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Appendicitis score for children with suspected appendicitis. A randomized clinical trial

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Abstract

Background/purpose

Appendicectomy is often performed without certainty of diagnosis. We have previously constructed and validated a diagnostic score for acute appendicitis in children. The purpose of this prospective study was to determine whether diagnosis by using the appendicitis score may improve clinical outcomes for children with suspected appendicitis.

Methods

A total of 126 children with suspected appendicitis were randomly assigned to either the appendicitis-score group or the no-score group. The attending general surgeon indicated a provisional diagnosis, a differential diagnosis and a provisional disposition on admission at 3 h and, if necessary, at 6, 9 and 12 h. The decision to operate was based on a clinical assessment in the no-score group and on the use of the diagnostic scoring system in the appendicitis-score group. The main outcome measures were the diagnostic accuracy (primary endpoint), the rate of unnecessary appendicectomies and adverse events between the two groups.

Results

The diagnostic accuracy was significantly greater in the appendicitis-score group compared with that in the no-score group (92% vs 80%; P = 0.04). A significantly higher rate of unnecessary appendicectomies was observed in the no-score group compared with that in the appendicitis-score group (29% vs 17%; P = 0.05). In the appendicitis-score group, the sensitivity was 100%, specificity was 88%, positive predictive value was 83% and negative predictive value was 100%, compared to sensitivity of 96%, specificity of 67%, positive predictive value of 70% and negative predictive value of 96% observed in the no-score group. There were no differences in terms of the length of hospital stay, rate of complications and appendiceal histology between the two groups. The only case with missed appendicitis was in the no-score group.

Conclusion

The use of the appendicitis score can reduce the unnecessary appendicectomy rate in general surgeons treating children with suspected appendicitis.

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References

  1. Kosloske AM, Love CL, Rohrer JE, Goldthorn JF, Lacey SR (2004) The diagnosis of appendicitis in children: outcomes of a strategy based on pediatric surgical evaluation. Pediatrics 113:29–34 doi:10.1542/peds.113.1.29

    Article  PubMed  Google Scholar 

  2. Smink DS, Finkelstein JA, Kleinman K, Fishman SJ (2004) The effect of hospital volume of pediatric appendectomies on the misdiagnosis of appendicitis in children. Pediatrics 113:18–23 doi:10.1542/peds.113.1.18

    Article  PubMed  Google Scholar 

  3. Roach JP, Partrick DA, Bruny JL, Allshouse MJ, Karrer FM, Ziegler MM (2007) Complicated appendicitis in children: a clear role for drainage and delayed appendectomy. Am J Surg 194:769–772 doi:10.1016/j.amjsurg.2007.08.021

    Article  PubMed  Google Scholar 

  4. Paajanen H, Somppi E (1996) Early appendicitis is still a difficult diagnosis. Acta Paediatr 85:459–462 doi:10.1111/j.1651-2227.1996.tb14061.x

    Article  CAS  PubMed  Google Scholar 

  5. Bachoo P, Mahomed AA, Ninan GK, Youngson GC (2001) Acute appendicitis. The continuing role for active observation. Pediatr Surg Int 17:125–128 doi:10.1007/s003830000483

    Article  CAS  PubMed  Google Scholar 

  6. Partrick DA, Janik JE, Janik JS, Bensard DD, Karrer FM (2003) Increased CT scan utilization does not improve the diagnostic accuracy of appendicitis in children. J Pediatr Surg 38:659–662 doi:10.1016/jpsu.2003.5017

    Article  PubMed  Google Scholar 

  7. Arnbjörnsson E (1985) Scoring system for computer-aided diagnosis of acute appendicitis. Ann Chir Gynaecol 74:159–166

    PubMed  Google Scholar 

  8. Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564 doi:10.1016/S0196-0644(86)80993-3

    Article  CAS  PubMed  Google Scholar 

  9. Christian F, Christian GP (1990) A simple scoring system to reduce the negative appendectomy rate. Ann R Coll 74:281–285

    Google Scholar 

  10. Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI (1992) Evaluation of the Alvarado score in acute appendicitis. J R Soc Med 85:87–88

    CAS  PubMed  Google Scholar 

  11. Bond GR, Tully SB, Chan LS, Bradley RL (1990) Use of the MANTRELS score in childhood appendicitis: a prospective study of 187 children with abdominal pain. Ann Emerg Med 19:1014–1018 doi:10.1016/S0196-0644(05)82440-0

    Article  CAS  PubMed  Google Scholar 

  12. Samuel M (2002) Pediatric appendicitis score. J Pediatr Surg 37:877–881 doi:10.1053/jpsu.2002.32893

    Article  PubMed  Google Scholar 

  13. Lintula H, Pesonen E, Kokki H, Vanamo K, Eskelinen M (2005) A diagnostic score for children with suspected appendicitis. Langenbecks Arch Surg 390:164–170 doi:10.1007/s00423-005-0545-8

