| Objective To explore the value of Pediatric Appendicitis Score combined with abdominal ultrasound in the diagnosis of acute appendicitis in children.Method Data collected from October 2019 to June 2020 Shanghai Children’s Hospital/Shanghai Jiaotong University Children’s Hospital,Dalian Children’s Hospital/Dalian Children’s Hospital of Dalian Medical University,Tai’an Maternal and Child Health Hospital/Tai’an Children’s Hospital,A patient aged 4-15 with abdominal pain suspected of acute appendicitis admitted to the Pediatric General Surgery of 4 hospitals in Quanzhou Children’s Hospital/Quanzhou Maternal and Child Health Hospital.PAS total score 10 po ints: right lower abdominal pain 2 points,anorexia 1 point,fever 1 point,nausea and vomiting 1 point,right lower abdominal tenderness 2 points,metastatic pain 1 point,white blood cell>10.0 x 109/L1 point,The percentage of neutrophils NE%>70% is 1 po int.According to the above item scores,they are divided into low-risk group(1-3 points),intermediate-risk group(4-7 points)and high-risk group(8-10points).The criteria for the diagnosis of acute appendicitis by AUS include: Primary signs: congesti on and edema of the appendix wall,or diameter ≥7mm;Secondary signs: appendix fecal stones,or visible appendix fat echo.The treatment of the above-mentioned patients is as follows: patients in the low-risk group are returned home for telephone follow-up or 6 hours of observation,and then PAS scores are performed again,and then grouped;patients in the intermediate-risk group with positive AUS are admitted to the hospital for laparoscopic appendectomy.For patients with negative AUS,follow-up will be conducted according to the low-risk group;patients in the high-risk group,regardless of AUS positive or negative,are admitted to the hospital for laparoscopic exploration and appendectomy.For all the above-mentioned children,radiological examinations c an be performed according to the needs of the disease and the experience of the clinician.Record the child’s age;gender;PAS score;AUS diagnosis;surgical diagnosis;pathological diagnosis;wound healing;hospital stay;postoperative follow-up,etc.The above data is the same as the previous abdominal pain diagnosed and treated in our hospital from October 2018 to June 2019,which is suspected of acute appendicitis,but the PAS combined with AUS method is not used and the computerized tomography(CT)examination is not excluded.Preliminary comparisons were made with case data of year-old children to record the age;gender;AUS diagnosis;CT diagnosis,clinical diagnosis;surgical diagnosis;pathological diagnosis;wound healing;hospital stay;postoperative follow-up,etc.With the final pathological diagnosis as the gold standard,SPSS22.0 software was used to statistically analyze the data and draw the ROC curve.Calculate the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the previously unused PAS combined with AUS and prospective application of PAS combined with AUS in the diagnosis of acute appendicitis in children.Results A total of 2216 children were included in the prospective study.Among them,2027 patients received complete follow-up,189 were lost to follow-up,and the lost follow-up rate was 8.5%.The average age is 87.47±36.21 months(37-180months): 1310 males and 717 females.Among them,there were1598 cases in the low-risk group.Five cases were followed up 6hours later for acute appendicitis and underwent surgery.There were no complications in the follow-up 1 month after the operation.The remaining 1593 children were followed up by telephone 1 month after the treatment,and there were n o other surgical diseases.There were 300 cases in the intermediate-risk group,212 cases were AUS-positive and 212 cases were operated on at the same time;88 cases were AUS-negative cases were followed up,6 hours later,2 cases had acute appendicitis an d underwent surgery,all patients were followed up 1 month after treatment and underwent surgery There were 4 patients with postoperative complications,and those without surgery were followed up without other surgical diseases.There were 129 cases in the high-risk group,all of whom received surgical treatment,of which 116 cases were AUS positive and 13 cases were AUS negative.All patients were followed up 1 month after surgery,and6 cases had postoperative complications.The 4 hospitals underwent laparoscopic and appendectomy cases in 547 cases.Among them,341 cases underwent surgery according to the PAS combined with AUS diagnosis method,and 206 cases underwent CT examination during the same period.The CT examination rate of children undergoing surgery was 37.6%(206/547).In retrospective statistics,from October 2018 to June 2019 in our hospital,a total of 2842 children with abdominal pain and suspected appendicitis were included in this study.Among them,2615 patients received complete follow-up and 277 were lost to follow-up.The interview rate was 9.6%.The average age was90.23±38.19 months(37-180 months),463 cases were clinically diagnosed as appendicitis,386 cases underwent laparoscopic surgery and pathological diagnosis of appendicitis,11 cases were operated but pathologically diagnosed as non-appendicitis,no operation and follow-up results There were 77 cases;2152 cases were clinically diagnosed as non-appendicitis,115 cases underwent laparoscopic surgery and pathological diagnosis of appendicitis,6 cases were operated but pathologically diagnosed as non-appendicitis,and 2037 cases were non-appendicitis without surgery and follow-up results.A total of 518 cases underwent surgery,of which 501 cases were pathologically diagnosed as appendicitis,17 cases were confirmed to be other surgical diseases during operation and pathology,437 cases were diagnosed as appendicitis and underwent CT examination,and the CT examination rate of surgical patients was 84.4%(437/518).All patients were followed up 1 month after the consultation.There were 11 cases of 501 cases of LA patients with postoperative complications,17 cases of non-appendicitis surgery had no postoperative complications,and those without surgery had no other surgical diseases.The sensitivity of the PAS combined with AUS to diagnose acute appendicitis in children was 77.1%,the specificity was94.6%,the positive predictive value PPV was 83.4%,and the negative predictive value NPV was 94.6%.Prospective application of PAS alone to diagnose children with acute appendicitis has a sensitivity of 91.2% and a specificity of 71.4%;the area under the ROC curve of the PAS score in the middle and high-risk group combined with AUS: 0.94(95%CI 0.90-0.98),and the sensitivity is 96.1%,The specificity was 85.1%,the positive predictive value PPV was 95.9%,and the negative predictive value NPV was 97.5%.The CT examination rate of surgical patients has dropped significantly compared with the same period last year,from 84.4% to 37.6%.Conclusion PAS combined with AUS has a larger area under the curve for the diagnosis of acute appendicitis in children,as well as a higher positive and negative predictive value,so it has the value of promotion in clinical work.This method can greatly improve the diagnostic accuracy of children with acute appendicitis and reduce missed and misdiagnosis,and at the same time greatly reduce children’s CT and other radiation exposure. |
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