023-06-09 Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis Kobayashi, Toshimichi Hidaka, Eiji Koganezawa, Itsuki Nakagawa, Masashi Yokozuka, Kei Ochiai, Shigeto Gunji, Takahiro Sano, Toru Tomita, Koichi Tabuchi, Satoshi Chiba, Naokazu Kawachi, Shigeyuki BMC Gastroenterol Research BACKGROUND: The mortality rate of gangrenous/perforated appendicitis is higher than that of uncomplicated appendicitis. However, non-operative management of such patients is ineffective. This necessitates their careful exam at presentation to identify gangrenous/perforated appendicitis and aid surgical decision-making. Therefore, this study aimed to develop a new scoring model based on objective findings to predict gangrenous/perforated appendicitis in adults. METHODS: We retrospectively analyzed 151 patients with acute appendicitis who underwent emergency surgery between January 2014 and June 2021. We performed univariate and multivariate analyses to identify independent objective predictors of gangrenous/perforated appendicitis, and a new scoring model was developed based on logistic regression coefficients for independent predictors. Receiver operating characteristic (ROC) curve analysis and the Hosmer–Lemeshow test were performed to assess the discrimination and calibration of the model. Finally, the scores were classified into three categories based on the probability of gangrenous/perforated appendicitis. RESULTS: Among the 151 patients, 85 and 66 patients were diagnosed with gangrenous/perforated appendicitis and uncomplicated appendicitis, respectively. Using the multivariate analysis, C-reactive protein level, maximal outer diameter of the appendix, and presence of appendiceal fecalith were identified as independent predictors for developing gangrenous/perforated appendicitis. Our novel scoring model was developed based on three independent predictors and ranged from 0 to 3. The area under the ROC curve was 0.792 (95% confidence interval, 0.721—0.863), and the Hosmer–Lemeshow test showed a good calibration of the novel scoring model (P = 0.716). Three risk categories were classified: low, moderate, and high risk with probabilities of 30.9%, 63.8%, and 94.4%, respectively. CONCLUSIONS: Our scoring model can objectively and reproducibly identify gangrenous/perforated appendicitis with good diagnostic accuracy and help in determining the degree of urgency and in making decisions about appendicitis management. BioMed Central 2023-06-07 /pmc/articles/PMC10249254/ /pubmed/37286951 http://dx.doi.org/10.1186/s12876-023-02767-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Kobayashi, Toshimichi Hidaka, Eiji Koganezawa, Itsuki Nakagawa, Masashi Yokozuka, Kei Ochiai, Shigeto Gunji, Takahiro Sano, Toru Tomita, Koichi Tabuchi, Satoshi Chiba, Naokazu Kawachi, Shigeyuki Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis |
title | Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis |
title_full | Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis |
title_fullStr | Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis |
title_full_unstemmed | Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis |
title_short | Development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis |
title_sort | development of a scoring model based on objective factors to predict gangrenous/perforated appendicitis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10249254/ https://www.ncbi.nlm.nih.gov/pubmed/37286951 http://dx.doi.org/10.1186/s12876-023-02767-7 |
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