Pediatric Emergency Department, General and University Hospital Gregorio Marañón, Calle de O'Donnell, 48, 28009 Madrid, Spain.
Pediatric Emergency Department, General and University Hospital Gregorio Marañón, Calle de O'Donnell, 48, 28009 Madrid, Spain.
Am J Emerg Med. 2019 Jul;37(7):1289-1294. doi: 10.1016/j.ajem.2018.09.038. Epub 2018 Sep 26.
Acute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics.
To investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA.
Prospective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological, and analytical data were collected.
We studied 285 children with an average age of 9.5 years (95% confidence interval [CI], 9.1-9.9). AA was diagnosed in 103 children (36.1%), with complications in 10 of them (9.7%). The mean concentration of pro-ADM (nmol/L) was higher in children with AA (0.51 nmol/L, SD 0.16) than in children with acute abdominal pain (AAP) of another etiology (0.44 nmol/L, SD 0.14; p < 0.001). This difference was greater in complicated cases compared with uncomplicated AA (0.64 nmol/L, SD 0.17 and 0.50 nmol/L, SD 0.15, respectively; p = 0.005). The areas under the receiver-operating characteristic curves were 0.66 (95% CI, 0.59-0.72) for pro-ADM, 0.70 (95% CI, 0.63-0.76) for C-reactive protein (CRP), 0.84 (95% CI, 0.79-0.89) for neutrophils, and 0.84 (95% CI, 0.79-0.89) for total leukocytes. The most reliable combination to rule out AA was CRP ≤1.25 mg/dL and pro-ADM ≤0.35 nmol/L with a sensitivity of 96% and a negative predictive value of 93%.
Children with AA presented higher pro-ADM values than children with AAP of other etiologies, especially in cases of complicated AA. The combination of low values of pro-ADM and CRP can help to select children with low risk of AA.
急性阑尾炎（AA）是儿科最常见的外科疾病之一。
研究前肾上腺髓质素（pro-ADM）在诊断 AA 中的应用。
这是一项在 6 个儿科急诊部门进行的前瞻性、分析性、观察性和多中心研究。纳入年龄在 18 岁以下疑似 AA 的儿童。收集临床、流行病学和分析数据。
我们研究了 285 名平均年龄为 9.5 岁（95%置信区间 [CI]，9.1-9.9）的儿童。103 名儿童被诊断为 AA，其中 10 名（9.7%）有并发症。AA 患儿的 pro-ADM（nmol/L）平均浓度（0.51 nmol/L，标准差 0.16）高于其他病因引起的急性腹痛（AAP）患儿（0.44 nmol/L，标准差 0.14；p < 0.001）。与单纯性 AA 相比，复杂性 AA 患儿的差异更大（0.64 nmol/L，标准差 0.17 和 0.50 nmol/L，标准差 0.15；p = 0.005）。pro-ADM 的受试者工作特征曲线下面积为 0.66（95%CI，0.59-0.72），C 反应蛋白（CRP）为 0.70（95%CI，0.63-0.76），中性粒细胞为 0.84（95%CI，0.79-0.89），白细胞总数为 0.84（95%CI，0.79-0.89）。排除 AA 的最可靠组合是 CRP≤1.25mg/dL 和 pro-ADM≤0.35nmol/L，其敏感性为 96%，阴性预测值为 93%。
AA 患儿的 pro-ADM 值高于其他病因引起的 AAP 患儿，尤其是复杂性 AA 患儿。低 pro-ADM 和 CRP 值的组合有助于选择 AA 风险较低的患儿。
