Diagnostic Value of Clinical Prediction Scores for Acute Appendicitis in Children Younger than 4 Years

Abstract Introduction Acute appendicitis can be difficult to diagnose, especially in children < 4 years old. The aim of the present study was to assess the diagnostic value of Alvarado score (AS), appendicitis inflammatory response (AIR) score, and pediatric appendicitis score (PAS) in children younger than 4 years. Materials and Methods All children younger than 4 years who underwent appendicectomy between 2005 and 2019 were included retrospectively. The diagnostic performance of the scores was analyzed using the area under the receiver-operating characteristic (ROC) curve and by calculating the diagnostic performances at optimal criterion value cutoff points. Results In this study, 100 children were included (58 boys and 42 girls) with a median age of 39.5 (12–47) months. Ninety children were diagnosed with pathologically proven acute appendicitis. The area under ROC curve of AS was 0.73, AIR score was 0.79, and PAS was 0.69 (p > 0.05, respectively). In children with low risk of acute appendicitis, negative predictive values were 75.0% for AS, 50.0% for AIR score, and 66.7% for PAS (p < 0.05, respectively). The positive predictive values in children with high risk of acute appendicitis were of 92.7% for AS, 92.6% for AIR score, and 93.6% for PAS (p > 0.05, respectively). AS, AIR score, and PAS plus positive ultrasonography have 0.58, 0.49, and 0.88 area under ROC curve. Conclusion The three scores can be of assistance in the suspicion of acute appendicitis. PAS markedly improved combined with positive ultrasonography, but none can be used in setting the diagnosis of acute appendicitis in young children.

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Diagnostic value of laboratory results in children with acute appendicitis

Turkish Journal of Biochemistry ◽

10.1515/tjb-2019-0292 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Tugay Tartar ◽

Ünal Bakal ◽

Mehmet Saraç ◽

Suleyman Aydin ◽

Ahmet Kazez

Keyword(s):

Acute Appendicitis ◽

Roc Curve ◽

Operating Characteristic ◽

Correct Diagnosis ◽

Perforated Appendicitis ◽

Diagnostic Value ◽

Alvarado Score ◽

P Values ◽

Reactive Protein ◽

Diagnosis Rate

AbstractBackgroundThe correct diagnosis rate in acute appendicitis (AA) is between 72 and 94% despite advanced laboratory and radiologic examinations. This study was conducted to determine the effectiveness of laboratory parameters in the diagnosis of children with appendicitis.Materials and methodsPatients who underwent appendectomy were divided as AA (subdivided into two groups as perforated and non-perforated) and without appendicitis. White blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), red cell distribution (RDW), mean platelet volume (MPV), C-reactive protein (CRP), procalcitonin levels and Alvarado score were recorded.ResultsWBC, NLR and CRP levels were higher in patients with AA (p<0.05). According to the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), p values and 95% confidence interval in predicting patients with and without appendicitis were NLR: 0.703, 0.025, 0.523–0.884; CRP: 0.822, <0.001, 0.725–0.919; procalcitonin: 0.631, 0.150, 506–0.755 and Alvarado score: 0.754, 0.05, 0.578–0.930, respectively. RDW, CRP and procalcitonin values of perforated appendicitis patients were higher compared with those of the non-perforated ones (p<0.05). According to the ROC curve, AUC, p values and 95%CI were NLR: 0.583, 0.094, 0.488–0.678; RDW: 0.715, <0.001, 0.628–0.802; CRP: 0.900, <0.001, 0.842–0.958; procalcitonin: 0.865, <0.001, 0.799–0.930 and Alvarado score: 0.727, <0.001, 0.641–0.812, respectively.ConclusionsCRP is the most effective bioindicator in the diagnosis of AA, the detection of perforated cases. It was revealed that NLR is effective in the diagnosis of AA, procalcitonin and RDW values are effective in the separation of perforated cases.

