Determining Surgeon's Accuracy in Predicting the Severity of Appendicitis in Children: A Comparison Between Clinical Diagnosis and Intraoperative Findings.

BACKGROUND

Appendicitis is one of the most common surgical emergencies in children. Despite the availability of a plethora of advanced diagnostic imaging, diagnosis of acute appendicitis in young children remains a challenge.

MATERIALS AND METHODS

This prospective observational study compared the surgeon's diagnosis with the intraoperative findings in the 78 children who underwent a laparoscopic appendectomy at a tertiary center over a duration of 18 months. After the clinical evaluation of the child, the surgeon was asked to fill out a pro forma. The delineation of complicated from uncomplicated appendicitis by a surgeon's clinical assessment was taken into consideration for the purpose of this study.

RESULTS

Symptoms such as loose stools and vomiting were statistically significant in predicting the severity of appendicitis ( = 0.04 and = 0.01). A value of total leukocyte count above 11,425 was found to be predictive of complicated appendicitis (sensitivity - 70.6% and specificity - 51.2% and area under the receiver operating characteristic curve [AUROC] - 0.67) with differential leukocyte count (neutrophils) above 74.4% (sensitivity - 80.6% and specificity - 62.5%). Similarly, on comparing the uncomplicated and complicated groups, the high-sensitivity C-reactive protein value was found to be significant ( = 0.001, sensitivity - 80%, specificity - 76.5%, and cutoff >71.20 mg/dl). Appendicitis Inflammatory Response score above 7 indicated complicated appendicitis (sensitivity - 73.5%, specificity - 61.4%, AUROC - 0.744, = 0.002). Ultrasound findings help identify complicated appendicitis cases ( = 0.0004, sensitivity: 59%, specificity: 60%, and AUROC: 0.67).

CONCLUSION

Surgeon prediction was compared with intraoperative findings which were statistically significant with = 0.0004, a sensitivity of 70.59%, and a specificity of 90.91% (accuracy - 82.05%, positive predictive value - 81.24%, and negative predictive value - 84.72%). Hence, a surgeon can play a crucial role in predicting the severity of the disease and can reduce the morbidity and mortality rates associated with complicated appendicitis.