Guo Hongxi,Yang Jun,Bian Hongqiang,et al.Diagnostic value of combining pediatric appendicitis score with high-frequency ultrasound for appendicitis typing in children aged above 5 years[J].Journal of Clinical Pediatric Surgery,,21():859-865.[doi:10.3760/cma.j.cn101785-202107022-012]
Diagnostic value of combining pediatric appendicitis score with high-frequency ultrasound for appendicitis typing in children aged above 5 years
- Keywords:
- Appendicitis/DI; Ultrasonography; Models; Statistical; Discriminant Analysis
- Abstract:
- Objective To explore the diagnostic value of combining pediatric appendicitis score (PAS) with high-frequency ultrasound for appendicitis types in children over 5 years of age.Methods Retrospective analysis was performed for 394 hospitalized appendicitis children fulfilling the inclusion criteria from January 2018 to December 2020.There were 270 boys and 124 girls with a mean age of (8.94±2.28) years.Depending on intraoperative finding and the final histology, patients were classified into two groups of simple appendicitis (n=113) and non-simple appendicitis (n=281).The effects of general data, PAS and ultrasonic images were compared between two groups.Fisher’s stepwise discriminant analysis was employed for establishing a discriminant function by applying significant variables.Then the diagnostic efficacy of this model was verified by self-test, cross-validation and validation group.Results Univariate analysis indicated that 13 factors were statistically different between two group (P < 0.05).Seven parameters of PAS, illegibility of wall layers, count of leucocyte, duration of symptoms, periappendiceal fluid, enlarged appendix and thickened periappendiceal fat were considered ultimately.The discriminant function equation was Y1=-14.446-1.312X3+1.102X5+0.481X2+0.065X1-1.884X6+4.046X4+3.878X7, Y2=-36.834+1.509X3+4.297X5+0.687X2+0.110X1-0.167X6+3.432X4+0.874X7.The results obtained by self-test and cross-validation all indicated that the accuracy rate of discriminant function was 94.7%(373/394); The results verified by validation group showed that the accuracy rate of discriminant function was 94.4%(84/89).Conclusion Combining PAS with high-frequency ultrasound is useful in distinguishing the types of appendicitis in children aged above 5 years.Thus clinicians may formulate reasonable treatments for acute appendicitis in children.
References:
[1] Stringer MD.Acute appendicitis[J].J Paediatr Child Health, 2017, 53(11):1071-1076.DOI:10.1111/jpc.13737.
[2] Gorter RR, The S, Gorter-Stam M, et al.Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis[J].J Pediatr Surg, 2017, 52(8):1219-1227.DOI:10.1016/j.jpedsurg.2017.04.005.
[3] Gorter RR, van der Lee JH, Heijsters F, et al.Outcome of initially nonoperative treatment for acute simple appendicitis in children[J].J Pediatr Surg, 2018, 53(9):1849-1854.DOI:10.1016/j.jpedsurg.2017.12.012.
[4] Podda M, Gerardi C, Cillara N, et al.Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children:a systematic review and meta-analysis[J].Ann Surg, 2019, 270(6):1028-1040.DOI:10.1097/SLA.0000000000003225.
[5] Maita S, Andersson B, Svensson JF, et al.Nonoperative treatment for nonperforated appendicitis in children:a systematic review and meta-analysis[J].Pediatr Surg Int, 2020, 36(3):261-269.DOI:10.1007/s00383-019-04610-1.
[6] Tiboni S, Bhangu A, Hall NJ.Outcome of appendicectomy in children performed in paediatric surgery units compared with general surgery units[J].Br J Surg, 2014, 101(6):707-714.DOI:10.1002/bjs.9455.
[7] Girard-Madoux M, Gomez de Agüero M, Ganal-Vonarburg SC, et al.The immunological functions of the appendix:An example of redundancy?[J].Semin Immunol, 2018, 36:31-44.DOI:10.1016/j.smim.2018.02.005.
