Bhatt Somya, Saxena Rahul, Pathak Manish, Rathod Kirtikumar J, Jadhav Avinash, Nayak Shubhalaxmi, Sinha Arvind
Department of Paediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
J Indian Assoc Pediatr Surg. 2025 Jul-Aug;30(4):469-476. doi: 10.4103/jiaps.jiaps_248_24. Epub 2025 Jul 4.
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.
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.
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).
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.
阑尾炎是儿童最常见的外科急症之一。尽管有大量先进的诊断成像手段，但幼儿急性阑尾炎的诊断仍然是一项挑战。
这项前瞻性观察性研究比较了在一家三级中心接受18个月腹腔镜阑尾切除术的78名儿童中外科医生的诊断与术中发现。在对儿童进行临床评估后，要求外科医生填写一份表格。本研究考虑了外科医生通过临床评估区分复杂型与非复杂型阑尾炎的情况。
腹泻和呕吐等症状在预测阑尾炎严重程度方面具有统计学意义（P = 0.04和P = 0.01）。发现白细胞总数高于11425可预测复杂型阑尾炎（敏感性 - 70.6%，特异性 - 51.2%，受试者工作特征曲线下面积[AUROC] - 0.67），白细胞分类计数（中性粒细胞）高于74.4%（敏感性 - 80.6%，特异性 - 62.5%）。同样，在比较非复杂型和复杂型组时，发现高敏C反应蛋白值具有显著性（P = 0.001，敏感性 - 80%，特异性 - 76.5%，临界值>71.20mg/dl）。阑尾炎炎症反应评分高于7表明为复杂型阑尾炎（敏感性 - 73.5%，特异性 - 61.4%，AUROC - 0.74,4，P = 0.002）。超声检查结果有助于识别复杂型阑尾炎病例（P = 0.0004，敏感性：59%，特异性：60%，AUROC：0.67）。
将外科医生的预测与术中发现进行比较，其具有统计学意义，P = 0.0004，敏感性为70.59%，特异性为90.91%（准确性 - 82.05%，阳性预测值 - 81.24%，阴性预测值 - 84.72%）。因此，外科医生在预测疾病严重程度方面可发挥关键作用，并可降低与复杂型阑尾炎相关的发病率和死亡率。
Zotero 插件