Skip to main content

Advertisement

SpringerLink
Log in

Comparison of non-invasive physiological assessment tools between simple and perforated appendicitis in children

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

The role of non-invasive measures of physiologic reserve, specifically the Compensatory reserve index (CRI) and the Shock index pediatric age-adjusted (SIPA), is unknown in the management of children with acute appendicitis. CRI is a first-in-class algorithm that uses pulse oximetry waveforms to continuously monitor central volume status loss. SIPA is a well-validated, but a discontinuous measure of shock that has been calibrated for children.

Methods

Children with suspected acute appendicitis (2–17 years old) were prospectively enrolled at a single center from 2014 to 2015 and monitored with a CipherOx CRI™ M1 pulse oximeter. CRI values range from 1 (normovolemia) to 0 (life-threatening hypovolemia). SIPA is calculated by dividing heart rate by systolic blood pressure and categorized as normal or abnormal, based on age-specific cutoffs. Univariate and multivariable regression models were developed with simple versus perforated appendicitis as the outcome.

Results

Almost half the patients (45/94, 48%) had perforated appendicitis. On univariate analysis, the median admission CRI value was significantly higher (0.60 versus 0.33, p < 0.001) and the ED SIPA values were significantly lower (0.90 versus 1.10, p = 0.002) in children with simple versus perforated appendicitis. In a multivariable model, only CRI significantly detected differences in the physiologic state between patients with simple and perforated appendicitis.

Conclusions

CRI is a non-invasive measure of physiologic reserve that may be used to accurately guide early management of children with acute simple versus perforated appendicitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Prystowsky JB, Pugh CM, Nagle AP (2005) Current problems in surgery. Append Curr Probl Surg 42(10):688–742

    Article  Google Scholar 

  2. Dian A, Ali A, Azam UF, Khan MM (2011) Perforated appendix-our local experience. Rawal Med J 36(2):97–99

    Google Scholar 

  3. Blakely ML, Williams R, Dassinger MS, Eubanks JW, Fischer P, Huang EY et al (2011) Early vs interval appendectomy for children with perforated appendicitis. Arch Surg 146(6):660–665

    Article  Google Scholar 

  4. Maloney PJ (2013) Sepsis and septic shock. Emerg Med Clin 31(3):583–600

    Article  Google Scholar 

  5. American Heart Association (2006) 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric advanced life support. Pediatrics 117(5):e1005–e1028

    Article  Google Scholar 

  6. Sinniah D (2012) Shock in children. IeJSME 1:129–136

    Google Scholar 

  7. Larsen GY, Mecham N, Greenberg R (2011) An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics 127(6):e1585–e1592

    Article  Google Scholar 

  8. Florin T, Ludwig S, Aronson PL, Werner HC (2011) Netter’s pediatrics E-Book. Elsevier Health Sciences

    Google Scholar 

  9. Biban P, Gaffuri M, Spaggiari S, Zaglia F, Serra A, Santuz P (2012) Early recognition and management of septic shock in children. Pediatr Rep 4(1):e13

    Article  Google Scholar 

  10. Plunkett A, Tong J (2015) Sepsis in children. BMJ 9(350):h3017

    Article  Google Scholar 

  11. Lemson J, Nusmeier A, van der Hoeven JG (2011) Advanced hemodynamic monitoring in critically ill children. Pediatrics 128(3):560–571

    PubMed  Google Scholar 

  12. Moulton SL, Mulligan J, Grudic GZ, Convertino VA (2013) Running on empty? The compensatory reserve index. J Trauma Acute Care Surg 75(6):1053–1059

    Article  Google Scholar 

  13. Choi YM, Leopold D, Campbell K, Mulligan J, Grudic GZ, Moulton SL (2018) Noninvasive monitoring of physiologic compromise in acute appendicitis: New insight into an old disease. J Pediatr Surg 53(2):241–246

    Article  Google Scholar 

  14. Gupta S, Alam A (2018) Shock index-A useful noninvasive marker associated with age-specific early mortality in children with severe sepsis and septic shock: age-specific shock index cut-offs. J Intensive Care Med. P. 35:0885066618802779.