    Article  PubMed  Google Scholar 

  14. de Dombal FT (1988) The OMGE acute abdominal survey, progress report 1986. Scand J Gastroenterol 23:35–42

    Google Scholar 

  15. Ceres L, Alonso L, Lopez P, Parra G, Echeverry J (1990) Ultrasound study of acute appendicitis in children with emphasis upon the diagnosis of retrocecal appendicitis. Pediatr Radiol 20:258–261 doi:10.1007/BF02019661

    Article  CAS  PubMed  Google Scholar 

  16. Ramachandran BP, Sivit CJ, Newman KD, Schwartz MZ (1996) Ultrasonography as an adjunct in the diagnosis of acute appendicitis: a 4-year experience. J Pediatr Surg 31:164–167 doi:10.1016/S0022-3468(96)90341-3

    Article  CAS  PubMed  Google Scholar 

  17. Hahn HB, Hoepner FU, Kalle T, MacDonald EB, Prantl F, Spitzer IM, Faerber DR (1998) Sonography of acute appendicitis in children: 7 years experience. Pediatr Radiol 28:147–151 doi:10.1007/s002470050316

    Article  CAS  PubMed  Google Scholar 

  18. Roosevelt GE, Reynold SL (1998) Does the use of ultrasonography improve the outcome of children with appendicitis. Acad Emerg Med 5:1071–1075

    Article  CAS  PubMed  Google Scholar 

  19. Rosendahl K, Aukland SM, Fosse K (2004) Imaging strategies in children with suspected appendicitis. Eur Radiol 14:138–145 doi:10.1007/s00330-003-2077-3

    Article  Google Scholar 

  20. Pena BM, Taylor GA, Lund DP, Mandl KD (1999) Effect of computed tomography on patient management and costs in children with suspected appendicitis. Pediatrics 104:440–446 doi:10.1542/peds.104.3.440

    Article  CAS  PubMed  Google Scholar 

  21. Stephen AE, Segev DL, Ryan DP, Mullins ME, Kim SH, Schnitzer JJ, Doody DP (2003) The diagnosis of acute appendicitis in a pediatric population: to CT or not to CT. J Pediatr Surg 38:367–371 doi:10.1053/jpsu.2003.50110

    Article  PubMed  Google Scholar 

  22. Hall EJ (2002) Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 33:811–814

    Google Scholar 

  23. Sivit CJ (2004) Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts. Pediatr Radiol 34:447–453 doi:10.1007/s00247-004-1179-7

    Article  PubMed  Google Scholar 

  24. Lindberg G, Fenyö G (1988) Algorithmic diagnosis of appendicitis using Bayes’ theorem and logistic regression. In: Bernardo JM, DeGront MH, Lindley DV, Smith AF (eds) Bayesian statistics. vol. 3. Oxford University Press, Oxford, pp 665–668

    Google Scholar 

  25. Eskelinen M, Ikonen J, Lipponen P (1992) A computer-based diagnostic score to aid in diagnosis of acute appendicitis. A prospective study of 1333 patients with acute abdominal pain. Theor Surg 7:86–90

    Google Scholar 

  26. Dado G, Anania U, Baccarani U, Marcotti E, Donini A, Risaliti A et al (2000) Application of a clinical score for the diagnosis of acute appendicitis in childhood: a retrospective analysis of 197 patients. J Pediatr Surg 35:1320–1322 doi:10.1053/jpsu.2000.9316

    Article  CAS  PubMed  Google Scholar 

  27. Schneider C, Kharbanda A, Bachur R (2007) Evaluating appendicitis scoring systems using a prospective pediatric cohort. Ann Emerg Med 49:778–784 doi:10.1016/j.annemergmed.2006.12.016

    Article  PubMed  Google Scholar 

  28. De Dombal FT (1991) Diagnosis of acute abdominal pain. Churchill Livingstone, Edinburgh, pp 33–106

    Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, Kuopio University Hospital, PO Box 1777, 70211, Kuopio, Finland

    Hannu Lintula

  2. Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland

    Hannu Kokki

  3. Department of Surgery, Kuopio University Hospital, Kuopio, Finland

    Riikka Kettunen

  4. Department of Surgery, Kuopio University Hospital, Kuopio, Finland

    Matti Eskelinen

Authors
  1. Hannu Lintula
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  2. Hannu Kokki
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  3. Riikka Kettunen
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  4. Matti Eskelinen
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Corresponding author

Correspondence to Hannu Lintula.

Additional information

The trial was not financially supported from any external source.

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Lintula, H., Kokki, H., Kettunen, R. et al. Appendicitis score for children with suspected appendicitis. A randomized clinical trial. Langenbecks Arch Surg 394, 999–1004 (2009). https://doi.org/10.1007/s00423-008-0425-0

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  • DOI: https://doi.org/10.1007/s00423-008-0425-0

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