Kharbanda Anupam B, Monuteaux Michael C, Bachur Richard G, Dudley Nanette C, Bajaj Lalit, Stevenson Michelle D, Macias Charles G, Mittal Manoj K, Bennett Jonathan E, Sinclair Kelly, Dayan Peter S
Department of Pediatrics Emergency Medicine, Children's Minnesota, Minneapolis.
Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Acad Pediatr. 2017 Apr;17(3):261-266. doi: 10.1016/j.acap.2016.11.014. Epub 2016 Nov 24.
To develop a clinical score to predict appendicitis among older, male children who present to the emergency department with suspected appendicitis.
Patients with suspected appendicitis were prospectively enrolled at 9 pediatric emergency departments. A total of 2625 patients enrolled; a subset of 961 male patients, age 8-18 were analyzed in this secondary analysis. Outcomes were determined using pathology, operative reports, and follow-up calls. Clinical and laboratory predictors with <10% missing data and kappa > 0.4 were entered into a multivariable model. Resultant β-coefficients were used to develop a clinical score. Test performance was assessed by calculating the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios.
The mean age was 12.2 years; 49.9% (480) had appendicitis, 22.3% (107) had perforation, and the negative appendectomy rate was 3%. In patients with and without appendicitis, overall imaging rates were 68.6% (329) and 84.4% (406), respectively. Variables retained in the model included maximum tenderness in the right lower quadrant, pain with walking/coughing or hopping, and the absolute neutrophil count. A score ≥8.1 had a sensitivity of 25% (95% confidence interval [CI], 20%-29%), specificity of 98% (95% CI, 96%-99%), and positive predictive value of 93% (95% CI, 86%-97%) for ruling in appendicitis.
We developed an accurate scoring system for predicting appendicitis in older boys. If validated, the score might allow clinicians to manage a proportion of male patients without diagnostic imaging.
制定一种临床评分系统，用于预测因疑似阑尾炎就诊于急诊科的大龄男性儿童是否患有阑尾炎。
在9家儿科急诊科对疑似阑尾炎患者进行前瞻性招募。共招募了2625例患者；在本次二次分析中，对961例年龄在8至18岁的男性患者亚组进行了分析。通过病理学、手术报告和随访电话确定结果。将缺失数据<10%且kappa>0.4的临床和实验室预测指标纳入多变量模型。使用所得的β系数制定临床评分。通过计算敏感性、特异性、阳性预测值、阴性预测值和似然比来评估测试性能。
平均年龄为12.2岁；49.9%（480例）患有阑尾炎，22.3%（107例）发生穿孔，阴性阑尾切除率为3%。患有和未患有阑尾炎的患者，总体影像学检查率分别为68.6%（329例）和84.4%（406例）。模型中保留的变量包括右下腹最大压痛、行走/咳嗽或跳跃时疼痛以及绝对中性粒细胞计数。评分≥8.1时，诊断阑尾炎的敏感性为25%（95%置信区间[CI]，20%-29%），特异性为98%（95%CI，96%-99%），阳性预测值为93%（95%CI，86%-97%）。
我们开发了一种准确的评分系统，用于预测大龄男孩是否患有阑尾炎。如果得到验证，该评分可能使临床医生在部分男性患者中无需进行诊断性影像学检查即可进行处理。
