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Evaluation of the Reliability of Pediatric Appendicitis Score and Ultrasonography Findings in the Diagnosis of Acute Appendicitis in Children

Yıl 2020, Cilt: 14 Sayı: 5, 445 - 451, 29.09.2020

Yasemin Günal Dilek Polat Erkan Gökçe Serap Yörübulut

https://doi.org/10.12956/tchd.761649

Öz

Objective: Acute appendicitis is the most common surgical emergency in childhood. Early diagnosis is essential to prevent perforation-related morbidity. In this study, we aimed to evaluate the effectiveness of pediatric appendicitis score (PAS) and ultrasonography (USG) findings in the diagnosis of acute appendicitis.
Materials and Methods: Patients who presented with acute abdominal pain and who were followed up or operated with a pre-diagnosis of appendicitis were analyzed retrospectively. The patients were divided into two groups as operated (n = 288) and non-operated (n = 161). PAS value of all patients was calculated and 1-4 negative (low risk), 5-6 suspect (moderate risk), 7 and above were considered positive (high risk). Patients who underwent USG were included in the study. The definitive diagnosis of the patients undergoing surgery was confirmed by histopathological evaluation.
Results: With the pre-diagnosis of acute appendicitis, 449 patients (171 girls, 278 boys) were hospitalized. Appendectomy was performed in 288 (64 %) of the patients. The remaining 161 patients (36 %) who recovered after the observation were discharged without any surgery. Histopathological diagnosis of patients undergoing appendectomy was acute appendicitis in 217 patients (75.3 %), perforated appendicitis in 67 patients (23.2 %) and normal appendix in 4 patients (1.4 %). Patients undergoing appendectomy had a significantly higher PAS value (p < 0.001). PAS value was significantly higher in the patients diagnosed with perforated appendicitis (p < 0.05). The sensitivity of USG and PAS were 81.59 % and 82.98 %, and their specificity was 88.81 % and 95.03 %, respectively, in the diagnosis of appendicitis. The sensitivity decreased significantly (67.70 %), and the specificity increased (100 %) when the patients with appendicitis in USG and PAS 7 and above were evaluated together. The sensitivity was 32.29 % and the specificity was 83.85 % when USG positivity or high-risk PAS value was used alone.
Conclusion: PAS is a useful clinical guide in determining the risk group for appendicitis and the use of additional imaging, and supports the diagnosis even in the high-risk group without additional imaging. However, in cases of incompatibility between USG and PAS values, we believe that close observation, repeated physical examination and, if necessary, further imaging are necessary to reduce the rate of negative appendectomy.

