Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score)
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Total (n = 199) | ACA (n = 74) | AUA (n = 125) | p |
---|---|---|---|---|
Age (years) | 9.44 (±2.69) | 8.77 (±2.98) | 9.83 (±2.44) | 0.031 |
Gender | 0.763 | |||
Male | 121 (60.8%) | 46 (62.2%) | 75 (60%) | |
Female | 78 (39.2%) | 28 (37.8%) | 50 (40%) | |
Appendiceal diameter (mm) | 9.03 (2.87) | 10.23 (3.51) | 8.32 (2.13) | <0.001 |
Anatomical position | 0.094 | |||
Usual | 179 (89.9%) | 70 (94.6%) | 109 (87.2%) | |
Unusual | 20 (10.1%) | 4 (5.4%) | 16 (12.8%) | |
Distinct appendiceal wall layers | <0.001 | |||
Yes | 90 (45.2%) | 46 (62.2%) | 44 (35.2%) | |
No | 109 (54.8%) | 28 (37.8%) | 81 (64.8%) | |
Non-compressible | 0.489 | |||
Yes | 185 (93%) | 70 (94.6%) | 115 (92%) | |
No | 14 (7%) | 4 (5.4%) | 10 (8%) | |
Target sign appearance | <0.001 | |||
Yes | 119 (59.8%) | 31 (41.9%) | 88 (70.4%) | |
No | 80 (40.2%) | 43 (58.1%) | 37 (29.6%) | |
Hypervascularisation | 0.140 | |||
Yes | 8 (4%) | 1 (1.4%) | 7 (5.6%) | |
No | 191 (96%) | 73 (98.6%) | 118 (94.4%) | |
Appendicolith | <0.001 | |||
Yes | 48 (24.1%) | 31 (41.9%) | 17 (13.6%) | |
No | 151 (75.9%) | 43 (58.1%) | 108 (86.4%) | |
Periappendiceal fat inflammation | 0.001 | |||
Yes | 116 (58.3%) | 54 (73%) | 62 (49.6%) | |
No | 83 (41.7%) | 20 (27%) | 63 (50.4%) | |
Free abdominal fluid | 0.050 | |||
Yes | 128 (64.3%) | 54 (73%) | 74 (59.2%) | |
No | 71 (35.7%) | 20 (27%) | 51 (40.8%) | |
DFIF | 0.034 | |||
Yes | 27 (13.6%) | 15 (20.3%) | 12 (9.6%) | |
No | 172 (86.4%) | 59 (79.7%) | 113 (90.4%) | |
PFIF | 0.034 | |||
Yes | 83 (41.7%) | 38 (51.4%) | 45 (36%) | |
No | 116 (58.3%) | 36 (48.6%) | 80 (64%) | |
DPFIF | 0.329 | |||
Yes | 48 (24.1%) | 15 (20.3%) | 33 (26.4%) | |
No | 151 (75.9%) | 59 (79.7%) | 92 (73.6%) | |
Lymphadenitis | 0.480 | |||
Yes | 68 (34.2%) | 23 (31.1%) | 45 (36%) | |
No | 131 (65.8%) | 51 (68.9%) | 80 (64%) | |
Abscess | <0.001 | |||
Yes | 14 (7%) | 13 (17.6%) | 1 (0.8%) | |
No | 185 (93%) | 61 (82.4%) | 124 (99.2%) | |
Peritonitis | <0.001 | |||
Yes | 14 (7%) | 12 (16.2%) | 2 (1.6%) | |
No | 185 (93%) | 62 (83.8%) | 123 (98.4%) | |
WBC count | 15.08 (4.96) | 16.49 (5.47) | 14.25 (4.46) | 0.010 |
NEUT (%) | 77.88 (11.6) | 81.07 (9.94) | 75.99 (12.07) | <0.001 |
PLT | 310.54 (83.81) | 332.57 (98.13) | 297.50 (71.32) | 0.032 |
CRP (mg/dL) | 4.7 (6.28) | 8.11 (8.41) | 2.66 (3.20) | <0.001 |
RLQ tenderness to percussion, coughing, hopping | <0.001 | |||
Yes | 137 (68.8%) | 74 (100%) | 63 (50.4%) | |
No | 62 (31.2%) | 0 (0) | 62 (49.6%) | |
Anorexia | 0.023 | |||
Yes | 125 (62.8%) | 54 (73%) | 71 (56.8%) | |
No | 74 (37.2%) | 20 (27%) | 54 (43.2%) | |
Body temperature ≥38 °C | 0.017 | |||
Yes | 68 (34.2%) | 33 (44.6%) | 35 (28%) | |
No | 131 (65.8%) | 41 (55.4%) | 90 (72%) | |
Nausea/vomiting | 0.038 | |||
Yes | 63 (31.7%) | 30 (40.5%) | 33 (26.4%) | |
No | 136 (68.3%) | 44 (59.5%) | 92 (73.6%) | |
Tenderness over RIF | - | |||
Yes | 199 (100%) | 74 (100%) | 125 (100%) | |
Pain migration to RLQ | <0.001 | |||
Yes | 58 (29.1%) | 34 (45.9%) | 24 (19.2%) | |
No | 141 (70.9%) | 40 (54.1%) | 101 (80.8%) | |
Duration of symptoms (h) | 0.671 | |||
<24 | 68 (34.2%) | 28 (37.8%) | 40 (32%) | |
24–48 | 86 (43.2%) | 31 (41.9%) | 55 (44%) | |
