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Objective To explore the characteristics and diagnostic significance of ultrasound signs in the diagnosis of acute appendicitis in children. Methods This study focused on 81 children with acute appendicitis and divided them into two groups based on pathological examination results: 34 children with severe progressive appendicitis (41.98%) and 47 children with simple appendicitis (58.02%). By analyzing the indirect and direct signs of ultrasound detection, as well as pathological examination data, and using ROC curve analysis to analyze the area under the curve ( area under curve, AUC) of ultrasound signs combined, a comprehensive analysis is conducted to score the ultrasound examination results of children. Results The detection rates of wall continuity interruption/low-level clarity, intraluminal fluid accumulation, periappendiceal or abdominal fluid accumulation, periappendiceal hyperechogenicity, cecal and ileal wall thickening in the advanced group were higher than those in the simple group (P < 0.05); The scores of indirect, direct, and combined ultrasound signs in the progressive group were higher than those in the simple group (P < 0.05); Under the ROC curve, the sensitivity, specificity, positive predictive value, and negative predictive value of combined signs were 98.77%, 97.53%, 98.77%, and 96.30%, respectively, higher than those of indirect signs and direct signs. The AUC was 0.835, higher than those of indirect signs and direct signs ( P < 0.05) . Conclusion The combined diagnosis of ultrasound examination signs can provide objective evidence for the early diagnosis of acute appendicitis in children, and can also achieve dynamic monitoring of the disease, which is conducive to the formulation of clinical treatment plans. [ABSTRACT FROM AUTHOR]

Objective To investigate the serum level of urokinase-type plasminogen activator receptor (uPAR) in children with acute appendicitis and assess the diagnostic value of uPAR combined with C-reactive protein (CRP) and modified Alvarado score for acute appendicitis. Methods We analyzed the clinical data of 57 children with pathologically confirmed acute appendicitis and 44 children with nonappendicitis abdominal pain (control group) admitted in our hospital between June 2017 and June 2019. We compared the age, gender, white blood cell count, neutrophil/lymphocyte ratio (NLR), CRP level, percentage of neutrophils, modified Alvarado score and serum uPAR level between the 2 groups. The correlation of serum uPAR level with CRP and modified Alvarado score was evaluated, and receiving-operator characteristic (ROC) curve was used to analyze their diagnostic efficacy, either alone or in combination, for acute appendicitis. The diagnostic value of each combined model was evaluated according to net reclassification improvement (NRI) and integrated discrimination index (IDI). Results White blood cell count, NLR, modified Alvarado score, CRP and uPAR levels were significantly higher in children with acute appendicitis than those in the control group. Serum uPAR level showed significantly positive correlations with modified Alvarado score and CRP level. The areas under the ROC curve of CRP combined with modified Alvarado score and uPAR combined with both CRP and modified Alvarado score were 0.819 (0.730~0.888) and 0.823 (0.734~0.891), respectively; the NRI and IDI of uPAR combined with CRP and modified Alvarado score was 0.653 (0.316~0.990) and 0.086 (0.036~0.136), respectively. Conclusion Serum uPAR level combined with modified Alvarado score and CRP can be used as an effective diagnostic indicator for acute appendicitis in children.

Abdominal pain in the pediatric patient presents a unique diagnostic challenge for emergency department (ED) providers due to the wide range of possible etiologies and sequelae. The list of differential diagnoses is extensive and includes the spectrum of conditions that range from benign and self-limiting to those that are potentially life-threatening. This article describes a case of a young toddler with an acute appendicitis complicated by perforation and abscess formation. Although acute appendicitis is uncommon in infants and younger children, it does occur and, as this case illustrates, is often misdiagnosed, which leads to delayed treatment and a higher incidence of complications. This article includes a discussion of the challenges faced by ED providers in the clinical-decision-making process when caring for a pediatric patient with abdominal pain due to an acute appendicitis. This discussion includes the age-associated epidemiology, pathophysiology, clinical presentation, and evidence-based recommendations for diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is an important differential diagnosis in children with pain in the right iliac fossa. Some patients have equivocal signs that make the diagnosis difficult. Many patients with suspected acute appendicitis are admitted for observation and finally discharged because they did not have appendicitis. We decided to design this study to investigate whether the Alvarado score could be used by emergency room doctors as a criterion for admission to hospital. Patients and Methods: This is a prospective study comprising 350 patients who attended the emergency department with suspected acute appendicitis in the period from May 2007 to April 2009. All patients were scored by Alvarado score in the emergency department before admission. The Alvarado score is based on three symptoms, three signs and two laboratory findings. The decision for admission and surgery was made independent of the score. The diagnosis of patients who underwent appendicectomy was confirmed by both operative findings and postoperative histopathology. Results: We studied the Alvarado scores of 350 patients who presented to the emergency department with pain in the right iliac fossa; their age ranged from 8 to 14 years; 182 patients (52%) operated with the aim to treat acute appendicitis, 168 patients (48%) were discharged without surgical intervention and advised to attend the out-patient clinic after 24 hours for re-evaluation. we have found that patients with a low Alvarado score (less than 6) did not have acute appendicitis. Conclusion: Patients with equivocal signs can present a diagnostic challenge and are very often admitted to the surgical department for observation. The Alvarado score can be used as a scoring system that help in taking the decision for admission of cases with suspected acute appendicitis especially by primary healthcare providers.

