scholarly journals 1439 Analysis of the children’s abdominal pain pathway pre and during COVID and implementation of the paediatric appendicitis score (PAS) in the Mid-Yorkshire Trust

2021 ◽  
Author(s):  
Fiona Costigan ◽  
Sam Quested
Keyword(s):  
Abdominal Pain ◽  
Pain Pathway ◽  
Appendicitis Score

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

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.

Abdominal Pain

2018 ◽  
pp. 295-299
Author(s):  
Peter Gutierrez
Keyword(s):  
Risk Assessment ◽  
Abdominal Pain ◽  
High Risk ◽  
Blood Cell ◽  
Cell Count ◽  
Physical Exam ◽  
Lower Quadrant ◽  
Red Flag ◽  
Right Lower Quadrant ◽  
Appendicitis Score

This chapter is a review of the approach to pediatric abdominal pain, specifically the recognition, diagnosis, and management of appendicitis. Topics covered include red flag symptoms for abdominal pain in the pediatric patient, classic and nonclassic appendicitis presentations, and physical exam techniques that can help in the diagnosis of appendicitis. Also discussed is the Pediatric Appendicitis Score, which rates risk based on anorexia; nausea/emesis; migration of pain; fever (>38°C); pain with cough, percussion, or hopping; right lower quadrant tenderness; white blood cell count; and absolute band count. Middle risk assessment may require further imaging whereas high risk assessment can proceed immediately to surgery. The chapter also compares imaging modalities and reviews the literature for medical versus surgical management of appendicitis.

scholarly journals Acute appendicitis and acute mesenteric adenitis in children: Are they clinically distinguishable?

2020 ◽  
Vol 8 (4) ◽  
pp. 200-205
Author(s):  
Manish Pokhrel
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Laboratory Data ◽  
College Teaching ◽  
Final Diagnosis ◽  
Clinical Parameters ◽  
Mesenteric Adenitis ◽  
Appendicitis Score

Background: Acute appendicitis and acute mesenteric adenitis have very similar clinical presentations but radically different treatment approaches in children. Objectives: This study aims to test the possibility of clinically distinguishing between acute appendicitis and acute mesenteric adenitis. Methodology: A cross-sectional study was designed to recruit all children (<16 years) presenting to Kathmandu Medical College Teaching Hospital with acute abdominal pain between July 2019 and November 2019. An initial diagnosis was made using clinical and laboratory data. Then all patients were subjected to ultrasound evaluation. The final diagnosis was based on the radiological or histopathological examination. The Paediatric Appendicitis score was calculated retrospectively, and a logistic regression model was used to assess the diagnostic accuracy of the clinical parameters. Results: A total of 107 patients were analysed. Among them, 31(28.97%) had acute appendicitis and 34 (31.77%) had acute mesenteric adenitis as the final diagnosis. The positive predictive value of clinical diagnosis was 0.91 for acute appendicitis and 0.73 for acute mesenteric adenitis, for Paediatric Appendicitis Score was 0.77 and for the predictive model to diagnose acute mesenteric adenitis was 0.89. Ultrasound had a positive predictive value of 0.97 to diagnose acute appendicitis and 0.94 to diagnose acute mesenteric adenitis. Conclusion: Although several clinical parameters show promise in differentiating AA from AMA, relying solely on clinical differentiation is not accurate enough to prevent diagnostic errors. It is still recommended to utilise abdominal ultrasound for the assessment of abdominal pain in children.

scholarly journals Pediatric Acute Appendicitis Score in Children With Acute Abdominal Pain (AAP)

2021 ◽  
Vol 41 (1) ◽  
pp. 297-306
Author(s):  
MAARET ESKELINEN ◽  
JANNICA MEKLIN ◽  
KARI SYRJÄNEN ◽  
MATTI ESKELINEN
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Acute Abdominal Pain ◽  
Appendicitis Score

Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation

2018 ◽  
Vol 88 (1) ◽  
pp. 32-38
Author(s):  
Marcos Prada Arias ◽  
Angel Salgado Barreira ◽  
Margarita Montero Sánchez ◽  
Pilar Fernández Eire ◽  
Silvia García Saavedra ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Appendicitis Score ◽  
Score Evaluation

EP.FRI.943 Time to surgical review in NELA patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Laura Kenny ◽  
Ahmed Waqas ◽  
Elizabeth Hall
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Royal College ◽  
Small Sample Size ◽  
Surgical Care ◽  
Small Sample ◽  
Surgical Patients ◽  
Emergency Laparotomy ◽  
Pain Pathway ◽  
National Emergency

Abstract Introduction The Royal College of Surgeons standards on unscheduled surgical care state that an ST3 or above should review emergency cases within 60 minutes of referral from the Emergency Department (ED). Method Data was gathered from all admissions (n = 50), from 01/9/19 to 31/10/19, registered on the National Emergency Laparotomy Audit (NELA).  After exclusions, there were 20 patients who were admitted to surgery from ED.  14 of these had both time of referral and time of review documented. Results On average, patients were reviewed 2 hours and 23 minutes after referral.  9 of these patients (64%) were referred overnight (20:00-08:00) and their average time to review was longer; 2 hours and 49 minutes. 7 of all 50 NELA patients (14%) were never referred to surgery from ED. Conclusion Limitations include that ED doctors did not document what time patients were referred to surgery, and a small sample size; partially due to poor documentation. The recommended 60 minutes time to registrar review is not being achieved but data is limited. To improve this, surgical registrars will be asked to document time of referral. Data on time to review will continue to be gathered. An abdominal pain pathway will be introduced to improve ED’s recognition of surgical patients. A re-audit which will encompass patients admitted via ED and ambulatory care, as well as including data on time to decision to operate is currently underway.

scholarly journals Max appendicitis score: a new diagnostic score for diagnosing acute appendicitis

2017 ◽  
Vol 4 (9) ◽  
pp. 3067
Author(s):  
Vidur Jyoti ◽  
Akhilesh Kumar ◽  
Preeti Yadav ◽  
Vaibhav Kapoor
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Scoring Systems ◽  
Cost Effective ◽  
Alvarado Score ◽  
Diagnostic Score ◽  
Negative Appendicectomy ◽  
Appendicitis Score

Background: Scoring systems are valuable and valid for discriminating between acute appendicitis and nonspecific abdominal pain. Alvarado scoring is classical and different modifications of Alvarado score have been introduced but none is ideal and negative appendicectomy rate is still high. The aim of the study is to design a more reliable scoring system which is cost effective, simple, easy to learn, high accuracy, which can be applied by any doctor at any health care facility.Methods: Retrospective study of 160 patients hospitalized with abdominal pain suggestive of acute appendicitis and subsequently operated over a period of 5 year from January 2012 to January 2017 at Max Super Speciality Hospital, Gurgaon.Results: In the present study based on six clinically most significant variables, a diagnostic accuracy of 96.25% was achieved while the same was 85% for classical Alvardo Score. This significantly increased the diagnostic accuracy and lowered the negative appendicectomy rate.Conclusions: Max Appendicitis Score is perfect scoring system for diagnosing appendicitis, it can be specially very handy in peripheral health centers where radiological facilities are sparse.

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