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Pediatric Appendicitis Score in differential diagnosis of acute nonspecific abdominal pain in children: age matters

Paediatric Surgery Ukraine ◽

10.15574/ps.2021.70.22 ◽

2021 ◽

pp. 22-31

Author(s):

V.G. Vakulchyk ◽

◽

A.V. Kapytski ◽

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Acute Appendicitis ◽

Roc Curves ◽

Diagnostic Value ◽

Diagnostic Significance ◽

Predictive Values ◽

Detection Frequency ◽

Specificity And Sensitivity ◽

Appendicitis Score

Acute nonspecific abdominal pain in children is the most common problem requiring differential diagnosis with acute appendicitis. Scales for integrated assessment of individual symptoms and their combinations have been proposed and are constantly being developed that allow predicting the likelihood of acute appendicitis. Purpose to assess diagnostic value of Pediatric Appendicitis Score (PAS) in groups of children in different ages. Materials and methods. 374 children aged 4 to 15 years with acute abdominal pain were evaluated in prospective randomized blinded study. Statistical analysis: ROC – curves, specificity and sensitivity, positive and negative predictive values; Kullback criteria; logistic regression analysis; discriminant analysis. Results. Detection frequency and diagnostic significance of the PAS scale predictors as well as obtained results by using the Pediatric Appendicitis Score depend on children age significantly. In terms of diagnosis of acute appendicitis, the PAS scale shows the best results in older children. Conclusions. Results of Pediatric Appendicitis Score depend on children ages due to different diagnostic value of predictors used in the PAS scale. Pediatric surgeons should keep in your mind these data. Modification of the scale is required taking into account the patient’s age. Further analysis of the issue of PAS using is needed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: acute appendicitis, children, diagnosis, PAS scale.

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A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20180430 ◽

2018 ◽

Vol 5 (3) ◽

pp. 796

Author(s):

Vamsavardhan Pasumarthi ◽

C. P. Madhu

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Roc Curve ◽

Predictive Value ◽

Scoring System ◽

Alvarado Score ◽

Predictive Values ◽

Sensitivity Specificity ◽

Ripasa Score

Background: The RIPASA Score is a new diagnostic scoring system developed for the diagnosis of Acute Appendicitis which showed higher sensitivity, specificity and diagnostic accuracy compared to ALVARADO Score, particularly when applied to Asian population. Not many studies have been conducted to compare RIPASA and ALVARADO scoring systems. Hence, author want to compare prospectively Alvarado and RIPASA score by applying them to the patients attending the hospital with right iliac fossa pain that could probably be acute appendicitis.Methods: A prospective analysis of 116 cases admitted with RIF pain during a 2 years period was performed. Patients between 15-60 years were scored as per Alvarado and RIPASA scoring system. Histopathological reports of the cases were collected and compared with the scores. ROC curve area analysis was performed to examine diagnostic accuracy of RIPASA and ALVARADO scores.Results: The sensitivity of ALVARADO score is estimated to be 52.08 for a cut off of 6. The specificity is 80%, positive predictive value is 92.59, negative predictive value is 25.81. The Diagnostic accuracy of ALVARADO scoring is found to be 56.9. The sensitivity, specificity, positive predictive value and negative predictive values of RIPASA scoring system are 75%, 65%, 91.14%, 35.14%. The diagnostic accuracy of RIPASA score is 73.28.Conclusions: The difference in the diagnostic accuracy between ALVARADO and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.

