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The Heidelberg Appendicitis Score Simplifies Identification of Pediatric Appendicitis

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Abstract

Objective

To identify the factors that facilitate the diagnosis of pediatric appendicitis.

Methods

Institutionally approved retrospective, single center analysis of all patients with acute abdominal pain was done. Medical history, symptoms, laboratory and radiologic findings of all children presenting with abdominal pain were evaluated. To identify the best predictors, uni- and multi-variate analysis were used.

Results

In 2 years, 431 patients fulfilled the inclusion criteria. Data was complete in all subjects. Of these, 156 (36.2 %) suffered from appendicitis. The best discriminators for appendicitis were clinical and ultrasound features. The four best factors were identified by CART analysis (continuous abdominal pain, tenderness on the right lower quadrant, rebound tenderness and conspicuous ultrasound) and combined to the Heidelberg Appendicitis score. A positive score (>3 features) is highly predictive for acute appendicitis (PPV 89.3 %, NPV 94.9 %) and includes all cases of perforated appendicitis.

Conclusions

It is possible to predict acute appendicitis in children. The decision making process can be simplified by the proposed Heidelberg Appendicitis score, which is comprised of four factors. It has great potential to facilitate and accelerate the diagnosis of pediatric appendicitis.

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Abbreviations

WBC :

White blood count

CRP :

C-reactive protein

US :

Ultrasound

CT :

Computerised tomography

SD :

Standard deviation

CART :

Classification and regression tree analysis

OR :

Odds ratio

CI :

Confidence intervals

PPV :

Positive predictive value

NPV :

Negative predictive value

PAS :

Pediatric appendicitis score

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Contributions

MB: Conceptualized and designed the study, acquired the data, drafted the initial manuscript, and approved the final manuscript as submitted; TB: Conceptualized and designed the study, acquired the data, and approved the final manuscript as submitted; PG: Conceptualized and designed the study, approved the final manuscript as submitted and will act as guarantor for the paper. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Authors and Affiliations

  1. Department of Pediatric Surgery, UKE Medical School, Martinistr. 52, 20246, Hamburg, Germany

    Michael Boettcher

  2. Department of Surgery, Section of Pediatric Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Michael Boettcher, Thomas Breil & Patrick Günther

Authors
  1. Michael Boettcher
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  2. Thomas Breil
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  3. Patrick Günther
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Corresponding author

Correspondence to Michael Boettcher.

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Additional information

Michael Boettcher and Thomas Breil contributed equally to this work.

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Boettcher, M., Breil, T. & Günther, P. The Heidelberg Appendicitis Score Simplifies Identification of Pediatric Appendicitis. Indian J Pediatr 83, 1093–1097 (2016). https://doi.org/10.1007/s12098-016-2106-2

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  • DOI: https://doi.org/10.1007/s12098-016-2106-2

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