scholarly journals Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 309
Author(s):  
Zenon Pogorelić ◽  
Jakov Mihanović ◽  
Stipe Ninčević ◽  
Bruna Lukšić ◽  
Sara Elezović Baloević ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Pediatric Patients ◽  
Area Under The Curve ◽  
Perforated Appendicitis ◽  
Risk Groups ◽  
Diagnostic Value ◽  
Cross Sectional ◽  
High Level

Background: This prospective observational study aimed to evaluate the validity of appendicitis inflammatory response (AIR) score in differentiating advanced (perforated) from simple (non-perforated) appendicitis in pediatric patients. Methods: A single-center prospective cross-sectional study was conducted between 1 January 2019 until 1 May 2020 including 184 pediatric patients who underwent appendectomy. Based on the intraoperative finding of advanced (n = 38) or simple (n = 146) appendicitis the patients were divided into two groups. Recipient-operator curve (ROC), with calculation of sensitivity and specificity of best cutoff and the area under the curve (AUC), were used to measure the diagnostic value and the potential for risk stratification of the AIR score, among the patients with simple or advanced acute appendicitis. Results: The median value of the AIR score in the perforated and non-perforated groups was 10 (interquartile range, IQR 9, 11), and was 7 (IQR 6, 9), respectively (p < 0.001). Based on the calculated value of AIR score, the patients were classified with a high precision into low, indeterminate and high risk groups for acute appendicitis (p < 0.001). A cutoff value of ≥9 was demonstrated to serve as a reliable indicator of perforated appendicitis with a sensitivity and a specificity of 89.5% and 71.9%, respectively (AUC = 0.80; 95% CI: 0.719–0.871; p < 0.001). Conclusions: Acute appendicitis can be detected with a high level of sensitivity and specificity using the AIR score. Also, the AIR score may differentiate perforated from non-perforated appendicitis in pediatric patients with a high level of accuracy.

scholarly journals C-reactive protein and total serum bilirubin as a predictor of perforated appendicitis: a cross sectional study

2018 ◽  
Vol 5 (7) ◽  
pp. 2574
Author(s):  
Anil Reddy Pinate ◽  
Shivakumar C. R. ◽  
Mohammad Fazelul Rahman Shoeb ◽  
Sharangouda Patil
Keyword(s):  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
Total Serum Bilirubin ◽  
Total Serum ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Perforated Appendix

Background: C-reactive protein (CRP) and bilirubin have been used as adjuncts for diagnosis of appendicitis. This study assessed the diagnostic value of these markers in patients with suspected acute appendicitis.Methods: CRP values and total serum bilirubin among the patients who presented with acute appendicitis were compared among patients who had perforated appendix and non- perforated appendix. The diagnostic value of CRP and TSB markers as a predictor for perforation were compared in terms of Sensitivity, specificity, PPVs and NPV and the diagnostic accuracy assessed by AUC using receiver operating characteristic (ROC) curve analysis.Results: This study showed sensitivity is 72.50%, specificity of 92.23%, positive predictive value of 78.38% for a raised CRP. The sensitivity of TSB for predicting perforation is 77.50 and the values of specificity, PPV and NPV of the same are 87.38 %, 70.45% and 90.91% respectively. The area under curve was more for CRP than TSB indicating that CRP is better predictor for perforation in appendicitis as compared to the TSB.Conclusions: Thus, serum CRP and total serum bilirubin (TSB) can be used as useful markers for early diagnosis and prediction of perforation in cases of acute appendicitis.

scholarly journals THE INCIDENCE OF PERFORATED APPENDICITIS AMONG PEDIATRIC PATIENTS IN KHARTOUM NORTH TEACHING HOSPITAL, SUDAN

2019 ◽  
Vol 1 (2) ◽  
pp. 90-95
Keyword(s):  
Acute Appendicitis ◽  
Teaching Hospital ◽  
Pediatric Patients ◽  
Iliac Fossa ◽  
Perforated Appendicitis ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Right Iliac Fossa Pain ◽  
The Mean