[8] Zani A, Teague WJ, Clarke SA, et al.Can common serum biomarkers predict complicated appendicitis in children?[J].Pediatr Surg Int, 2017, 33(7):799-805.DOI:10.1007/s00383-017-4088-1.
[9] Gudjonsdottir J, Marklund E, Hagander L, et al.Clinical prediction scores for pediatric appendicitis[J].Eur J Pediatr Surg, 2021, 31(3):252-260.DOI:10.1055/s-0040-1710534.
[10] Carpenter JL, Orth RC, Zhang W, et al.Diagnostic performance of US for differentiating perforated from nonperforated pediatric appendicitis:a prospective cohort study[J].Radiology, 2017, 282(3):835-841.DOI:10.1148/radiol.2016160175.
[11] Riedesel EL, Weber BC, Shore MW, et al.Diagnostic performance of standardized ultrasound protocol for detecting perforation in pediatric appendicitis[J].Pediatr Radiol, 2019, 49(13):1726-1734.DOI:10.1007/s00247-019-04475-5.
[12] Samuel M.Pediatric appendicitis score[J].J Pediatr Surg, 2002, 37(6):877-881.DOI:10.1053/jpsu.2002.32893.
[13] Rawolle T, Reismann M, Minderjahn MI, et al.Sonographic differentiation of complicated from uncomplicated appendicitis[J].Br J Radiol, 2019, 92(1099):20190102.DOI:10.1259/bjr.20190102.
[14] Atema JJ, van Rossem CC, Leeuwenburgh MM, et al.Scoring system to distinguish uncomplicated from complicated acute appendicitis[J].Br J Surg, 2015, 102(8):979-990.DOI:10.1002/bjs.9835.
[15] Fujii T, Tanaka A, Katami H, et al.Usefulness of the pediatric appendicitis score for assessing the severity of acute appendicitis in children[J].Pediatr Int, 2020, 62(1):70-73.DOI:10.1111/ped.14032.
[16] Hao TK, Chung NT, Huy HQ, et al.Combining ultrasound with a pediatric appendicitis score to distinguish complicated from uncomplicated appendicitis in a pediatric population[J].Acta Inform Med, 2020, 28(2):114-118.DOI:10.5455/aim.2020.28.114-118.
[17] Gonzalez DO, Lawrence AE, Cooper JN, et al.Can ultrasound reliably identify complicated appendicitis in children?[J].J Surg Res, 2018, 229:76-81.DOI:10.1016/j.jss.2018.03.012.
[18] Blumfield E, Yang D, Grossman J.Scoring system for differentiating perforated and non-perforated pediatric appendicitis[J].Emerg Radiol, 2017, 24(5):547-554.DOI:10.1007/s10140-017-1535-1.
[19] 徐永康, 云叶, 赵永祥, 等.血清C反应蛋白、白介素-6和降钙素原对小儿急性复杂性阑尾炎的诊断价值研究[J].临床小儿外科杂志, 2021, 20(1):60-64.DOI:10.12260/lcxewkzz.2021.01.012. Xu YK, Yun Y, Zhao YX, et al.Applicable values of serum C-reactive protein, interleukin 6 and procalcitonin in acute complex pediatric appendicitis[J].J Clin Ped Sur, 2021, 20(1):60-64.DOI:10.12260/lcxewkzz.2021.01.012.
[20] Bickell NA, Aufses AH Jr, Rojas M, et al.How time affects the risk of rupture in appendicitis[J].J Am Coll Surg, 2006, 202(3):401-406.DOI:10.1016/j.jamcollsurg.2005.11.016.
[21] Bonadio W.Time to appendectomy and risk of complicated appendicitis and adverse outcomes in children[J].JAMA Pediatr, 2018, 172(1):94.DOI:10.1001/jamapediatrics.2017.4095.
Memo
收稿日期:2021-07-11。
基金项目:武汉市卫生局科研项目（WG13B11）
通讯作者:杨俊,Email:yang12391@tom.com