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“A COMPARATIVE STUDY OF RIPASA SCORE AND ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS”

10.36106/ijar/3200856 ◽

2021 ◽

pp. 25-28

Author(s):

M. Vijaya Kumar ◽

Manasa Manasa

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Scoring System ◽

Local Population ◽

Scoring Systems ◽

Signs And Symptoms ◽

Alvarado Score ◽

Predictive Values ◽

Ripasa Score

Acute appendicitis is the most common condition encountered in the Emergency department .Alvarado and Modied Alvarado scores are the most commonly used scoring system used for diagnosing acute appendicitis.,but its performance has been found to be poor in certain population . Hence our aim was to compare the diagnostic accuracy of RIPASA and ALVARADO Scoring system and study and compare sensitivity, specicity and predictive values of these scoring systems. The study was conducted in Government district hospital Nandyal . We enrolled 176 patients who presented with RIF pain . Both RIPASA and ALVARADO were applied to them. Final diagnosis was conrmed either by CT scan, intra operative nding or post operative HPE report. Sensitivity,specicity, positive predictive value, negative predictive value, diagnostic accuracy was calculated both for RIPASA and ALVARADO. It was found that sensitivity and specicity of the RIPASA score in our study are 98.7% and 83.3%, respectively. PPV and NPV were 98.1% and 88.2% and sensitivity and specicity of the Alvardo score in our study are 94.3% and 83.3%, respectively. PPV and NPV were 98% and 62.5%.Diagnostic accuracy of RIPASA score and Alvarado score are 97% and 93% respectively. RIPASA is a more specic and accurate scoring system in our local population when compared to ALVARADO . It reduces the number of missed appendicitis cases and also convincingly lters out the group of patients that would need a CT scan for diagnosis (score 5-7.5 ) BACKGROUND: Acute appendicitis is one of the most commonly dealt surgical emergencies, with a lifetime prevalence rate of approximately 1 one in seven. The incidence is 1.5–1.9 per 1,000 in the male and female population, and is approximately 1.4 times greater in men than in women. Despite being a common problem, it remains a difcult diagnosis to establish, particularly among the young, the elderly and females of reproductive age, where a host of other genitourinary and gynaecological inammatory conditions can present with signs and symptoms that are 2 similar to those of acute appendicitis. A delay in performing an appendectomy in order to improve its diagnostic accuracy increases the risk of appendicular perforation and peritonitis, which in turn increases morbidity and mortality. A variable combination of clinical signs and symptoms has been used together with laboratory ndings in several scoring systems proposed for suggesting the probability of Acute Appendicitis and the possible subsequent management pathway. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and ALVARADO score are new diagnostic scoring systems developed for the diagnosis of Acute Appendicitis and has been shown to have signicantly higher sensitivity, specicity and diagnostic accuracy. AIMS AND OBJECTIVES PRIMARY OBJECT 1. To compare RIPASA Scoring system and ALVARADO Scoring system in terms of diagnostic accuracy in Acute Appendicitis. 2. To study and compare sensitivity, specicity and predictive values of above scoring systems. SECONDARY OBJECT 1. To study the rate of negative appendicectomy based on above scoring systems. CONCLUSION: The RIPASA score is a simple scoring system with high sensitivity and specicity for the diagnosis of acute appendicitis. The 14 clinical parameters are all present in a good clinical history and examination and can be easily and quickly applied. Therefore, a decision on the management can be made early. Although the RIPASA score was developed for the local population of Brunei, we believe that it should be applicable to other regions. The RIPASA score presents greater Diagnostic accuracy and Sensitivity and equal specicity as a diagnostic test compared to the Alvarado score and is helpful in making appropriate therapeutic decisions. In hospitals like ours, the diagnosis of AA relies greatly on the clinical evaluation performed by surgeons. An adequate clinical scoring system would avoid diagnostic errors, maintaining a satisfactory low rate of negative appendectomies by adequate patient stratication, while limiting patient exposure to ionizing radiation, since 21 there is an increased risk of developing cancer with computed tomography, particularly for the paediatric age group.