Introduction: Acute appendicitis is a common emergency condition in paediatrics with different ages. The perforated appendicitis is one of the most serious complications of acute appendicitis which may lead to peritonitis. The aim of our study is to calculate the incidence of perforated appendicitis. Methods: This is a retrospective cross-sectional study has been conducted at Khartoum north teaching hospital. The total number of patients was 214. Results: the most common age in this study are 13 years old and the mean age is 11 years, 128 of cases were male 59.8% and 86 were females 40.2%. All cases of our study presented with fever 100%, 80.8% presented with right iliac fossa pain, and anorexia 100%. 50.5% of cases came within the first day of presentation and 26.6% of cases came in 4thday of presentation, all cases presented with right iliac fossa tenderness, 15.9% of cases presented with perforated acute appendicitis, 67.29% of cases operated after 6 hours, 5.61% operated in more than 6 hours and 27.1% operated after 6 weeks. Conclusion: In this study the incidence of perforated acute appendicitis was 15.9% which is low in comparison with another study because there was no delay in appendectomy operation and the majority of patients came within the first day of the disease.

scholarly journals P0614URINARY EXOSOMAL MICRORNA-21 AS A MARKER OF SCRUB TYPHUS-ASSOCIATED ACUTE KIDNEY INJURY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
In O Sun ◽  
Kwang Young Lee ◽  
A Young Cho
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Scrub Typhus ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Total Leukocyte Count ◽  
Cross Sectional ◽  
Exosomal Mirna

Abstract Background and Aims Urinary microRNA (miRNA)-21 is reported to be a biomarker for detection of acute kidney injury (AKI). Analysis of urinary exsome may serve as a novel diagnostic approach in kidney disease. The aim of this study is to investigate the clinical significance of urinary exosomal miRNA-21 for AKI in patients with scrub typhus. Method In a cross-sectional study, we collected 138 urine samples at the time of admission from 145 patients with scrub typhus. For 25 patients with scrub typhus-associated AKI and 25 age, sex-matched scrub typhus patient without AKI, we measured miRNA-21 in urinary exosomal fraction and compared diagnostic value in predictiong AKI. Results Compared with patients in the non-AKI group, patients in the AKI group were more likely to have one or more comorbidity such as diabetes (50% vs. 5%, P&lt;0.01) and chronic kidney disease (8% vs. 0%, P&lt;0.01). Total leukocyte count were higher in patients with AKI than in those without AKI (10.40 × 103/ mL vs. 6.40 × 103/mL, P&lt;0.01). The levels of urinary miRNA-21 were higher in the AKI group than in the non-AKI group. Urinary exosomal miRNA-21 levels correlated directly with serum neutrophil gelatinase-associated lipocalin values and total leukocyte counts and inversely with estimated glomerular filtration rate. The receiver operator characteristics curve analysis for urinary exosomal miRNA-21 showed good discriminative power for the diagnosis of scrub typhus-associated AKI, with area under the curve value of 0.907. Conclusion Urinary exosomal miRNA-21 could be a surrogate markers for the diagnosis of scrub typhus–associated AKI.

scholarly journals The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications

2013 ◽  
Vol 95 (3) ◽  
pp. 215-221 ◽  
Author(s):  
I G Panagiotopoulou ◽  
D Parashar ◽  
R Lin ◽  
S Antonowicz ◽  
AD Wells ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Cell Count ◽  
Inflammatory Markers ◽  
White Cell Count ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
White Cell ◽  
C Reactive Protein ◽  
Reactive Protein

Introduction Inflammatory markers such as white cell count (WCC) and C-reactive protein (CRP) and, more recently, bilirubin have been used as adjuncts in the diagnosis of appendicitis. The aim of this study was to determine the diagnostic accuracy of the above markers in acute and perforated appendicitis as well as their value in excluding the condition. Methods A retrospective analysis of 1,169 appendicectomies was performed. Patients were grouped according to histological examination of appendicectomy specimens (normal appendix = NA, acute appendicitis = AA, perforated appendicitis = PA) and preoperative laboratory test results were correlated. Receiver operating characteristic (ROC) curve area analysis (area under the curve [AUC]) was performed to examine diagnostic accuracy. Results ROC analysis of all laboratory variables showed that no independent variable was diagnostic for AA. Good diagnostic accuracy was seen for AA when all variables were combined (WCC/CRP/bilirubin combined AUC: 0.8173). In PA, the median CRP level was significantly higher than that of AA (158mg/l vs 30mg, p<0.0001). CRP also showed the highest sensitivity (100%) and negative predictive value (100%) for PA. CRP had the highest diagnostic accuracy in PA (AUC: 0.9322) and this was increased when it was combined with WCC (AUC: 0.9388). Bilirubin added no diagnostic value in PA. Normal levels of WCC, CRP and bilirubin could not rule out appendicitis. Conclusions CRP provides the highest diagnostic accuracy for PA. Bilirubin did not provide any discriminatory value for AA and its complications. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis.

