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.

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

2021 ◽  
Author(s):  
Ricardo Rassi ◽  
Florencia Muse ◽  
José Sánchez-Martínez ◽  
Eduardo Cuestas
Keyword(s):  
Acute Appendicitis ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Diagnostic Value ◽  
Clinical Prediction ◽  
Alvarado Score ◽  
Predictive Values ◽  
Optimal Criterion ◽  
Area Under Roc Curve ◽  
Appendicitis Score

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.

APPENDECTOMY IN CHILDREN WITH ACUTE RHEUMATIC FEVER

PEDIATRICS ◽  
1969 ◽  
Vol 43 (4) ◽  
pp. 573-577
Author(s):  
Jer-Shoung Lin ◽  
Ramon Rodriguez-Torres
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Laboratory Data ◽  
Initial Symptom ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
The Right

Clinical and laboratory data on five patients with appendectomy, later proved to have acute rheumatic fever, are presented in detail. The findings indicate that abdominal pain simulating acute appendicitis can be presented as the only initial symptom in acute rheumatic fever. Awareness and knowledge of the presence of clues-high fever, rapid sedimentation rate, prolonged P-R interval, and 4 plus C-reactive protein-usually help to make the differential diagnosis. However, if doubt remains, the right approach is to go ahead with surgery since these patients tolerate anesthesia and laparotomy very well.

scholarly journals Polyclonal pancreatic elastase assay is superior to monoclonal assay for diagnosis of acute pancreatitis

1997 ◽  
Vol 43 (12) ◽  
pp. 2339-2344 ◽  
Author(s):  
Volker Keim ◽  
Niels Teich ◽  
Andrea Reich ◽  
Fritz Fiedler ◽  
Joachim Mössner
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Polyclonal Antibodies ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Serum Concentrations ◽  
Clinical Value ◽  
Serum Samples ◽  
Pancreatic Elastase ◽  
Serum Elisa

Abstract We compared the clinical values for diagnosis of acute pancreatitis of two commercial assays for pancreatic elastase: an ELISA procedure with monoclonal antibodies and a RIA technique with polyclonal antibodies. In 14 patients with acute pancreatitis, serum concentrations of elastase determined by ELISA (ELISA-elastase) decreased much faster (half-life 0.4 days) than those of elastase determined by RIA (RIA-elastase) (2.2 days), amylase (0.8 days), or lipase (0.9 days). Serum samples from 253 additional patients with abdominal pain (32 of these with acute pancreatitis) were analyzed. In sera collected up to 48 h after the onset of disease, the ROC curves showed a slightly higher diagnostic value of RIA-elastase. In samples taken later, at a sensitivity of 90% the specificity of RIA-elastase was 95% (ELISA-elastase 40%). We conclude that serum ELISA-elastase is of much lower clinical value than RIA-elastase for diagnosis of acute pancreatitis.

scholarly journals Abdominal Pain in the Female Patient: A Case of Concurrent Acute Appendicitis and Ruptured Endometrioma

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Martine A. Louis ◽  
Amanda R. Doubleday ◽  
Elizabeth Lin ◽  
Ji Yoon Baek ◽  
Alda Andoni ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Acute Abdominal Pain ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Common Cause ◽  
Surgical Emergencies ◽  
Ovarian Endometrioma ◽  
General Surgeons

General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. We report a case of concurrent acute appendicitis and ruptured ovarian endometrioma.

scholarly journals Uncommon Differential Diagnosis of Acute Right-sided Abdominal Pain – Case Report

2019 ◽  
Vol 4 (1) ◽  
pp. 33-36
Author(s):  
Cédric Kwizera ◽  
Benedikt Wagner ◽  
Johannes B. Wagner ◽  
Călin Molnar
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Fragile X ◽  
Pleural Empyema ◽  
Blind Ending ◽  
Rare Differential Diagnosis ◽  
Mentally Impaired ◽  
The Right ◽  
Tract Infections

Abstract The appendix is a worm-like, blind-ending tube, with its base on the caecum and its tip in multiple locations. Against all odds, it plays a key role in the digestive immune system and appendectomy should therefore be cautiously considered and indicated. We report the case of a 45-year-old male with a known history of Fragile-X syndrome who presented to the emergency department with intense abdominal pain and was suspected of acute appendicitis, after a positive Dieulafoy’s triad was confirmed. The laparoscopic exploration showed no signs of inflammation of the appendix; nonetheless, its removal was carried out. Rising inflammatory laboratory parameters led to a focused identification of a pleural empyema due to a tooth inlay aspiration. Our objective is to emphasize the importance of a thorough anamnesis, even in cases of mentally impaired patients, as well as to highlight a rare differential diagnosis for appendicitis. Acute appendicitis is an emergency condition that requires a thorough assessment and appropriate therapy. Clinical examinations are important, but in this particular case, imaging methods had a much more important role in establishing the right treatment approach. Furthermore, the signs of acute appendicitis are mimicked by several medical conditions including respiratory tract infections.

