Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Pre-Coronavirus Disease 2019 Pediatric Acute Appendicitis: Risk Factors Model and Diagnosis Modality in a Developing Low-Income Country

  • Received : 2021.08.04
  • Accepted : 2021.10.03
  • Published : 2022.01.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Pediatric acute appendicitis has a stable incidence rate in Western countries with an annual change of -0.36%. However, a sharp increase was observed in the Asian region. The Indonesian Health Department reveals appendicitis as the fourth most infectious disease, with more than 64,000 patients annually. Hence, there is an urgent need to identify and evaluate the risk factors and diagnostic modalities for accurate diagnosis and early treatment. This study also clarifies the usage of pediatric appendicitis score (PAS) for children <5 years of age. Methods: The current study employed a cross-sectional design with purposive sampling through demographic and PAS questionnaires with ultrasound sonography (USG) results. The analysis was performed using the chi-square and Mann-Whitney tests and logistic regression. Results: This study included 21 qualified patients with an average age of 6.76±4.679 years, weighing 21.72±10.437 kg, and who had been hospitalized for 4.24±1.513 days in Siloam Teaching Hospital. Compared to the surgical gold standard, PAS and USG have moderate sensitivity and specificity. Bodyweight and stay duration were significant for appendicitis (p<0.05); however, all were confounders in the multivariate regression analysis. Incidentally, a risk prediction model was generated with an area under the curve of 72.73%, sensitivity of 100.0%, specificity of 54.5%, and a cut-off value of 151. Conclusion: PAS outperforms USG in the sensitivity of diagnosing appendicitis, whereas USG outperforms PAS in terms of specificity. This study demonstrates the use of PAS in children under 5 years old. Meanwhile, no risk factors were significant in multivariate pediatric acute appendicitis risk factors.