  15. Nordin A, Coleman A, Shi J, Wheeler K, Xiang H, Acker S et al (2018) Validation of the age-adjusted shock index using pediatric trauma quality improvement program data. J Pediatr Surg 53(1):130–135

    Article  Google Scholar 

  16. Acker SN, Ross JT, Partrick DA, Tong S, Bensard DD (2015) Pediatric specific shock index accurately identifies severely injured children. J Pediatr Surg 50(2):331–334

    Article  Google Scholar 

  17. Traynor MD Jr, Hernandez MC, Clarke DL, Kong VY, Habermann EB, Polites SF et al (2019) Utilization of age-adjusted shock index in a resource-strained setting. J Pediatr Surg 54(12):2621–2626

    Article  Google Scholar 

  18. Bröker ME, van Lieshout EM, van der Elst M, Stassen LP, Schepers T (2012) Discriminating between simple and perforated appendicitis. J Surg Res 176(1):79–83

    Article  Google Scholar 

  19. van den Bogaard VAB, Euser SM, van der Ploeg T, de Korte N, Sanders DG, de Winter D et al (2016) Diagnosing perforated appendicitis in pediatric patients: a new model. J Pediatr Surg. 51(3):444–448

    Article  Google Scholar 

  20. Mittal MK, Dayan PS, Macias CG, Bachur RG, Bennett J, Dudley NC et al (2013) Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Acad Emerg Med 20(7):697–702

    Article  Google Scholar 

  21. Lindestam U, Almström M, Jacks J, Malmquist P, Lönnqvist P, Jensen BL, et al (2019) Low plasma sodium concentration predicts perforated acute appendicitis in children: a prospective diagnostic accuracy study. Eur J Pediatr Surg

  22. Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD (2011) The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med 9(1):139

    Article  Google Scholar 

  23. Sencan A, Aksoy N, Yıldız M, Okur Ö, Demircan Y, Karaca İ (2014) The evaluation of the validity of Alvarado, Eskelinen, Lintula and Ohmann scoring systems in diagnosing acute appendicitis in children. Pediatr Surg Int 30(3):317–321

    Article  Google Scholar 

  24. Phillips R, Acker S, Shahi N, Shirek G, Meier M, Goldsmith A, et al (2020) The Shock Index, Pediatric Age-Adjusted (SIPA) Enhanced: pre-hospital and emergency department SIPA values forecast transfusion needs for blunt solid organ injured children. Surgery 168(4):690–694

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Surgery, Children’s Hospital Colorado, 13123 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA

    Niti Shahi, Ryan Phillips, Gabrielle Shirek, Shannon N. Acker, Denis Bensard & Steven Moulton

  2. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Niti Shahi, Ryan Phillips, Shannon N. Acker, Denis Bensard & Steven Moulton

  3. The Center for Research in Outcomes for Children’s Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Maxene Meier

  4. Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA

    Young Mee Choi

  5. Department of Surgery, Denver Health Medical Center, Denver, CO, USA

    Denis Bensard

Authors
  1. Niti Shahi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maxene Meier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gabrielle Shirek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Young Mee Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shannon N. Acker
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Denis Bensard
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven Moulton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Niti Shahi.

Ethics declarations

Conflicts of interest and source of funding

Dr. Moulton co-invented the Compensatory Reserve Index algorithm used in this study. The intellectual property is assigned to the Regents of the University of Colorado. Dr. Moulton co-founded Flashback Technologies, Inc. in 2009 and licensed the technology from the University. He is a consultant at Flashback Technologies, has an equity interest in the company, and receives royalty payments through the University of Colorado. Flashback Technologies did not sponsor this study. The remaining authors have no conflicts of interest. No grant funding was used to support this research. Institutional funding was provided by the Children’s Hospital Colorado Foundation, Children's Hospital Colorado Center for Research in Outcomes in Children's Surgery, and generous support from the Colorado Firefighter Calendar.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was evaluated and approved by the Colorado Multiple Institution Review Board (COMIRB), and written informed consent was obtained from all participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shahi, N., Phillips, R., Meier, M. et al. Comparison of non-invasive physiological assessment tools between simple and perforated appendicitis in children. Pediatr Surg Int 37, 851–857 (2021). https://doi.org/10.1007/s00383-021-04876-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-021-04876-4

Keywords

Search

Navigation