Comparative Analysis of Diagnostic Value for Shear Wave Elastography and Real-Time Elastographic Imaging for Thyroid Nodules

2019 ◽  
Vol 9 (2) ◽  
pp. 334-338
Author(s):  
Qing Yang ◽  
Wenhong Zhou ◽  
Jiyu Li ◽  
Guojun Wu ◽  
Feng Ding ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Shear Wave ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Shear Wave Elastography ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Sensitivity Specificity

Objective: To compare the diagnostic value of shear wave elastography (SWE) and real-time elastography (RTE) in the diagnosis of benign and malignant thyroid nodules. Methods: A total of 34 patients who ever received thyroidectomy in our hospital from January 2016 to January 2018 were identified. Meanwhile, all the patients received SWE and RTE before surgery, and all the diagnoses were confirmed by pathological examinations. With respect to SWE technique, the Subject Operating Characteristics (ROC) curves were drawn, in order to obtain the optimal threshold and then make differential diagnoses of benign and malignant thyroid nodules. In terms of RTE, the Rago 5 scoring method was utilized to make differential diagnoses of benign and malignant thyroid nodules. Besides, the pathological examinations after surgery could be considered as the golden standard. At last, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE and RTE were calculated, respectively. Results: A total of 51 thyroid nodules were identified, and 41 nodules were benign, 10 nodules were malignant. On the basis of ROC curves, with respect to SWE, the best threshold for differential diagnosis of benign and malignant thyroid nodules is 38.3 kPa. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SWE were 72.7% (8/11), 85% (34/40), 82.4% (42/51), 68.4% (13/19), and 87.5% (35/40), respectively. And the diagnostic indicators of RTE were 81.8% (9/11), 87.5% (35/40), 84.3% (43/51), 73.7% (14/19), and 90.0% (36/40). The sensitivity of quasi-static elastography in differential diagnosis of benign and malignant thyroid nodules with diameter ≤1 cm was 87.5% (7/8), and the sensitivity of SWE was 50.0% (5/10). In addition, the accuracy of SWE in differential diagnosis of benign and malignant thyroid nodules with diameter ≥3 cm was 100% (6/6), and the accuracy of RTE for this kind of thyroid nodules was 66.7% (4/6). Conclusion: Both SWE and RTE technology have good application value in differential diagnosis of benign and malignant thyroid nodules. But, SWE is preferable when making diagnosis of benign and malignant thyroid nodules with diameter ≥3 cm, and RTE was superior in detecting benign and malignant thyroid nodules with diameter ≤1 cm.

scholarly journals sB7H3 in Children with Acute Appendicitis: Its Diagnostic Value and Association with Histological Findings

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Xiaochen Du ◽  
Yan Chen ◽  
Jie Zhu ◽  
Zhenjiang Bai ◽  
Jun Hua ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Performance ◽  
Perforated Appendicitis ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Control Group ◽  
Histological Findings ◽  
Routine Examination ◽  
Valuable Marker ◽  
Diagnostic Capacity

Background. Several efforts have been made to find out a valuable marker to assist the diagnosis and differentiation of gangrenous/perforated appendicitis. We aimed to determine the diagnostic capacity of soluble B7H3 (sB7H3) in acute appendicitis (AA) and its accuracy as a predictor of the severity of appendicitis. Methods. 182 children were allocated into four groups as follows: control group (CG, 90), simple appendicitis (SA, 12), purulent appendicitis (PA, 49), and gangrenous appendicitis (GA, 31). Prior to appendectomy, blood was collected and sent for analysis of routine examination and cytokines (sB7H3 and TNF-α). We compared values of all measured parameters according to histological findings. Furthermore, we assigned AA patients into the nonperforated appendicitis group and the perforated appendicitis group. The diagnostic effects of significant markers were assessed by ROC curves. Results. Only the levels of CRP, FIB, and sB7H3 had a remarkable rising trend in AA-based groups, while differences in the levels of CRP and FIB between simple appendicitis and purulent appendicitis were not statistically significant. In addition, sB7H3 was found as the only marker in children with AA, which was markedly associated with the degree of histological findings of the appendix. Furthermore, sB7H3 had a high diagnostic value in predicting AA and complex appendicitis (PA+GA) in children. However, the diagnostic performance of sB7H3 for distinguishing PA from GA was not remarkable. Additionally, only the levels of CRP and sB7H3 were statistically different between the nonperforated appendicitis group and the perforated appendicitis group. The diagnostic performance of CRP and sB7H3 could not merely predict perforation of AA in children; however, the diagnostic performance was improved after combination. Conclusions. sB7H3 could be used as a valuable marker to predict the presence of AA and complex AA in children. However, the diagnostic value of sB7H3 to predict gangrenous/perforated appendicitis was not found to be remarkable. The combination of sB7H3 and CRP might improve the prediction of perforated appendicitis.

