Prediction of acute appendicitis among patients with undifferentiated abdominal pain at emergency department.

ABSTRACT

BACKGROUND: Early screening and accurately identifying Acute Appendicitis (AA) among patients with undifferentiated symptoms associated with appendicitis during their emergency visit will improve patient safety and health care quality. The aim of the study was to compare models that predict AA among patients with undifferentiated symptoms at emergency visits using both structured data and free-text data from a national survey. METHODS: We performed a secondary data analysis on the 2005-2017 United States National Hospital Ambulatory Medical Care Survey (NHAMCS) data to estimate the association between emergency department (ED) patients with the diagnosis of AA, and the demographic and clinical factors present at ED visits during a patient's ED stay. We used binary logistic regression (LR) and random forest (RF) models incorporating natural language processing (NLP) to predict AA diagnosis among patients with undifferentiated symptoms. RESULTS: Among the 40,441 ED patients with assigned International Classification of Diseases (ICD) codes of AA and appendicitis-related symptoms between 2005 and 2017, 655 adults (2.3%) and 256 children (2.2%) had AA. For the LR model identifying AA diagnosis among adult ED patients, the c-statistic was 0.72 (95% CI 0.69-0.75) for structured variables only, 0.72 (95% CI 0.69-0.75) for unstructured variables only, and 0.78 (95% CI 0.76-0.80) when including both structured and unstructured variables. For the LR model identifying AA diagnosis among pediatric ED patients, the c-statistic was 0.84 (95% CI 0.79-0.89) for including structured variables only, 0.78 (95% CI 0.72-0.84) for unstructured variables, and 0.87 (95% CI 0.83-0.91) when including both structured and unstructured variables. The RF method showed similar c-statistic to the corresponding LR model. CONCLUSIONS: We developed predictive models that can predict the AA diagnosis for adult and pediatric ED patients, and the predictive accuracy was improved with the inclusion of NLP elements and approaches.