Timmerman, M. (Marjolijn) (2014) Nieuwe diagnostische methode om te differentiëren tussen appendicitis en andere diagnoses en tussen obstipatie en appendicitis bij kinderen met acute buikpijn. thesis, Medicine.
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Abstract
Aim of the study Previous studies have shown that a substantial part of children visiting the emergency department with the suspicion of appendicitis, have constipation or other diagnosis and it can be difficult to clinical differentiate between appendicitis and other diagnosis. The aim of this study is therefore to find factors that can help differentiate between appendicitis and other diagnoses and between constipation and appendicitis to make the correct diagnosis. Methods A retrospective database was used that consisted of 941 children between 4 and 18 years old, which were presented at the emergency department with acute abdominal pain. We developed predictive model with a scoring system. The discriminatory power and diagnostic accuracy were conducted to evaluate the clinical value of the scoring system. Main results The predictive model for appendicitis compared to all other diagnoses, consisted of the following significant factors: migration of pain (P = 0.007), anorexia (P = 0.044), diarrhea (P = 0.028), muscular guarding (P = 0.010), impacted feces by rectal examination (P = 0.038), leukocytosis (P = 0.006) and increased CRP (P = 0.101). The score ranged from 0 till 12 points, with a cut-off point of 8 the risk on appendicitis was 91.5%. At this cut-off point, the sensitivity was between 94.2% and 93.3% with specificity between 76.1% and 77.1%. The score showed a good discrimination power of 0.961. Significant differentiating factors between appendicitis and constipation were amount of days since last defecation (P = 0.050), diarrhea (P = 0.042), muscular guarding (P = 0.003), leukocytosis (P < 0.001) and increased CRP (P = 0.001). The score ranged from 0 till 19 points, with a cut-off point of 10 the risk on the diagnosis constipation was 81%. At this cut-off point, the sensitivity was between 86.5% and 93.3% and specificity between 88.1% and 91.7%. The score had a good discrimination power of 0.946. Conclusion Since the Alvarado score and the Peadiatric Appendicitis Score are not always sufficient enough in diagnosing appendicitis in specific population groups, we created a different diagnostic score to differentiate between appendicitis and other diagnosis. This score has a comparable sensitivity and specificity as the Alvarado score or the Paediatric Appendicitis Score, but consists of fewer factors which makes it an easier diagnostic method. In certain situations, however, most causes of acute abdominal pain are already excluded, except for constipation since this is an exclusion diagnosis. Therefore we created a specific diagnostic method to differentiate between constipation and appendicitis.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Broens, dr. P.M.A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1399 |
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