scholarly journals PEMERIKSAAN TINGKAT sdLDL SERUM SEBAGAI PETANDA DIAGNOSTIK STENOSIS KORONER (Serum sdLDL Level as A Diagnostic Marker of Coronary Stenosis)

2018 ◽  
Vol 22 (1) ◽  
pp. 9
Author(s):  
Indranila K Samsuria ◽  
Laily Adninta
Keyword(s):  
Predictive Value ◽  
Coronary Stenosis ◽  
Area Under The Curve ◽  
Clinical Pathology ◽  
Diagnostic Value ◽  
T Test ◽  
Cross Sectional ◽  
Increased Risk ◽  
Test Kit ◽  
Vascular Stenosis

Small dense LDL (sdLDL) is the LDL which particles are small and dense, it is pro-atherogenic. Increased levels of serum sdLDL areassociated with an increased risk of coronary stenosis. The aim of this study was to examine the diagnostic value of sd LDL in coronarystenosis. An analytical observational study with cross sectional approach was conducted at the Department of Clinical Pathology, MedicalFaculty of Diponegoro University/Dr. Kariadi Hospital and the Unit of Cardiac diseases during the period of March-October 2013. Thesubjects were 39 patients suspected of suffering a coronary stenosis. The diagnosis of coronary stenosis, degree of stenosis and numberof vascular stenosis was established at the time of cardiac catheterization. SdLDL assessment used a test kit. The statistical analysis usedwere unpaired t-test, Spearman correlation test, ROC analysis and diagnostic test. LDL levels in stenosis subjects, 35.4±9.01 mg/dL weresignificantly higher compared to levels in subjects that had no stenosis, 20.7±7.10 mg/dL (p<0.001; unpaired t-test). Correlation testresults showed a correlation between levels of serum sdLDL with severe degree of stenosis (correlation coefficient -0.64, p <0.001) and amoderate positive correlation between the number of vascular stenosis (Coefficient correlation 0.46; p=0.003; Spearman Correlation’sTest). The area under the curve of ROC was 0.9 (p <0.001). The cut off levels sdLDL were used to detect stenosis. The results showeda sensitivity of 85.2%, specificity of 75%, positive predictive value of 88.5%, negative predictive value of 69.2% and accuracy of 82%.Levels of serum sdLDL were associated with severe to extensive stenosis degree, and showed a good diagnostic value, thus, it can beused for screening to determine the presence of coronary stenosis.

scholarly journals Evaluation of diagnostic value of neutrophil to lymphocyte ratio in younger and older pediatrics suspect to acute appendicitis in Imam Hossein hospital

2020 ◽  
Vol 5 (2) ◽  
pp. e26-e26
Author(s):  
Azar Baradaran ◽  
Azar Naimi ◽  
Elahe Pirpiran ◽  
Masoud Akhlaghi
Keyword(s):  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Medical Center ◽  
Statistical Tests ◽  
The United States ◽  
Diagnostic Value ◽  
Neutrophil To Lymphocyte Ratio ◽  
Significance Level ◽  
Suspected Appendicitis ◽  
Lymphocyte Ratio

Introduction: Acute appendicitis in children is the most common acute surgical condition in children. Each year, 80000 children in the United States suffer from appendicitis. Objectives: The aim of this study was to evaluate diagnostic value of neutrophil to lymphocyte ratio (NLR) in younger and older pediatrics suspect of acute appendicitis in Imam Hossein hospital. Patients and Methods: This was a retrospective study conducted at Imam Hossein hospital from 2015-2017. The study population was all children with suspected appendicitis who refer to Imam Hossein medical center in Isfahan. The sample size was 423 people. The collected data were imported into SPSS software version 22 and analyzed with appropriate statistical tests. The significance level in the present study was less than 0.05. Results: The average age of participants was 7.2 ± 3.8 years. In both study groups, it was observed that the mean NLR in the normal and reactive follicular groups was significantly lower than the appendicitis and complication groups (P<0.05). The results of the present study showed that NLR diagnostic test can be a good predictor for the evaluation of appendicitis in both groups under 4 years and over 4 years. For more than 4 years’ group; AUC=0.74, P<0.001 and for less than 4 years’ group; AUC=0.69, P<0.001. For less than 4 years’ group, the cut-off score for appendicitis diagnosis was 2.3. In this cut-off, the sensitivity and specificity were equal to 0.65% and 0.72%. Additionally, for more than 4 years’ group, the cut-off for the diagnosis of appendix was 3.5. In this cut-off, the sensitivity and specificity were equal to 0.73% and 67%. Conclusion: This analysis demonstrates that NLR, in the context of appropriate clinical assessment of patients with a high a priori probability of appendicitis, has a greater diagnostic accuracy in supporting the diagnosis of appendicitis.