Anahtar Kelimeler

Acute appendicitis ultrasonography clinical score children

Kaynakça

  • 1. Sayed AO, Zeidan NS, Fahmy DM, Ibrahim HA. Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis. Ther Clin Risk Manag 2017;13:847-54.
  • 2. Lembcke B. Ultrasonography for acute appendicitis – the way it looks today. Z Gastroenterol 2016;54:1156–65.
  • 3. Bachur RG, Dayan PS, Bajaj L, Macias CG, Mittal MK, Stevenson MD, et al. The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis. Ann Emerg Med 2012;60:582–90.
  • 4. Erikci VS. Management of Pediatric Appendicitis. In: Garbuzenko DV (ed). Current Issues in the Diagnostics and Treatment of Acute Appendicitis. 1nd ed. London, United Kingdom, IntechOpen, 2018:77-90.
  • 5. Sivit C, Siegel M et all. When appendicitis is suspected in children. Radiografics 2001;21:247-62.
  • 6. Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Ann Emerg Med 2007;49:778-84.
  • 7. Shera AH, Nizami FA, Malik AA, Naikoo ZA, Wani MA. Clinical scoring system for diagnosis of acute appendicitis in children. Indian J Pediatr 2011;78:287-90.
  • 8. Nielsen JW, Boomer L, Kurtovic K, Lee E, Kupzyk K, Mallory R, et al. Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg 2015;50:144-8.
  • 9. Sauvain MO, Slankamenac K, Muller MK, Wildi S, Metzger U, Schmid W, et al. Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications. Langenbecks Arch Surg 2016;401:643-9.
  • 10. Pena B, Cook F, Mandl K. Selective imaging strategies for the diagnosis of appendicitis in chidren. Pediatrics 2004;113:24-8.
  • 11. Toprak H, Kilincaslan H, Ahmad IC, et al. Integration of ultrasound findings with Alvarado score in children with suspected appendicitis. Pediatr Int 2014;56:95-9.
  • 12. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557– 64.
  • 13. Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002;37:877– 81.
  • 14. Bhatt M, Joseph L, Ducharme FM, Dougherty G, McGillivray D. Prospective validation of the pediatric appendicitis score in a Canadian pediatric emergency department. Acad Emerg Med 2009;16:591– 6.
  • 15. Mandeville K, Pottker T, Bulloch B, Liu J. Using appendicitis scores in the pediatric ED. Am J Emerg Med 2011;29:972– 7.
  • 16. Pedram A, Asadian F, Roshan N. Diagnostic Accuracy of Abdominal Ultrasonography in pediatric Acute Appendicitis. Bull Emerg Trauma 2019;7:278-83.
  • 17. Kaiser S, Jorulf H, Söderman E, Frenckner B. Impact of radiologic imaging on the surgical decisionmaking process in suspected appendicitis in children. Acad Radiol 2004;11:971-9.
  • 18. Alvarado A. Clinical Approach in the Diagnosis of Acute Appendicitis. In: Garbuzenko DV (ed). Current Issues in the Diagnostics and Treatment of Acute Appendicitis. 1nd ed. London, United Kingdom, Intech Open,2018:13-43.
  • 19. Goldin AB, Khanna P, Thapa M, McBroom JA, Garrison MM, Parisi MT. Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy. Pediatr Radiol 2011;41:993-9.
  • 20. Tasar S, Tasar MA, Ayyildiz NK, Guder L, Arikan FI, Dallar YB. Pediatric appendicitis score and ultrasonographic findings of acute appendicitis in a pediatric emergency department. Turk J Pediatr Dis 2015;3:184–8.
  • 21. İnan M, Tulay SH, Besim H, Karakaya J. Akut apandisit tanısında ultrasonografinin yeri ve Alvarado skoru ile karşılaştırılması. Ulusal Cerrahi Dergisi 2011;27:149-53.
  • 22. Kurane S, Sangolli MS, Gogate AS. A one year prospective study to compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in acute appendicitis, in adults. Indian J Surg 2008;70:125–9.
  • 23. Nasiri S, Mohebbi F, Sodagari N, Hedayar A. Diagnostic values of ultrasound and modified Alvarado scoring system in acute appendicitis. Int J Emerg Med 2012;5:26.
  • 24. Sivit CJ, Newman KD, Boenning DA, Nussbaum-Blask AR, Bulas DI, Bond SJ, et al. Appendicitis: Usefulness of US in diagnosis in a pediatric population. Radiology 1992;185:549–52.
  • 25. Crady SK, Jones JS, Wyn T, Luttenton CR. Clinical validity of ultrasound in children with suspected appendicitis. Ann Emerg Med 1993;22:1125–9.
  • 26. Pogorelić Z, Rak S, Mrklić I, Jurić I. Prospective validation of Alvarado score and Pediatric Appendicitis Score for the diagnosis of acute appendicitis in children. Pediatr Emerg Care 2015;31:164-8.
  • 27. Cotton DM, Vinson DR, Vazquez-Benitez G, Warton EM, Reed ME, Chettipally UK, et al. Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting. Ann Emerg Med 2019;74:471-80.
  • 28. Goldman RD, Carter S, Stephens D, Antoon R, Mounstephen W, Langer JC. Prospective validation of the pediatric appendicitis score. J Pediatr 2008;153:278-82.
  • 29. Ertürk A, Tuncer IS, Balci O, Karaman I, Karaman A, Afşarlar ÇE, et al. The Value of Pediatric Appendicitis Score and Laboratory Findings on the Diagnosis of Pediatric Appendicitis. Turk J Pediatr 2015;9:79-84.
  • 30. Zuniga RV, Arribas JL, Montes SP et al. Application of Pediatric Appendicitis Score on the emergency department of a secondary level hospital. Pediatr Emerg Care 2012;28:489– 92.
  • 31. Aydin D, Turan C, Yurtseven A, Bayindir P, Toker B, Dokumcu Z, et al. Integration of radiology and clinical score in pediatric appendicitis. Pediatr Int 2018;60:173-8.
  • 32. Çavuşoğlu YH, Erdoğan D, Karaman A, Aslan MK, Karaman İ, Tütün ÖÇ. Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis. Pediatr Surg Int 2009;25:277-82.
  • 33. Yazıcı M, Özkısacık S, Öztan MO, Gürsoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 2010;52:400-3.

