Zhan Yishan,Zhang Shouhua,Peng Xiaojie,et al.Development and validation of a predictive model for diagnosing acute appendicitis in children excluding anaphylactoid purpura[J].Journal of Clinical Pediatric Surgery,,():846-852.[doi:10.3760/cma.j.cn101785-202406020-008]
Development and validation of a predictive model for diagnosing acute appendicitis in children excluding anaphylactoid purpura
- Keywords:
- Appendicitis; Purpura; Sch?enlein-Henoch; Surgical Procedures; Operative; Child
- Abstract:
- Objective In clinical practices, pediatric abdominal type Henoch-Sch?nlein purpura (HSP) is frequently misdiagnosed as acute appendicitis (AA), leading to unnecessary appendectomies.Based upon a substantial amount of clinical data, simple and readily available clinical indicators were used for developing a predictive model for differential diagnosis between pediatric AA and abdominal type HSP. Methods A retrospective collection of complete data were collected on AA and abdominal type HSP cases treated from January 2010 to December 2020.The relevant data were divided into internal and external validation groups.Univariate analysis was utilized for screening independent variables and R language for model development and validation.Lasso regression analysis was utilized for selecting predictive factors and constructing a regression model.And K-fold cross-validation was performed for internal validation.Brier scores, calibration intercepts and calibration slopes were calculated for external validation.Due to a significant impact of fever on the outcomes after modeling, a separate model for afebrile children was developed and validated using the same methods.Both receiver operating characteristic (ROC) and calibration curves were plotted for evaluating both models. Results A total of 5, 264 complete data cases were included in modeling group, comprising AA (n=3, 375) and HSP (n=1, 889).External validation group (n=903) consisted of AA (n=599) and HSP (n=304).The differential diagnosis prediction model indicated that fever (OR=0.22, 95%CI=0.18-0.28), neutrophil ratio (OR=0.94, 95%CI=0.94-0.95), albumin (OR=0.86, 95%CI=0.84-0.88), direct bilirubin (OR=0.78, 95%CI=0.74-0.83), alkaline phosphatase (OR=0.99, 95%CI=0.99-0.99), and C-reactive protein (OR=0.96, 95%CI=0.95-0.96) are predictive factors for diagnosing abdominal type HSP.The model has developed a web calculator: https://8dc439cf433f6e89f389d65b5116fd53.shinyapps.io/dynnomapp/.Among a total of 3050 afebrile cases, there were AA (n=1, 384) and HSP (n=1, 666); validation group included 552 afebrile cases, consisting of 282 AA cases and 270 HSP cases.In afebrile children model, neutrophil ratio (OR=0.95, 95%CI=0.94-0.96), albumin (OR=0.84, 95%CI=0.82-0.87), direct bilirubin (OR=0.80, 95%CI=0.75-0.85), alkaline phosphatase (OR=0.99, 95%CI=0.99-0.99), C-reactive protein (OR=0.95, 95%CI=0.95-0.96) and potassium (OR=2.71, 95%CI=2.19-3.38) were identified as predictive factors for diagnosing abdominal type HSP; the web calculator for this model can be found at: https://1af7732f98ae1ac1bc0a023291462db1.shinyapps.io/dynnomapp/.The evaluation metrics for internal and external validation of both models were satisfactory, with C-statistic for internal cross-validation after calibration in modeling group 0.9450 and area under the ROC curve for external validation 0.8873 (95%CI=0.8660-0.9086) with a calibration intercept of -0.3377, a calibration slope of 0.7325 and a Brier score of 0.1317.For modeling group and validation group of afebrile cases, area under the ROC curve was 0.9164 (95%CI=0.9056-0.9272) and 0.8472 (95%CI=0.8150-0.8794), respectively, with a C-statistic of 0.9161, an intercept of -0.3162, a calibration slope of 0.7481 and a Brier score of 0.1625. Conclusions The above two differential diagnosis models developed here exhibit excellent discriminative and calibration capabilities.The included indicators are simple and readily available, assisting healthcare structures at all levels in excluding HSP in pediatric AA diagnoses.For afebrile cases, afebrile model calculator may be utilized for differentiation, thereby avoiding unnecessary appendectomy.
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Memo
收稿日期:2024-6-12。
基金项目:2025年江西省卫生健康委科技计划项目青年项目(202510079)
通讯作者:饶小平，Email: 369272877@qq.com