[Hospital emergency room diagnosis of acute appendicitis in patients aged 2 to 20 years: the INFURG-SEMES score from the emergency infections study of the Spanish Society of Emergency Medicine]. / Escala INFURG-SEMES para el diagnóstico de apendicitis aguda en los pacientes de 2 a 20 años atendidos en los servicios de urgencias hospitalarios.

OBJECTIVES: To develop the INFURG-SEMES scale (based on the emergency infections study of the Spanish Society of Emergency Medicine) using clinical and laboratory data to diagnose acute appendicitis (AA) in patients aged 2 to 20 years who were evaluated in hospital emergency departments and to compare its diagnostic yield to that of the Alvarado score. MATERIAL AND METHODS: Prospective observational cohort study enrolling consecutive patients between the ages of 2 and 20 years who came to 4 hospital emergency departments with abdominal pain suggestive of AA and of less than 72 hours' duration. We collected demographic, clinical, analytic (white blood cell count, differential counts, and C-reactive protein [CRP] levels), and radiographic data (ultrasound and/or computed tomography scans). We also recorded surgical data if pertinent. The main outcome was a diagnosis of AA within 14 days of the index visit. RESULTS: We included 331 patients with a mean (SD) age of 11.8 (3.8) years; 175 (52.9%) were male. The final diagnosis was AA in 116 cases (35.0%). The INFURG-SEMES scale included the following predictors: male sex, right quadrant pain (right iliac fossa) on examination, pain on percussion, pain on walking, and elevated neutrophil count and CRP level. The areas under the receiver operating characteristic curves for the INFURG-SEMES scale and the Alvarado score, respectively, were 0.84 (95% CI, 0.79-0.88) and 0.77 (95% CI, 0.72-0.82). The difference was statistically significant (P=.002). CONCLUSION: The INFURG-SEMES scale may prove useful for diagnosing AA in patients aged between 2 and 20 years evaluated for abdominal pain in hospital emergency departments. The INFURG-SEMES score showed greater discrimination than the Alvarado score.

OBJETIVO: Derivar una escala clínico-analítica diagnóstica de apendicitis aguda (AA) en pacientes entre 2 y 20 años atendidos por dolor abdominal con sospecha de AA en servicios de urgencias hospitalarios (SUH), y comparar su capacidad diagnóstica con la Escala de Alvarado (EA). METODO: Estudio observacional de cohorte prospectivo que incluyó de forma consecutiva pacientes entre 2 y 20 años con dolor abdominal sospechoso de AA de menos de 72 horas de evolución atendidos en 4 SUH españoles entre junio y diciembre de 2014. Se recogieron datos demográficos, clínicos, analíticos (recuento leucocitario, fórmula y proteína C reactiva) y radiológicos (ecografía y/o TC) y, si procedía, quirúrgicos. La variable resultado principal fue el diagnóstico final de AA en los 14 días desde la visita índice. RESULTADOS: Se incluyeron 331 pacientes con edad media de 11,8 (DE 3,8) años, siendo 175 (52,9%) hombres. Ciento dieciséis (35,0%) tuvieron diagnóstico final de AA. La escala INFURG-SEMES incluye sexo masculino, dolor en fosa ilíaca derecha a la exploración, dolor a la percusión, dolor al caminar, presencia de neutrofilia y proteína C reactiva elevada. El área bajo la curva (ABC) de la característica operativa del receptor (COR) de dicha escala fue 0,84 (IC 95% 0,79-0,88) y para la EA 0,77 (IC95% 0,72-0,82) siendo la diferencia estadísticamente significativa (p = 0,002). CONCLUSIONES: La escala INFURG-SEMES podría ser una herramienta de ayuda para el diagnóstico de AA en los pacientes entre 2 y 20 años atendidos con dolor abdominal sospechoso de apendicitis en los SUH, y ha mostrado una mayor capacidad discriminativa que la EA.

Diagnostic accuracy of the APPY1 Test in patients aged 2-20 years with suspected acute appendicitis presenting to emergency departments.

OBJECTIVE: Evaluate the diagnostic accuracy of the APPY1 Test alone and in combination with the Alvarado score (AS) to rule out acute appendicitis (AA) in patients presenting to EDs with abdominal pain suspicious for AA. METHODOLOGY: Observational study in a prospective consecutive cohort including all patients from 2 to 20 years with abdominal pain suggestive of AA in four EDs. The APPY1 Test was performed and AS was calculated to determine risk stratification for each patient. RESULTS: 321 patients enrolled (mean age 11.8 (SD 3.8) years, 52.0% male), with 32.4% low risk, 23.7% intermediate risk and 43.9% high risk according to the AS. 111 (34.6%) had AA, of whom 1 (0.9%) had a false-negative APPY1 Test result. The APPY1 Test had a sensitivity (Se) of 99.1% (95% CI 94.4% to 99.9%), specificity (Sp) of 32.9% (95% CI 26.6% to 39.7%), negative predictive value (NPV) of 98.6% (95% CI 91.2% to 99.9%) and negative likelihood ratio (LHR-) of 0.03 (0.00 to 0.19) in this population. For patients at low risk by AS, the APPY1 Test had a Se of 100% (95% CI 62.9% to 100%), NPV of 100% (95% CI 91.1% to 100%) and LHR- of 0.0 (not calculable), and for patients at intermediate risk by AS, the APPY1 Test had a Se of 94.4% (95% CI 70.6% to 99.7%), NPV of 94.7% (95% CI 71.9% to 99.7%) and LHR- of 0.18 (0.0 to 1.2), respectively. CONCLUSIONS: APPY1 Test is a potentially useful diagnostic tool to rule out AA in this population, with clinical utility primarily in those patients classified as having low clinical risk of appendicitis according to the AS.

Effective coil embolization of intracavernous carotid artery pseudoaneurysm with parental artery preservation following severe head trauma in a pediatric patient.

BACKGROUND: Intracranial traumatic pseudoaneurysms are rare in children. If left untreated, mortality rate can be as high as 50% due to delayed rupture and disastrous bleeding. Endovascular embolization is considered the preferred treatment option because of its minimal invasiveness and negligible mortality. However, exclusion of the pseudoaneurysm with preservation of the parental vessel is not always possible. In comparison with peripheral aneurysms, intracavernous internal carotid artery lesions are technically more challenging with both open surgery and endovascular techniques. CASE REPORT: We report the case of a successful two-stage coil embolization of a traumatic intracavernous carotid artery pseudoaneurysm with preservation of parental vessel in a 6-year-old boy. CONCLUSION: Endovascular embolization with parental vessel preservation should be considered the first treatment option for traumatic intracavernous internal carotid artery pseudoaneurysms in children. Although treatment of pseudoaneurysms in this location may be technically difficult, it is feasible in experienced hands.