Çocuklarda Akut Apandisit Tanısında Pediatrik Apandisit Skoru ve Ultrasonografi Bulgularının Güvenilirliğinin Değerlendirilmesi

Yıl 2020, Cilt: 14 Sayı: 5, 445 - 451, 29.09.2020

Yasemin Günal Dilek Polat Erkan Gökçe Serap Yörübulut

https://doi.org/10.12956/tchd.761649

Öz

Amaç: Akut apandisit, çocukluk çağında en sık görülen cerrahi acil durumdur. Perforasyonla ilişkili morbiditeyi önlemek için erken tanı şarttır. Bu çalışmada, pediatrik apandisit skoru (PAS) ve ultrasonografi (USG) bulgularının apandisit tanısı koymadaki etkinliklerinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Akut karın ağrısı şikayeti ile başvuran ve apandisit ön tanısı ile yatırılarak takip veya ameliyat edilen hastalar geriye dönük olarak değerlendirildi. Hastalar cerrahi uygulanan (n=288) ve cerrahi uygulanmayan (n=161) olarak iki gruba ayrıldı. Tüm hastaların PAS değeri hesaplandı ve 1-4 arası negatif (düşük risk), 5-6 arası şüpheli (orta risk), 7 ve üzeri olanlar pozitif (yüksek risk) olarak kabul edildi. Çalışmaya USG yapılmış olan hastalar dahil edildi. Cerrahi uygulanan hastaların kesin tanısı histopatolojik değerlendirme ile doğrulandı.
Bulgular: Akut apandisit ön tanısıyla 449 hasta (171 kız, 278 erkek) yatırıldı. Hastaların 288’ine (% 64) apendektomi uygulandı. Gözlem sonrası iyileşen 161 hasta (% 36) ise herhangi bir cerrahi uygulanmadan taburcu edildi. Apendektomi uygulanan hastaların histopatolojik tanıları 217 hastada (% 75,3) akut apandisit, 67 hastada (% 23,2) perfore apandisit ve 4 hastada (% 1,4) normal apendiks idi. Apendektomi yapılan hastaların PAS değeri anlamlı olarak yüksekti (p <0,001). Perfore apandisit tanısı alan hastalarda PAS değeri anlamlı olarak yüksek saptandı (p <0,05). Apandisit tanısında USG ve PAS’ın sırası ile duyarlılıkları % 81,59 ve % 82,98, seçicilikleri % 88,81 ve % 95,03 olarak bulundu. Ameliyat kararı verilirken doğru tanıya ulaşabilmek için USG de apandisit saptanan ve PAS 7 ve üzeri olan hastalar birlikte değerlendirildiğinde duyarlılık belirgin düştü (% 67,70), seçicilik ise arttı (% 100). USG pozitifliği veya yüksek riskli PAS değerlerinden yalnızca birinin olması durumunda duyarlılık % 32,29, seçicilik ise % 83,85 olarak saptandı.
Sonuç: PAS apandisit risk grubunun belirlenmesinde ve ek görüntüleme kullanımıyla ilgili karar vermede yararlı bir klinik rehberdir ve yüksek risk grubunda olan vakalarda ek görüntüleme yapılmadan bile tanıyı desteklemektedir. Bununla birlikte USG ve PAS değerleri arasında uyumsuzluk olan vakalarda negatif apendektomi oranını azaltmak için yakın gözlem, tekrarlayan fizik muayene ve gerekirse daha ileri görüntülemenin gerekli olduğuna inanıyoruz.