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Roll-over test in primigravidae attending a public primary care service

Sao Paulo Medical Journal ◽

10.1590/s1516-31801997000500004 ◽

1997 ◽

Vol 115 (5) ◽

pp. 1533-1536

Author(s):

Luiz Francisco Marcopito

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Roc Curve ◽

Operating Characteristic ◽

Care Setting ◽

Care Service ◽

Primary Care Service ◽

Pregnancy Induced Hypertension ◽

Predictive Values ◽

Induced Hypertension

OBJECTIVE:To determine the roll-over test (ROT) performance in predicting pregnancy-induced hypertension (PIH) in primigravidae aged 15-29 years in a public primary care service. METHOD: Prospective cohort study enrolling 369 consecutive and initially normotensive primigravidae. The ROT was applied within 28-32 weeks of pregnancy. PIH was defined as diastolic blood pressure (DBP) 90 mm Hg or systolic blood pressure (SBP) 140 mm Hg, or a rise in DBP 15 mm Hg or a rise in SBP 30 mm Hg. The ROT prognostic properties were calculated, and a receiver operating characteristic (ROC) curve was constructed. RESULTS: For the 20 mm Hg cutoff point, sensitivity was 20% and specificity was 93%. Positive and negative predictive values were, respectively, 23% and 92%, for a PIH cumulative incidence of 9.5%. With other cutoff points, the ROC curve showed a poor discriminatory value of the test. CONCLUSION: The ROT was not useful for predicting PIH in a primary prenatal care setting.

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Neonatal Sepsis-Early detection comparing Procalcitonin and CRP as Markers and Newer Tools

International Journal of Medical and Dental Sciences ◽

10.19056/ijmdsjssmes/2016/v5i1/83574 ◽

2016 ◽

Vol 5 (1) ◽

pp. 1048

Author(s):

Altaf Ahmad Bhat ◽

Anjum Shamim ◽

Sabeeha Gul ◽

Rukaya Akther ◽

Iqra Bhat

Keyword(s):

Early Detection ◽

Roc Curve ◽

Neonatal Sepsis ◽

Individual Performance ◽

Hematological Parameter ◽

Total Leukocyte Count ◽

P Value ◽

Predictive Values ◽

Maternal Risk ◽

Area Under Roc Curve

Background:Neonatal sepsis continues to be a major cause of morbidity and mortality in India, but is treatable if diagnosis is made in time.Objectives: The present study was undertaken to evaluate and highlight the importance of procalcitonin v\s CRP in early detection of neonatal sepsis.Materials and Methods: The prospective study enrolled 150 neonates who had maternal risk factors and clinically suspected of infection (study group). Abnormal total leukocyte count, abnormal total polymorphonuclear neutrophils (PMN) count, elevated immature PMN count, elevated immature: Total (I:T) PMN ratio, platelet count ≤150,000/mm3, and pronounced degenerative or toxic changes in PMN were noted by the pathologist who were blind for the clinical status of the baby in NICU. Blood culture was taken as a gold standard for septicemia. The perinatal history, clinical profile and laboratory data were recorded and correlated in each case. Each hematological parameter was assessed for its individual performance and also with the culture-proven sepsis. Sensitivity, specificity, positive and negative predictive values (NPVs) were calculated for each parameter and for different gestational ages. P value was also calculated for different parameters.Results: Among 150 babies evaluated for sepsis in NICU over a period of one year, Procalcitonin is observed as better early marker of neonatal sepsis over and CRP:- Procalcitonin in comparison with CRP: - Sensitivity was 97% Specificity was 59% PPV was 70% and NPV was 99.9%. With area under ROC curve being 0.915(p-value of 0.02) CRP in comparison with Procalcitonin: - Sensitivity was 75% Specificity was 75% PPV was 86% and NPV was 99%. With area under ROC curve being 0.769 (p- value 0.61).Conclusion: The sensitivities of the screening test namely C-reactive protein and Procalcitonin were found to be satisfactory in identifying neonatal sepsis. Comparing to Other test procalcitonin appears to be simple and feasible diagnostic tool although costly.