>48 | 45 (22.6%) | 15 (20.3%) | 30 (24%) |
Univariate Logistic Regression | Multivariate Logistic Regression | |||
---|---|---|---|---|
OR (95% CI) | p | OR (95% CI) | p | |
Appendiceal diameter ≥ 8.45: Yes | 3.79 (2.04–7.03) | <0.001 | 4.43 (1.46–13.45) | 0.009 |
Anatomical position: Usual | 2.57 (0.82–8.00) | 0.104 | 4.85 (0.80–29.43) | 0.086 |
Distinct appendiceal wall layers: Yes | 3.02 (1.67–5.49) | <0.001 | 0.87 (0.29–2.58) | 0.799 |
Non-compressible: Yes | 1.52 (0.46–5.04) | 0.492 | 1.40 (0.15–12.64) | 0.765 |
Target sign appearance: No | 3.30 (1.81–6.01 | <0.001 | 4.12 (1.39–12.18) | 0.010 |
Hypervascularisation: Yes | 0.23 (0.03–1.92) | 0.174 | 0.80 (0.06–10.17) | 0.865 |
Appendicolith: Yes | 4.58 (2.30–9.12) | <0.001 | 6.50 (2.21–19.16) | 0.001 |
Periappendiceal fat inflammation: Yes | 2.74 (1.47–5.11) | 0.001 | 1.40 (0.47–4.19) | 0.551 |
Free abdominal fluid: Yes | 1.86 (1.01–3.48) | 0.051 | 2.12 (0.39–11.56) | 0.385 |
DFIF: Yes | 2.39 (1.05–5.45) | 0.037 | 2.50 (0.53–11.75) | 0.247 |
PFIF: Yes | 1.88 (1.05–3.37) | 0.035 | 0.90 (0.20–4.04) | 0.893 |
DPFIF: Yes | 0.71 (0.35–1.42) | 0.330 | 0.26 (0.06–1.07) | 0.062 |
Lymphadenitis: Yes | 0.80 (0.43–1.48) | 0.480 | 1.83 (0.64–5.22) | 0.258 |
Abscess: Yes | 26.43 (3.38–206.7) | 0.002 | 40.05 (2.21–724.56) | 0.012 |
Peritonitis: Yes | 11.9 (2.58–54.85) | 0.001 | 29.27 (1.03–832.36) | 0.048 |
WBC ≥ 15.96: Yes | 1.69 (0.95–3.03) | 0.076 | 0.55 (0.17–1.74) | 0.305 |
NEUT ≥ 78.95: Yes | 2.48 (1.35–4.56) | 0.003 | 3.48 (1.11–10.88) | 0.032 |
PLT ≥ 321.5: Yes | 2.09 (1.16–3.75) | 0.014 | 2.32 (0.84–6.42) | 0.106 |
CRP ≥ 1.99: Yes | 4.55 (2.38–8.70) | <0.001 | 3.46 (1.23–9.71) | 0.018 |
Anorexia: Yes | 2.05 (1.10–3.83) | 0.024 | 3.02 (0.97–9.34) | 0.056 |
Body temperature ≥ 38 °C: Yes | 2.07 (1.13–3.78) | 0.018 | 3.15 (1.07–9.29) | 0.038 |
Nausea/vomiting: Yes | 1.90 (1.03–3.50) | 0.039 | 0.93 (0.32–2.70) | 0.895 |
Pain migration to RLQ: Yes | 3.58 (1.89–6.77) | <0.001 | 4.17 (1.44–12.12) | 0.009 |
Duration of symptoms (h): <24 | 1.40 (0.64–3.07) | 0.401 | 7.76 (1.48–40.60) | 0.015 |
Duration of symptoms (h): 24–48 | 1.13 (0.53–2.41) | 0.757 | 2.33 (0.52–10.51) | 0.271 |
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Bekiaridou, K.; Kambouri, K.; Giatromanolaki, A.; Foutzitzi, S.; Kouroupi, M.; Aggelidou, M.; Deftereos, S. Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score). Diagnostics 2023, 13, 2275. https://doi.org/10.3390/diagnostics13132275
Bekiaridou K, Kambouri K, Giatromanolaki A, Foutzitzi S, Kouroupi M, Aggelidou M, Deftereos S. Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score). Diagnostics. 2023; 13(13):2275. https://doi.org/10.3390/diagnostics13132275
Chicago/Turabian StyleBekiaridou, Konstantina, Katerina Kambouri, Alexandra Giatromanolaki, Soultana Foutzitzi, Maria Kouroupi, Maria Aggelidou, and Savas Deftereos. 2023. "Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score)" Diagnostics 13, no. 13: 2275. https://doi.org/10.3390/diagnostics13132275
APA StyleBekiaridou, K., Kambouri, K., Giatromanolaki, A., Foutzitzi, S., Kouroupi, M., Aggelidou, M., & Deftereos, S. (2023). Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score). Diagnostics, 13(13), 2275. https://doi.org/10.3390/diagnostics13132275