Anahtar Kelimeler

Akut apandisit Ultrasonografi clinical score children

Kaynakça

  • 1. Sayed AO, Zeidan NS, Fahmy DM, Ibrahim HA. Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis. Ther Clin Risk Manag 2017;13:847-54.
  • 2. Lembcke B. Ultrasonography for acute appendicitis – the way it looks today. Z Gastroenterol 2016;54:1156–65.
  • 3. Bachur RG, Dayan PS, Bajaj L, Macias CG, Mittal MK, Stevenson MD, et al. The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis. Ann Emerg Med 2012;60:582–90.
  • 4. Erikci VS. Management of Pediatric Appendicitis. In: Garbuzenko DV (ed). Current Issues in the Diagnostics and Treatment of Acute Appendicitis. 1nd ed. London, United Kingdom, IntechOpen, 2018:77-90.
  • 5. Sivit C, Siegel M et all. When appendicitis is suspected in children. Radiografics 2001;21:247-62.
  • 6. Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Ann Emerg Med 2007;49:778-84.
  • 7. Shera AH, Nizami FA, Malik AA, Naikoo ZA, Wani MA. Clinical scoring system for diagnosis of acute appendicitis in children. Indian J Pediatr 2011;78:287-90.
  • 8. Nielsen JW, Boomer L, Kurtovic K, Lee E, Kupzyk K, Mallory R, et al. Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg 2015;50:144-8.
  • 9. Sauvain MO, Slankamenac K, Muller MK, Wildi S, Metzger U, Schmid W, et al. Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications. Langenbecks Arch Surg 2016;401:643-9.
  • 10. Pena B, Cook F, Mandl K. Selective imaging strategies for the diagnosis of appendicitis in chidren. Pediatrics 2004;113:24-8.
  • 11. Toprak H, Kilincaslan H, Ahmad IC, et al. Integration of ultrasound findings with Alvarado score in children with suspected appendicitis. Pediatr Int 2014;56:95-9.
  • 12. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557– 64.
  • 13. Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002;37:877– 81.
  • 14. Bhatt M, Joseph L, Ducharme FM, Dougherty G, McGillivray D. Prospective validation of the pediatric appendicitis score in a Canadian pediatric emergency department. Acad Emerg Med 2009;16:591– 6.
  • 15. Mandeville K, Pottker T, Bulloch B, Liu J. Using appendicitis scores in the pediatric ED. Am J Emerg Med 2011;29:972– 7.
  • 16. Pedram A, Asadian F, Roshan N. Diagnostic Accuracy of Abdominal Ultrasonography in pediatric Acute Appendicitis. Bull Emerg Trauma 2019;7:278-83.
  • 17. Kaiser S, Jorulf H, Söderman E, Frenckner B. Impact of radiologic imaging on the surgical decisionmaking process in suspected appendicitis in children. Acad Radiol 2004;11:971-9.
  • 18. Alvarado A. Clinical Approach in the Diagnosis of Acute Appendicitis. In: Garbuzenko DV (ed). Current Issues in the Diagnostics and Treatment of Acute Appendicitis. 1nd ed. London, United Kingdom, Intech Open,2018:13-43.
  • 19. Goldin AB, Khanna P, Thapa M, McBroom JA, Garrison MM, Parisi MT. Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy. Pediatr Radiol 2011;41:993-9.
  • 20. Tasar S, Tasar MA, Ayyildiz NK, Guder L, Arikan FI, Dallar YB. Pediatric appendicitis score and ultrasonographic findings of acute appendicitis in a pediatric emergency department. Turk J Pediatr Dis 2015;3:184–8.