scholarly journals DIFFERENCES IN LEUKOCYTE RATE BETWEEN ACUTE NONPERFORATED AND PERFORATED APPENDICITIS IN HOSPITALISED PATIENTS BANDAR LAMPUNG-INDONESIA

2019 ◽  
Vol 2 (1) ◽  
pp. 25-31
Author(s):  
Festy Ladyani ◽  
Nur Fitria Dewi
Keyword(s):  
Acute Appendicitis ◽  
Public Hospital ◽  
Leucocyte Count ◽  
Univariate Analysis ◽  
Perforated Appendicitis ◽  
Sampling Technique ◽  
Bivariate Analysis ◽  
P Value ◽  
Cross Sectional ◽  
Hospitalised Patients

Background: Acute appendicitis is one of the most common acute abdominal pain. A late check up and diagnosis could bring harms which is turning into perforated appendicitis. Leukocyte count is a laboratory collation that is generous and quick to diagnose the acute apendicitis and perforated appendicitis, however there’s no certain limit of the leukocytes count to recognize whether it is acute apendicitis or perforated appendicitis.Purpose: This research was to find out the comparison of leucocyte count average between acute appendicitis and perforation appendicitis in Dr. H. Abdul Moeleok public hospital of Lampung province in 2014-2016.Methods: An analytic research with cross sectional approach. Population was 382 patients with appendicitis in Dr. Hi. Abdul Moeloek public hospital. Samples were taken using total sampling technique with 196 respondent samples for acute appendicitis and 196 respondent samples for perforation appendicitis. Data were analyzed by using univariate analysis with percentage and bivariate analysis with t-test.Results: the average of leucocyte count of acute appendicitis patients was 10,907 with minimum and maximum leucocyte count of 5,000 and 18,500 respectively. The average of leucocyte count of perforation appendicitis patients was 22,789 with minimum and maximum leucocyte count of 16,500 and 31,000 respectively. There were differences of leucocyte counts between acute appendicitis patients and perforation appendicitis patients with p-value < 0.05.Conclusion: there were significant differences of leucocyte count averages between acute appendicitis and perforation appendicitis.

scholarly journals A study to assess the role of raised total leucocyte count in diagnosis of acute appendicitis

2020 ◽  
Vol 7 (10) ◽  
pp. 1541
Author(s):  
Rajesh Kumar ◽  
Renu Chauhan
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Leucocyte Count ◽  
Histopathological Examination ◽  
Perforated Appendicitis ◽  
Cross Sectional Study ◽  
Total Leucocyte Count ◽  
Cross Sectional ◽  
Gandhi Medical College ◽  
Low Sensitivity

Introduction: Total Leucocyte Count (TLC) is an easily available and commonly performed investigation and studies have reported various degrees of leucocytosis in patients with acute appendicitis. This study was performed with the aim to assess the diagnostic validity of raised TLC count in acute appendicitis.Methods: This was a cross sectional study conducted from 2013 to 2015, in the Department of General Surgery, Indira Gandhi Medical College, Shimla. A clinical diagnosis of acute appendicitis was made based on detailed history taking, clinical examination, and laboratory investigations including TLC count. 50 patients with acute appendicitis were enrolled in the study by convenience sampling, after taking a written, informed consent. Appendicectomy specimen were sent for histopathological examination (HPE).Results: The mean age of the patients was 26.48 ± 12.28 years. 29 (58%) patients were male, and 21 (42%) were female. The negative appendicectomy rate in the present study was 14%. 7 (14%) were normal appendices, 31 (62%) inflamed appendices, 4 (8%) perforated appendices, and 8 (16%) gangrenous appendices as per HPE report. In our study, there were 12 (24%) cases of complicated appendicitis i.e., 8 (16%) cases of gangrenous appendicitis and 4 (8%) cases of perforated appendicitis). TLC had a sensitivity 76.74%, specificity 51.14%, positive predictive value 91.66%, and negative predictive value 28.57%.Conclusion: In our study, TLC was found to have low sensitivity and specificity for acute appendicitis. Hence, used alone, TLC may not be diagnostic of acute appendicitis. However, used in conjunction with other laboratory parameters, it will lead to improvement of diagnostic accuracy.

