Cargando…

A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score

AIM: This study aims to construct and validate a new score for diagnosis of complicated appendicitis in children, complicated appendicitis pediatric score (CoAPS), to guide residents’ clinical decision-making on choosing the correct patients for immediate surgery, reducing the emergency negative sur...

Descripción completa

Detalles Bibliográficos
Autores principales: Tzortzopoulou, Adelais K., Tsolia, Mariza, Spyridis, Nicolaos, Giamarelou, Panagiota, Sfakiotaki, Rodanthi, Passalides, Alexander, Zavras, Nicolaos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9552662/
https://www.ncbi.nlm.nih.gov/pubmed/36238344
http://dx.doi.org/10.4103/jiaps.jiaps_110_21
_version_ 1784806294190817280
author Tzortzopoulou, Adelais K.
Tsolia, Mariza
Spyridis, Nicolaos
Giamarelou, Panagiota
Sfakiotaki, Rodanthi
Passalides, Alexander
Zavras, Nicolaos
author_facet Tzortzopoulou, Adelais K.
Tsolia, Mariza
Spyridis, Nicolaos
Giamarelou, Panagiota
Sfakiotaki, Rodanthi
Passalides, Alexander
Zavras, Nicolaos
author_sort Tzortzopoulou, Adelais K.
collection PubMed
description AIM: This study aims to construct and validate a new score for diagnosis of complicated appendicitis in children, complicated appendicitis pediatric score (CoAPS), to guide residents’ clinical decision-making on choosing the correct patients for immediate surgery, reducing the emergency negative surgeries. METHODS: This prospective observational study enrolled two cohorts of patients 5–15 years old. Four hundred and seven consecutive patients were enrolled for the derivation cohort. Demographic data, clinical features, and histopathology data were collected. The outcome measure was the histological diagnosis of gangrenous appendicitis with or without perforation. The score was next validated in a separate cohort of 312 consecutive patients who were classified according to their risk of complicated appendicitis. The diagnostic performance of the score and the potential for the risk stratification to select patients for diagnostic imaging, emergency operative management, and reduce emergency negative operation rates were quantified. RESULTS: A positive “jumping up” test, vomiting, white blood cell >13.5 × 10^3/ml, lymphocytes <18%, and C-reactive protein >50 mg/dl were independent predictors for complicated appendicitis. The final prediction model exhibited an area under the curve of 0.890 (95% confidence interval: 0.859–0.922). The low-risk group demonstrated high sensitivity (90.4%) for complicated appendicitis, while scores 6 or more were very specific (95%) for the disorder. Describing the potential utility of the score, emergency ultrasound imaging would have been postponed in 14.5% of patients (P = 0.0016), and emergency negative explorations would have been cut by 87%. CONCLUSION: The CoAPS score could guide residents in emergency management of children with complicated appendicitis reducing hospitalizations and urgent surgeries.
format Online
Article
Text
id pubmed-9552662
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Wolters Kluwer - Medknow
record_format MEDLINE/PubMed
spelling pubmed-95526622022-10-12 A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score Tzortzopoulou, Adelais K. Tsolia, Mariza Spyridis, Nicolaos Giamarelou, Panagiota Sfakiotaki, Rodanthi Passalides, Alexander Zavras, Nicolaos J Indian Assoc Pediatr Surg Original Article AIM: This study aims to construct and validate a new score for diagnosis of complicated appendicitis in children, complicated appendicitis pediatric score (CoAPS), to guide residents’ clinical decision-making on choosing the correct patients for immediate surgery, reducing the emergency negative surgeries. METHODS: This prospective observational study enrolled two cohorts of patients 5–15 years old. Four hundred and seven consecutive patients were enrolled for the derivation cohort. Demographic data, clinical features, and histopathology data were collected. The outcome measure was the histological diagnosis of gangrenous appendicitis with or without perforation. The score was next validated in a separate cohort of 312 consecutive patients who were classified according to their risk of complicated appendicitis. The diagnostic performance of the score and the potential for the risk stratification to select patients for diagnostic imaging, emergency operative management, and reduce emergency negative operation rates were quantified. RESULTS: A positive “jumping up” test, vomiting, white blood cell >13.5 × 10^3/ml, lymphocytes <18%, and C-reactive protein >50 mg/dl were independent predictors for complicated appendicitis. The final prediction model exhibited an area under the curve of 0.890 (95% confidence interval: 0.859–0.922). The low-risk group demonstrated high sensitivity (90.4%) for complicated appendicitis, while scores 6 or more were very specific (95%) for the disorder. Describing the potential utility of the score, emergency ultrasound imaging would have been postponed in 14.5% of patients (P = 0.0016), and emergency negative explorations would have been cut by 87%. CONCLUSION: The CoAPS score could guide residents in emergency management of children with complicated appendicitis reducing hospitalizations and urgent surgeries. Wolters Kluwer - Medknow 2022 2022-07-26 /pmc/articles/PMC9552662/ /pubmed/36238344 http://dx.doi.org/10.4103/jiaps.jiaps_110_21 Text en Copyright: © 2022 Journal of Indian Association of Pediatric Surgeons https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Tzortzopoulou, Adelais K.
Tsolia, Mariza
Spyridis, Nicolaos
Giamarelou, Panagiota
Sfakiotaki, Rodanthi
Passalides, Alexander
Zavras, Nicolaos
A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score
title A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score
title_full A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score
title_fullStr A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score
title_full_unstemmed A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score
title_short A New Score for the Diagnosis of Complicated Appendicitis in Children - Complicated Appendicitis Pediatric Score
title_sort new score for the diagnosis of complicated appendicitis in children - complicated appendicitis pediatric score
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9552662/
https://www.ncbi.nlm.nih.gov/pubmed/36238344
http://dx.doi.org/10.4103/jiaps.jiaps_110_21
work_keys_str_mv AT tzortzopoulouadelaisk anewscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT tsoliamariza anewscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT spyridisnicolaos anewscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT giamareloupanagiota anewscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT sfakiotakirodanthi anewscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT passalidesalexander anewscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT zavrasnicolaos anewscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT tzortzopoulouadelaisk newscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT tsoliamariza newscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT spyridisnicolaos newscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT giamareloupanagiota newscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT sfakiotakirodanthi newscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT passalidesalexander newscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore
AT zavrasnicolaos newscoreforthediagnosisofcomplicatedappendicitisinchildrencomplicatedappendicitispediatricscore