  • 21. İnan M, Tulay SH, Besim H, Karakaya J. Akut apandisit tanısında ultrasonografinin yeri ve Alvarado skoru ile karşılaştırılması. Ulusal Cerrahi Dergisi 2011;27:149-53.
  • 22. Kurane S, Sangolli MS, Gogate AS. A one year prospective study to compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in acute appendicitis, in adults. Indian J Surg 2008;70:125–9.
  • 23. Nasiri S, Mohebbi F, Sodagari N, Hedayar A. Diagnostic values of ultrasound and modified Alvarado scoring system in acute appendicitis. Int J Emerg Med 2012;5:26.
  • 24. Sivit CJ, Newman KD, Boenning DA, Nussbaum-Blask AR, Bulas DI, Bond SJ, et al. Appendicitis: Usefulness of US in diagnosis in a pediatric population. Radiology 1992;185:549–52.
  • 25. Crady SK, Jones JS, Wyn T, Luttenton CR. Clinical validity of ultrasound in children with suspected appendicitis. Ann Emerg Med 1993;22:1125–9.
  • 26. Pogorelić Z, Rak S, Mrklić I, Jurić I. Prospective validation of Alvarado score and Pediatric Appendicitis Score for the diagnosis of acute appendicitis in children. Pediatr Emerg Care 2015;31:164-8.
  • 27. Cotton DM, Vinson DR, Vazquez-Benitez G, Warton EM, Reed ME, Chettipally UK, et al. Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting. Ann Emerg Med 2019;74:471-80.
  • 28. Goldman RD, Carter S, Stephens D, Antoon R, Mounstephen W, Langer JC. Prospective validation of the pediatric appendicitis score. J Pediatr 2008;153:278-82.
  • 29. Ertürk A, Tuncer IS, Balci O, Karaman I, Karaman A, Afşarlar ÇE, et al. The Value of Pediatric Appendicitis Score and Laboratory Findings on the Diagnosis of Pediatric Appendicitis. Turk J Pediatr 2015;9:79-84.
  • 30. Zuniga RV, Arribas JL, Montes SP et al. Application of Pediatric Appendicitis Score on the emergency department of a secondary level hospital. Pediatr Emerg Care 2012;28:489– 92.
  • 31. Aydin D, Turan C, Yurtseven A, Bayindir P, Toker B, Dokumcu Z, et al. Integration of radiology and clinical score in pediatric appendicitis. Pediatr Int 2018;60:173-8.
  • 32. Çavuşoğlu YH, Erdoğan D, Karaman A, Aslan MK, Karaman İ, Tütün ÖÇ. Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis. Pediatr Surg Int 2009;25:277-82.
  • 33. Yazıcı M, Özkısacık S, Öztan MO, Gürsoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 2010;52:400-3.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm ORIGINAL ARTICLES
Yazarlar

Yasemin Günal 0000-0003-4488-236X

Dilek Polat Bu kişi benim 0000-0002-4166-9216

Erkan Gökçe 0000-0003-3251-4519

Serap Yörübulut 0000-0003-0781-4405

Yayımlanma Tarihi 29 Eylül 2020
Gönderilme Tarihi 1 Temmuz 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 14 Sayı: 5

Kaynak Göster

Vancouver Günal Y, Polat D, Gökçe E, Yörübulut S. Evaluation of the Reliability of Pediatric Appendicitis Score and Ultrasonography Findings in the Diagnosis of Acute Appendicitis in Children. Türkiye Çocuk Hast Derg. 2020;14(5):445-51.

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