Abdominal Computed Tomography in the Evaluation of Acute and Perforated Appendicitis in the Community Setting

2007 ◽  
Vol 73 (10) ◽  
pp. 1002-1005 ◽  
Author(s):  
D.O. Vu Huynh ◽  
Fariborz Lalezarzadeh ◽  
Shokry Lawandy ◽  
David T. Wong ◽  
Victor C. Joe
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Predictive Value ◽  
Perforated Appendicitis ◽  
Community Setting ◽  
Diagnostic Value ◽  
Academic Community ◽  
Negative Appendectomy ◽  
Community Based ◽  
Abdominal Computed Tomography

Several studies report sensitivity and specificity of abdominal computed tomography scans (CT) for the evaluation of acute appendicitis as high as 98 per cent. Despite increased utilization of CT, the rate of negative appendectomy has remained constant at 10 to 20 per cent. The objective of this study was to assess the effectiveness of CT in the evaluation of acute and perforated appendicitis in an academic community-based setting. A retrospective review of 550 patient charts with International Classification of Diseases-9 (ICD-9) codes for acute and perforated appendicitis from January 2002 to October 2005 was performed. Sensitivity of CT was 87 per cent with a positive predictive value of 92 per cent. Specificity was 42 per cent with a negative predictive value of 29 per cent. Negative appendectomy rates were similar with or without CT (11% vs 13%, respectively). Our data suggests that CT used liberally in everyday practice in a community-based setting to evaluate acute appendicitis may not have as strong of a diagnostic value as those used in protocol-driven research studies. Further prospective studies are needed to formulate criteria to better delineate the role of CT in the evaluation of acute appendicitis.

scholarly journals Predictive value of scoring systems for the diagnosis of acute appendicitis in emergency department patients: Is there an accurate one?

2019 ◽  
Vol 27 (5) ◽  
pp. 262-269
Author(s):  
Rohat Ak ◽  
Fatih Doğanay ◽  
Ebru Unal Akoğlu ◽  
Haldun Akoğlu ◽  
Aslı Bahar Uçar ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Acute Appendicitis ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Acute Inflammatory Response ◽  
Quadrant Pain ◽  
Lower Quadrant Pain ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
Right Lower Quadrant

Background: Acute appendicitis is one of the challenging surgical conditions presented in the emergency departments. Clinical scoring systems were developed to reduce the negative appendectomy rate and also to avoid unnecessary diagnostic evaluation. Objectives: The primary aim was to compare the clinical adequacy of the Alvarado, Acute Inflammatory Response, and the Raja Isteri Pengiran Anak Saleha Appendicitis scores in patients with right lower quadrant pain for the diagnosis of acute appendicitis. Methods: This was a prospective and observational study. All patients over the age of 18 years who presented with a complaint of right lower quadrant pain were enrolled. The Alvarado, Acute Inflammatory Response, and Raja Isteri Pengiran Anak Saleha Appendicitis scoring systems were compared. The patients were either admitted or followed-up as out-patient. Face-to-face or telephone follow-up visits were arranged for the patients who did not have surgery and who were not admitted. Results: 232 patients were included and 14 patients were excluded from the study. Of the 218 patients, 114 patients underwent surgery. Of the 114 patients, 107 patients were pathologically diagnosed with acute appendicitis. It was determined that Raja Isteri Pengiran Anak Saleha Appendicitis score was the most valuable score with 0.88 accuracy, followed by Acute Inflammatory Response (area under the curve = 0.79) and Alvarado (area under the curve = 0.71) scores. Conclusion: The accuracy of Raja Isteri Pengiran Anak Saleha Appendicitis scoring system was higher for the diagnosis of acute appendicitis than the other scores. The cut-off of the Raja Isteri Pengiran Anak Saleha Appendicitis score from a 7.5-point threshold provides a practical, non-invasive, rapid diagnostic method that increases acute appendicitis discriminative power in patients presenting with right lower quadrant pain.

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