Abstract：
OBJECTIVE:To develop a clinical score to predict appendicitis among older, male children who present to the emergency department with suspected appendicitis. METHODS: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. RESULTS: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. CONCLUSIONS: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.
journal_name
Acad Pediatrjournal_title
Academic pediatricsauthors
Kharbanda AB,Monuteaux MC,Bachur RG,Dudley NC,Bajaj L,Stevenson MD,Macias CG,Mittal MK,Bennett JE,Sinclair K,Dayan PS,Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics.doi
10.1016/j.acap.2016.11.014subject
Has Abstractpub_date
2017-04-01 00:00:00pages
261-266issue
3eissn
1876-2859issn
1876-2867pii
S1876-2859(16)30504-6journal_volume
17pub_type
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