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SOX9 stands for a bio-marker for prostate cancer detection

10.21203/rs.3.rs-53227/v1 ◽

2020 ◽

Author(s):

Hao Zi ◽

Wen-Lin Tao ◽

Lei Gao ◽

Zhao-Hua Yu ◽

Xiao-Dong Bai ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Roc Curve ◽

Operating Characteristic ◽

Diagnostic Value ◽

Quantitative Real Time Pcr ◽

Optimal Cutoff ◽

Qrt Pcr ◽

Incidence And Mortality ◽

The Relationship

Abstract Background Prostate cancer is one of common cancers around the world, and in our country the incidence and mortality of PCa are both increasing. More and more reports have revealed that SOX9 is involved in various human cancers. In this study, we aimed to explore the relationship between SOX9 expression and diagnostic value of PCa patients. Methods In this study, quantitative real-time PCR (qRT-PCR) was performed to determine the expression of SOX9 of the 131 PCa patients and 74 healthy volunteers. And receiver operating characteristic (ROC) curve was used to determine the diagnostic value of SOX9 for PCa patients. Results The results of qRT-PCR showed that the expression of serum SOX9 in PCa patients was higher than that in healthy controls (P < 0.05). And the expression of SOX9 was significantly associated with PSA (P = 0.001), differentiation (P = 0.000), and lymph node metastasis (P = 0.000). Besides, the area under the ROC curve (AUC) was 0.966 with the sensitivity of 93.2% and specificity of 87.8% respectively. The optimal cutoff value of SOX9 was 2.34. Conclusions Our results found that SOX9 is a novel oncogene for PCa, and may be a novel and effective biomarker for the diagnosis of patients with PCa.

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Clinical Prediction Scores for Pediatric Appendicitis

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1710534 ◽

2020 ◽

Author(s):

Johanna Gudjonsdottir ◽

Emma Marklund ◽

Lars Hagander ◽

Martin Salö

Keyword(s):

Age Groups ◽

False Positives ◽

Curve Analysis ◽

Clinical Prediction ◽

Operating Characteristics ◽

Roc Curve Analysis ◽

Alvarado Score ◽

Predictive Values ◽

Decision Curve Analysis ◽

Suspected Appendicitis

Abstract Introduction The rate of misdiagnosis of appendicitis in children is a challenge and clinical prediction scores could be part of the solution. However, the pediatric appendicitis score (PAS) and the Alvarado score have shown disappointing diagnostic accuracy in pediatric validation studies, while the appendicitis inflammatory response (AIR) score and the novel pediatric appendicitis risk calculator (pARC) have not yet been validated thoroughly. Therefore, the aim of the present study was to evaluate these four prediction scores prospectively in children with suspected appendicitis. Materials and Methods A prospective study was conducted over a 2-year period. All patients <15 years with suspected appendicitis were eligible for inclusion. The four prediction scores were compared regarding predictive values, receiver operating characteristics (ROC) curves, decision curve analysis, and clinical outcome. Results Of the 318 patients included, 151 (47 %) patients had appendicitis. The AIR score and the pARC had substantially higher specificity and positive predictive value, and lower rate of false positives (7% and 2%), than the PAS and Alvarado score (36 and 28%, p < 0.001). Across the different gender and age groups, the AIR score and the pARC generally had fewer false positives than the PAS and Alvarado score. There were no significant differences in sensitivity, negative predictive values, rates of missed appendicitis, or ROC curve analysis. In decision curve analysis, the AIR score and the pARC outperformed the PAS and Alvarado score at most threshold probabilities. Conclusion The AIR score and the pARC are superior to the PAS and Alvarado score in diagnosing children with suspected appendicitis.

