背景:小儿急性阑尾炎(PAA)今天仍然是一个诊断挑战。经典指数的诊断性能只有中等,尤其是在儿科人群中。本研究旨在定义一种临床,诊断PAA的放射学和分析指标。
方法:这项前瞻性研究包括151例患者,分为两组:(1)53例非手术性腹痛(NSAP)患者和(2)98例确诊PAA患者。使用Mann-WhitneyU检验和Fisher精确检验比较各组之间的社会人口统计学和临床特征。为了确定PAA的预测因子,我们使用正向逐步分析进行了多变量逻辑回归,并为所选变量分配了整数值的倍数.通过计算受试者工作特征曲线下的面积来评估指标的诊断性能。使用Hosmer-Lemeshow测试评估队列内校准。
结果:我们开发了BIDIAP指数(儿科阑尾炎诊断的BIomarker),其中包括三个独立预测PAA几率较高的变量:阑尾口径(≥6.9mm),全身免疫炎症指数(≥890)和腹膜刺激,得了4分,3分和2分,分别。参与者的平均(SD)评分在第1组中为2.38(2.06),在第2组中为7.89(1.50)。ROC下面积为0.97(95%CI0.95-0.99)。截止点确定在4点,灵敏度为98.98%,特异性为77.78%。
结论:BIDIAP指数在PAA中具有出色的诊断性能。这些结果的重要性在于它的新颖性和索引的简单性。尽管需要进行外部验证,初步结果看起来很有希望。
BACKGROUND: Pediatric acute appendicitis (PAA) continues to be a diagnostic challenge today. The diagnostic performance of classical indices is only moderate, especially in pediatric population. This study aimed to define a clinical, radiological and analytical index for the diagnosis of PAA.
METHODS: This prospective study included 151 patients divided into two groups: (1) 53 patients with non-surgical abdominal pain (NSAP) and (2) 98 patients with a confirmed PAA. Sociodemographic and clinical characteristics were compared between groups using the Mann-Whitney U test and the Fisher exact test. To identify the predictors of PAA, we performed a multivariable logistic regression using a forward stepwise analysis and we assigned multiples of integer values to the selected variables. The diagnostic performance of the index was assessed by calculating the area under the receiver operating characteristic curve. Intra-cohort calibration was assessed with the Hosmer-Lemeshow test.
RESULTS: We developed the BIDIAP index (BIomarkers for the DIagnosis of Appendicitis in Pediatrics), which included three variables that independently predicted higher odds of PAA: appendiceal caliber (≥ 6.9 mm), systemic immune-inflammation index (≥ 890) and peritoneal irritation, which scored 4, 3 and 2 points, respectively. Mean (SD) score of the participants was 2.38 (2.06) in group 1 and 7.89 (1.50) in group 2. The area under the ROC was 0.97 (95% CI 0.95-0.99). The cut-off point was established at 4 points, resulting in a sensitivity of 98.98% and a specificity of 77.78%.
CONCLUSIONS: The BIDIAP index has an exceptional diagnostic performance in PAA. The importance of these results lies in its novelty and in the simplicity of the index. Although external validation will be necessary, initial results look promising.