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Journal of Gastrointestinal Surgery

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Open Access 01-10-2019 | Original Article

Ruling out Appendicitis in Children: Can We Use Clinical Prediction Rules?

Authors: Paul van Amstel, Ramon R. Gorter, Johanna H. van der Lee, Huib A. Cense, Roel Bakx, Hugo A. Heij

Published in: Journal of Gastrointestinal Surgery | Issue 10/2019

Abstract

Purpose

To identify available clinical prediction rules (CPRs) and investigate their ability to rule out appendicitis in children presenting with abdominal pain at the emergency department, and accordingly select CPRs that could be useful in a future prospective cohort study.

Methods

A literature search was conducted to identify available CPRs. These were subsequently tested in a historical cohort from a general teaching hospital, comprising all children (< 18 years) that visited the emergency department between 2012 and 2015 with abdominal pain. Data were extracted from the electronic patient files and scores of the identified CPRs were calculated for each patient. The negative likelihood ratios were only calculated for those CPRs that could be calculated for at least 50% of patients.

Results

Twelve CPRs were tested in a cohort of 291 patients, of whom 87 (29.9%) suffered from acute appendicitis. The Ohmann score, Alvarado score, modified Alvarado score, Pediatric Appendicitis score, Low-Risk Appendicitis Rule Refinement, Christian score, and Low Risk Appendicitis Rule had a negative likelihood ratio < 0.1. The Modified Alvarado Scoring System and Lintula score had a negative likelihood ratio > 0.1. Three CPRs were excluded because the score could not be calculated for at least 50% of patients.

Conclusion

This study identified seven CPRs that could be used in a prospective cohort study to compare their ability to rule out appendicitis in children and investigate if clinical monitoring and re-evaluation instead of performing additional investigations (i.e., ultrasound) is a safe treatment strategy in case there is low suspicion of appendicitis.

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Title: Ruling out Appendicitis in Children: Can We Use Clinical Prediction Rules?
Authors: Paul van Amstel
Ramon R. Gorter
Johanna H. van der Lee
Huib A. Cense
Roel Bakx
Hugo A. Heij
Publication date: 01-10-2019
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 10/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-018-3997-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Ruling out Appendicitis in Children: Can We Use Clinical Prediction Rules?

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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