[Appendicitis predictive score for children younger than 4 years] / Escala predictiva de apendicitis para menores de 4 años.

Introduction: The clinical presentation of acute appendicitis in infants and young children is nonspecific. The diagnosis is often delayed and is accompanied by high rates of appendiceal perforation. The aim of the present study was to develop an early diagnostic scale for acute appendicitis in children less than 4 years of age. Results: The scale had a high discrimination index area under the ROC curve of 0.96 (95%CI 0.88-0.99), sensitivity of 95.1% (95%CI 86.3-99.0%), specificity of 90.0% (95%CI 55.7-89.5%), positive predictive value of 98.3% (95%CI 90.0-99.7%) and negative predictive value of 75.0% (95%CI 49.4-90.2). Conclusions: In this study, a risk score based on characteristics of children less than 4 years with abdominal pain was developed that may help predict a patient's risk of developing acute appendicitis. Patients and methods: 100 children less than 4 years of age with a presumptive diagnosis of acute appendicitis were retrospectively evaluated in 4 hospitals. The case group comprised 90 patients with histopathological diagnosis of positive appendicitis (with inflammation in the appendiceal wall) while the control group comprised 10 patients with a histopathological diagnosis of negative appendicitis (without inflammation). Epidemiological, clinical, laboratory, and ultrasound variables were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score. Accuracy of the score was measured by the area under the receiver operating characteristic curve. Final model comprised 4 variables (Blumberg's sign, C-reactive protein, neutrophil-lymphocyte index and positive ultrasound). Results: The scale had a high discrimination index area under the ROC curve of 0.96 (95%CI 0.88-0.99), sensitivity of 95.1% (95%CI 86.3-99.0%), specificity of 90.0% (95%CI 55.7-89.5%), positive predictive value of 98.3% (95%CI 90.0-99.7%) and negative predictive value of 75.0% (95%CI 49.4-90.2). Conclusions: In this study, a risk score based on characteristics of children less than 4 years with abdominal pain was developed that may help predict a patient's risk of developing acute appendicitis.

Introducción: La presentación clínica de la apendicitis aguda en niños pequeños es inespecífica. El diagnóstico suele demorarse y se acompaña de elevadas tasas de perforación apendicular. Objetivo: Desarrollar una escala de diagnóstico temprano de apendicitis para menores de 4 años. Pacientes y métodos: 100 menores de 4 años apendicectomizados con diagnóstico presuntivo de apendicitis aguda fueron estudiados retrospectivamente en 4 hospitales. El grupo de casos estuvo conformado por 90 pacientes con diagnóstico histopatológico de apendicitis positiva (con inflamación en la pared apendicular) mientras que el grupo de controles estuvo conformado por 10 pacientes con diagnóstico histopatológico de apendicitis negativa (sin inflamación). Las variables demográficas, clínicas, de laboratorio y ecográficas se analizaron mediante selección LASSO y regresión logística para construir una escala predictiva de riesgo de apendicitis. La precisión de la escala se midió por el área bajo la curva de características operativas del receptor. El modelo final comprendió 4 variables (signo de Blumberg, proteína C reactiva, índice neutrófilos-linfocitos y ecografía). Resultados: La escala presentó una elevada precisión 0,96 (IC95% 0,88-0,99), una sensibilidad de 95,1% (IC95 86,3-99,0%), una especificidad de 90,0% (IC95% 55,7-89,5%), un valor predictivo positivo de 98,3% (IC95% 90,0-99,7%) y un valor predictivo negativo de 75,0% (IC95% 49,4-90,2). Conclusiones: En este estudio se desarrolló una escala predictiva basada en las características de los niños menores de 4 años con dolor abdominal agudo que puede ayudar a predecir el riesgo de apendicitis aguda en este grupo etario.

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

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.

Acute appendicitis in children under 4 years:a diagnostic dilemma. / [Apendicitis aguda en niños menores de 4 años:Un dilema diagnóstico.]

Introducction: Acute appendicitis is a pathology caused by inflammation of the cecal appendix , due tocthe obstruction of the appendicular lumen,witch leads to a venous congestion and then eventually to an arterial compromise of the appendicular wall with the consequent perforation of it.The main problem of this pathology in children under 4 years is the high index of appendicecal preforations presented by patients at the time of diagnosis,mainly driven by an unspecific clinical presentation,which leads to a low index of suspicion and a high percentage of complications in that age group. Objetive: perform a literature review on the subject and investigate what is known of appendicitis in children under four years old to date. The data were obtained through a systematic bibliographic search in the pubmed data base from 1980 to 2017 Conclussion: Conclussion the increase in morbidity of acute apendicitis in children under 4 years has a mixed origin since organic factors are mixed age,together with a temporary diagnostic delay and with it the appearance of complicated forms of the disease, there is no sign,symptom or group of them that allows early detection of appendicitis in children under 4 years of age.

Introducción: La apendicitis aguda es una patología producida por la inflamación del apéndice cecal, debido a la obstrucción de la luz apendicular, que lleva a una congestión venosa y luego eventualmente a un compromiso arterial de la pared apendicular con la consiguiente perforación del mismo. El problema principal de ésta patología en menores de 4 años radica en el alto índice de perforaciones apendiculares que presentan los pacientes al momento del diagnóstico; propulsado principalmente por una presentación clínica inespecífica,que conlleva a un bajo índice de sospecha y a un alto porcentaje de complicaciones en dicho grupo etario. Objetivo: realizar una revisión bibliográfica sobre el tema e investigar que se sabe de apendicitis en niños menores de cuatro años hasta el momento.Fuente de Datos se realizo una búsqueda bibliográfica sistemática en la base de datos PubMed desde el año 1980 al año 2017, Conclusiones: El aumento en la morbilidad de la apendicitis aguda en menores de 4 años tiene un orígen mixto ya que se mezclan factores orgánicos propios de la edad,junto a un retraso diagnóstico temporal y con ello a la aparición de formas complicadas de la enfermedad , sin que exista en la actualidad signo, síntoma o conjunto de ellos , que nos permita la detección precoz de apendicitis en menores de 4 años.