Keywords

References

  1. Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg 2017;266:237-41. https://doi.org/10.1097/SLA.0000000000002188
  2. Coward S, Kareemi H, Clement F, Zimmer S, Dixon E, Ball CG, et al. Incidence of appendicitis over time: a comparative analysis of an administrative healthcare database and a pathology-proven appendicitis registry. PLoS One 2016;11:e0165161. https://doi.org/10.1371/journal.pone.0165161
  3. Norsalan NH. Karakteristik pasien dan pola pengobatan apendisitis di RSUP Dr. Sardjito, Yogyakarta periode Januari 2010 - Desember 2014 [Thesis]. Yogyakarta: Gadjah Mada University; 2016.
  4. Arifuddin A, Salmawati L, Prasetyo A. Faktor risiko kejadian apendisitis di bagian rawat inap Rumah Sakit Umum Anutapura Palu. Preventif 2017;8:26-33. Indonesian.
  5. Totapally A, Martinez P, Raszynski A, Alkhoury F, Totapally BR. Do racial/ethnic and economic factors affect the rate of complicated appendicitis in children? Surg Res Pract 2020;2020:3268567.
  6. Taneja V. Sex hormones determine immune response. Front Immunol 2018;9:1931. https://doi.org/10.3389/fimmu.2018.01931
  7. Rea IM, Gibson DS, McGilligan V, McNerlan SE, Alexander HD, Ross OA. Age and age-related diseases: role of inflammation triggers and cytokines. Front Immunol 2018;9:586. https://doi.org/10.3389/fimmu.2018.00586
  8. Obsa MS, Adema BG, Shanka GM, Lake EA, Azeze GA, Fite RO. Prevalence of acute appendicitis among patient admitted for acute abdomen in Ethiopia: systematic review and meta-analysis. Int J Surg Open 2020;26:154-60. https://doi.org/10.1016/j.ijso.2020.09.003
  9. Upadhyaya P, Agarwal CS, Karak AK, Karki S, Pradhan A, Subba TN. Prevalence of histologically proven acute appendicitis and incidental carcinoid tumour in the practice of surgical pathology at BPKIHS. J BP Koirala Inst Health Sci 2018;1:73-80. https://doi.org/10.3126/jbpkihs.v1i2.22083
  10. Mukendi AM, Mahlobo F, Doherty S. Prostatic cyst: incidental finding on ultrasound. Worldw Med 2019;1:199-201.
  11. Sayed AO, Zeidan NS, Fahmy DM, Ibrahim HA. Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis. Ther Clin Risk Manag 2017;13:847-54. https://doi.org/10.2147/TCRM.S134153
  12. Reddan T, Corness J, Mengersen K, Harden F. Sonographic diagnosis of acute appendicitis in children: a 3-year retrospective. Sonography 2016;3:87-94. https://doi.org/10.1002/sono.12068
  13. Hajalioghli P, Mostafavi S, Mirza-Aghazadeh-Attari M. Ultrasonography in diagnosis of appendicitis and its complications in pediatric patients: a cross-sectional study. Ann Pediatr Surg 2020;16:12. https://doi.org/10.1186/s43159-020-00023-1
  14. Abo A, Shannon M, Taylor G, Bachur R. The influence of body mass index on the accuracy of ultrasound and computed tomography in diagnosing appendicitis in children. Pediatr Emerg Care 2011;27:731-6. https://doi.org/10.1097/PEC.0b013e318226c8b0
  15. Trout AT, Sanchez R, Ladino-Torres MF, Pai DR, Strouse PJ. A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography? Pediatr Radiol 2012;42:813-23. https://doi.org/10.1007/s00247-012-2358-6
  16. Srinivasan A, Servaes S, Pena A, Darge K. Utility of CT after sonography for suspected appendicitis in children: integration of a clinical scoring system with a staged imaging protocol. Emerg Radiol 2015;22:31-42. https://doi.org/10.1007/s10140-014-1241-1
  17. Lin W, Jeffrey RB, Trinh A, Olcott EW. Anatomic reasons for failure to visualize the appendix with graded compression sonography: insights from contemporaneous CT. AJR Am J Roentgenol 2017;209:W128-38. https://doi.org/10.2214/AJR.17.18059
  18. Junewick J, Dombrowski K, Woolpert L, VanDop S, Schreiner M, Sutton P, et al. Rate of and factors affecting sonographic visualization of the appendix in asymptomatic children. Emerg Radiol 2013;20:135-8. https://doi.org/10.1007/s10140-012-1084-6
  19. Kim MS, Kwon HJ, Kang KA, Do IG, Park HJ, Kim EY, et al. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis. Br J Radiol 2018;91:20170529.
  20. Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging 2016;7:255-63. https://doi.org/10.1007/s13244-016-0469-6
  21. Jennings R, Guo H, Goldin A, Wright DR. Cost-effectiveness of imaging protocols for suspected appendicitis. Pediatrics 2020;145:e20191352. https://doi.org/10.1542/peds.2019-1352
  22. Whitt B. Systematic review of the accuracy of magnetic resonance imaging in the diagnosis of acute appendicitis in children: comparison with computed tomography. Med Student Res J 2015;4:54-8.
  23. Menteri Kesehatan Republik Indonesia. Standar tarif pelayanan kesehatan pada fasilitas kesehatan tingkat pertama dan fasilitas kesehatan tingkat lanjutan dalam penyelenggaraan program jaminan kesehatan. Jakarta: Menteri Kesehatan Republik Indonesia, 2013.
  24. BPS - Statistics Indonesia. Statistik pendapatan = Income statistics. Jakarta: BPS - Statistics Indonesia, 2021. Indonesian, English.
  25. Goldman RD, Carter S, Stephens D, Antoon R, Mounstephen W, Langer JC. Prospective validation of the pediatric appendicitis score. J Pediatr 2008;153:278-82. https://doi.org/10.1016/j.jpeds.2008.01.033
  26. Salo M, Friman G, Stenstrom P, Ohlsson B, Arnbjornsson E. Appendicitis in children: evaluation of the pediatric appendicitis score in younger and older children. Surg Res Pract 2014;2014:438076. https://doi.org/10.1155/2014/438076
  27. Timmerman ME, Groen H, Heineman E, Broens PM. The influence of underweight and obesity on the diagnosis and treatment of appendicitis in children. Int J Colorectal Dis 2016;31:1467-73. https://doi.org/10.1007/s00384-016-2614-6
  28. Kang MJ. The adiposity rebound in the 21st century children: meaning for what? Korean J Pediatr 2018;61:375-80. https://doi.org/10.3345/kjp.2018.07227
  29. Vollrath ME, Hampson SE, Peneau S, Rolland-Cachera MF, Ystrom E. Child temperament predicts the adiposity rebound. A 9-year prospective sibling control study. PLoS One 2018;13:e0207279. https://doi.org/10.1371/journal.pone.0207279
  30. Direktorat Pencegahan dan Pengendalian Penyakit Tidak Menular, Kementerian Kesehatan Republik Indonesia. Tiga periode kritis dalam perkembangan jaringan lemak di tubuh - bagian kedua, periode adiposity rebound. Jakarta: Direktorat Pencegahan dan Pengendalian Penyakit Tidak Menular, Kementerian Kesehatan Republik Indonesia, 2018.
  31. Childs CE, Calder PC, Miles EA. Diet and immune function. Nutrients 2019;11:1933. https://doi.org/10.3390/nu11081933
  32. Kim DY, Shim DH, Cho KY. Use of the pediatric appendicitis score in a community hospital. Indian Pediatr 2016;53:217-20. https://doi.org/10.1007/s13312-016-0823-2
  33. Khan D, Ansar Ahmed S. The immune system is a natural target for estrogen action: opposing effects of estrogen in two prototypical autoimmune diseases. Front Immunol 2016;6:635.
  34. Waledziak M, Lasek A, Wysocki M, Su M, Bobowicz M, Mysliwiec P, et al. Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study. Sci Rep 2019;9:14793. https://doi.org/10.1038/s41598-019-51172-2
  35. Kuamr A, Kumar M, Eqbal Ahmad M. Acute appendicitis: correlation between ultrasonographic and surgical findings. Int J Health Clin Res. 2021;4:170-2.
  36. Monajemzadeh M, Hagghi-Ashtiani MT, Montaser-Kouhsari L, Ahmadi H, Zargoosh H, Kalantari M. Pathologic evaluation of appendectomy specimens in children: is routine histopatholgic examination indicated? Iran J Pediatr 2011;21:485-90.
  37. Howell EC, Dubina ED, Lee SL. Perforation risk in pediatric appendicitis: assessment and management. Pediatric Health Med Ther 2018;9:135-45. https://doi.org/10.2147/PHMT.S155302