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Diagnostic Accuracy of the Alvarado Scoring System in Patients Undergoing Appendicectomy at the University Teaching Hospital in Lusaka

University of Zambia Journal of Agricultural and Biomedical Sciences ◽

10.53974/unza.jabs.4.2.441 ◽

2020 ◽

Vol 4 (2) ◽

pp. 21-28

Author(s):

Songiso Mutumba ◽

◽

J Mulundika ◽

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Teaching Hospital ◽

Roc Curve ◽

Scoring System ◽

Area Under The Curve ◽

University Teaching ◽

Alvarado Score ◽

Negative Case ◽

The University

Background: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis has been associated with a reduction of negative appendicectomies. This study aimed to assess the diagnostic accuracy of the Alvarado scoring system at predicting acute appendicitis in patients undergoing appendicectomy at the University Teaching Hospital (UTH). Methods: A prospective study was done to evaluate the diagnostic value of the Alvarado score in patients undergoing appendicectomy at the UTH. Data was collected from the participants diagnosed with acute appendicitis and undergoing appendicectomy. The Alvarado scores for all the participants enrolled into the study were tabulated and correlated with the histopathology results. The sensitivity and the specificity of the Alvarado score was determined and used to construct the ROC curve using the SPSS version 20. The area under the curve was used to determine the diagnostic accuracy of the Alvarado score in this study. Setting: The University Teaching Hospital in Lusaka, Zambia. Results: To determine the diagnostic accuracy of the Alvarado score the ROC curve test was run in SPSS version 20. The results showed that the area under the curve was C=0.842 with SE=0.047 and 95% CI from 0.750 to 0.934. The area under the curve represents the probability that the Alvarado score result for a randomly chosen positive case will exceed the result for a randomly chosen negative case. It shows from the ROC that the Alvarado score is a good indicator to anticipate acute appendicitis. In other words, these results have confirmed that the Alvarado scoring system has very high predictive ability to discriminate acute appendicitis from normal appendix subjects. Conclusion: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis at UTH will reduce the rate of negative appendicectomies. This will lead to a reduction in unnecessary operations, which are a burden on the health care system.

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Diagnostic Value of Rapid Biophysical Profile in Comparison to Biophysical Profile in Pregnant Women with Insulin-dependent Diabetes

Journal of Family & Reproductive Health ◽

10.18502/jfrh.v13i4.2648 ◽

2020 ◽

Author(s):

Nasrin Soufizadeh ◽

Fariba Farhadifar ◽

Saghar Tamri ◽

Sara Behafarid ◽

Karim Sharifi ◽

...

Keyword(s):

Pregnant Women ◽

Gestational Age ◽

Roc Curve ◽

Diagnostic Value ◽

Insulin Dependent Diabetes ◽

Care Process ◽

Predictive Values ◽

Biophysical Profile ◽

Insulin Dependent ◽

Sensitivity Specificity

Objective: Having a rapid and low cost diagnostic approach in assessment of fetal wellbeing is an important goal for prenatal care process. The aim of this study was to determine the diagnostic value of rapid biophysical profile (rBPP) in comparison to biophysical profile (BPP). Materials and methods: In this study 142 pregnant women with insulin-dependent diabetes referred to Besat Hospital (Sanandaj, Iran) were evaluated in terms of fetal health. Age, gestational age and non-stress test (NST) data of patients were collected. The fetuses were evaluated using the standard BPP and selected rBPP methods. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated. The receiver operating characteristic (ROC) curve was plotted. The data were analyzed in Stata 14 software, using appropriate statistical analyses. Results: The mean ± standard deviation (SD) of maternal age and gestational age of the studied subjects were 30.6 ± 6.3 and 35.6 ± 1.5 weeks, respectively. The frequency of normal cases were 126 (88.7%) in the BPP method and 121 (85.2%) in the rBPP method. The results showed that sensitivity, specificity, PPV and NPV of rBPP in this study were 56.2%, 90.5%, 42.8% and 94.2%, respectively. The area under the ROC curve was 73.3%. Pearson Test showed a significant correlation between scores obtained through BPP and rBPP methods (p < 0.001). Conclusion: Considering the high profile of the sensitivity and PPV of the RBPP method compared to BPP, rBPP method has a better capacity to discriminate non-distressed fetuses from distress-exposed fetuses. It can also be used as a quick and easy method in crowded centers with limited evaluation tests, where not much skill is needed.

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