scholarly journals Significance of peripheral blood indexes in differential diagnoses of SARS-CoV-2 and New Bunia virus

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wentao He ◽  
Xiaoyi Liu
Keyword(s):  
Differential Diagnosis ◽  
T Lymphocyte ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Blood Parameters ◽  
Control Group ◽  
Clinical Value ◽  
T Lymphocyte Subsets ◽  
Reactive Protein ◽  
Tnf Α

AbstractWe aimed to provide a laboratory basis for differential diagnosis of COVID-19 and severe fever with thrombocytopenia syndrome (SFTS). Clinical data were collected from 32 COVID-19 patients (2019-nCoV group), 31 SFTS patients (SFTS group) and 30 healthy controls (control group). For each group of hospitalized patients, a retrospective analysis was performed on specific indices, including cytokines, T-lymphocyte subsets, routine blood parameters, C-reactive protein (CRP) and procalcitonin (PCT), and receiver operating characteristic (ROC) curves for the indices revealed the differences among groups. Compared with the 2019-nCoV group, the SFTS group had a significantly and greatly decreased counts of WBC, absolute lymphocyte, PLT and absolute CD4+ T lymphocyte (P < 0.05); the IL-6, TNF-α, D-D and PCT levels of the SFTS group were higher than those of the 2019-nCoV group (P < 0.05). Compared with those of the SFTS group, the CRP and FIB levels of the 2019-nCoV group were greatly increased (P < 0.05). The ROC curves showed that area under the curves (AUCs) for FIB, PLT and TNF-α were greater than 0.85, demonstrating high diagnostic value. At the initial stage of SARS-CoV-2 or SFTS virus infection, PLT, FIB and TNF-α have definitive clinical value for the early and differential diagnosis of these two infections.

Provocation testing is irreplaceable to uncover or refute Brugada syndrome – an electrocardiographic validation study during ajmaline provocation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.H Van Der Ree ◽  
J Vendrik ◽  
J.A Kors ◽  
A.A.M Wilde ◽  
H.L Tan ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Peak Effect ◽  
Characteristic Type ◽  
Predictive Values ◽  
Provocation Tests ◽  
Diagnostic Characteristics

Abstract Background A Brugada syndrome (BrS) diagnosis is made upon documenting its characteristic type-1 ECG abnormality, being either spontaneously present or provoked by drug challenge, in the absence of co-morbidities resulting in similar ECG characteristics. In patients without type-1 ECG but in whom a suspicion of BrS exists, several ECG characteristics have been proposed that could aid in distinguishing BrS from non-BrS, particularly in individuals with incomplete right bundle branch block. Purpose To validate the diagnostic value of ECG characteristics that were previously proposed. Methods For this retrospective study, ECGs were evaluated from consecutive patients suspected of BrS who underwent ajmaline testing (n=1392). Baseline ECG and peak-effect ECG were analyzed with the MEANS software. Parameters considered were P, PR, QRS, S, JT, QT and QTc durations (all in ms), J and S amplitudes (both in mV), and QRS and T axes (both in °). ECG evaluations also included b-angles (in °) and duration of the base of a triangle (DBT) at 0.5 mV from the r' (in ms) in right precordial leads (V1, V2, V1ic3, V2ic3). Results Diagnostic type-1 ECGs were uncovered in 345 subjects and 1047 subjects had a negative test. Patients with BrS had significantly more atrial and ventricular conduction abnormalities (P, PR, QRS, and S duration) at baseline; these differences, except in PR duration, were aggravated upon ajmaline administration. In particular, the b-angle (e.g., V1: 28° [20; 46.5] versus 18° [12; 24], p&lt;0.01) and DBT (e.g., V1: 130 ms [89; 214] versus 65 ms [42; 92.3], p&lt;0.01) were significantly larger at baseline in patients with BrS, however, only with modest diagnostic value (area-under-the-curve 0.67–0.80). The optimal b-angle cut-off value based on the ROC curves to rule out BrS was determined at an angle of &gt;15°, negative predictive values ranged from 78.6–95.5 and sensitivities ranged from 80–98.1% among different leads. Conclusions Patients with BrS show more baseline ECG abnormalities and display more conduction slowing upon ajmaline infusion. The b-angle and DBT do not demonstrate strong enough diagnostic characteristics to serve as a stand-alone diagnostic tool. Drug provocation tests remain necessary for diagnosing BrS in patients without a spontaneous type-1 ECG. Funding Acknowledgement Type of funding source: None

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