Objective: Appendicitis is the most common abdominal emergency usually requiring surgery in the pediatric age group. Diagnosis of acute appendicitis can at times be difficult, especially in children. A failure to diagnose can lead to a progression of disease with its associated morbidity and mortality. The authors used a modification of Alvarado scoring system which consists of eight variables and would provide an accurate guide to the preoperative diagnosis of acute appendicitis leading to proper and timely management. Methods: This was a prospective study conducted from Jan 2005 through Dec 2006 and included 90 consecutive patients with suspected acute appendicitis. They were given specific scores according to variables of scoring system and divided into 3 groups. Group III patients (score 7 or more) underwent surgery, group II (score 5-6) were admitted for close observation and group I (score 4 or less) were discharged home. Patients from group II with increased symptom intensity (score 7 or more) on re-evaluation underwent surgery. Diagnosis was confirmed by operative findings and histopathological examination. Reliability of scoring system was assessed by calculating negative appendicectomy rate and positive predictive value. Results: Out of total 90 patients, 73 patients underwent surgery and appendicitis was confirmed in 68 cases. The negative appendicectomy rate was 6.84%, perforation rate was 36.9%. Positive predictive value was 93.1%. Conclusions: Our scoring system is useful as a first line, rapid, reliable and economic way of early preoperative diagnosis of acute appendicitis in children and in reducing the incidence of negative appendicectomy rate. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate the feasibility of conservative treatment of noncomplicated acute appendicitis in children in our institute. Patients and methods This prospective study was conducted on children with noncomplicated acute appendicitis diagnosed by means of clinical, laboratory, and radiological investigations admitted for conservative treatment and checked in a regular manner to detect and manage complications. The study was conducted during the period between March 2015 and February 2016. Results Thirty-nine patients with noncomplicated acute appendicitis, with a mean age of 7.8 years, were admitted for conservative management. Twenty-five (64%) patients improved on medical treatment and were discharged home within 2-3 days and 14 (36%) patients required surgical intervention. Conclusion Most of the children who were managed with antibiotics for noncomplicated acute appendicitis improved and the risks of appendectomy were avoided. Therefore, we should not embark on appendectomy in children with noncomplicated appendicitis and imply the possibility of medical treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Appendicitis is the most common surgical emergency in children; yet, diagnosis of equivocal presentations continues to challenge clinicians. Aim The objective of this study was to investigate the hypothesis that the use of a modified clinical practice and harmonic ultrasonographic grading scores (MCPGS) may improve the accuracy in diagnosing acute appendicitis in the pediatric population. Patients & Methods Main outcome measures Sensitivity, specificity, and accuracy of the modified scoring system. Five hundred and thirty patients presented with suspected diagnosis of acute appendicitis during the period from December 2000 to December 2009 were enrolled in this study. Children's data that have already been published of those who presented with suspected diagnosis of acute appendicitis- to whom a special clinical practice grading scores (CPGS) incorporating clinical judgment and results of gray scale ultrasonography (US) was applied- were reviewed and compared to the data of 265 pediatric patients with equivocal diagnosis of acute appendicitis (AA), to whom a modified clinical practice grading scores (MCPGS) was applied. Statistical analyses were carried out using Z test for comparing 2 sample proportions and student's t-test to compare the quantitative data in both groups. Sensitivity and specificity for the 2 scoring systems were calculated using Epi-Info software. Results The Number of appendectomies declined from 200 (75.5%) in our previous CPGS to 187 (70.6%) in the MCPGS (P > 0.05). Specificity was significantly higher when applying MCPGS (90.7%) in this study compared to 70.47% in our previous work when CPGS was applied (P < 0.01). Furthermore, the positive predictive value (PPV) was significantly higher (95.72%) than in our previous study (82.88%), (P < 0.01). Overall agreement (accuracy) of MCPGS was 96.98%. Kappa = 0.929 (P < 0.001). Negative predictive power was 100%. And the Overall agreement (accuracy) was 96.98%. Conclusions MCPGS tends to help in reduce the numbers of avoidable and unnecessary appendectomies in suspected cases of pediatric acute appendicitis that may help in saving hospital resources.

Background: Enhanced recovery after surgery (ERAS), as a new concept in surgery, has dramatically changed the mode of perioperative treatment for children with acute appendicitis., Methods: The retrieval strategy developed by the Cochrane Collaboration was conducted using the CNKI database, Wanfang Medical Network, PubMed, EBSCO, Medline, and Cochrane database by combining subject headings and free words. A review of the randomized controlled trials on the use of the ERAS concept in the perioperative treatment of acute appendicitis in children was conducted between the establishment of the database and May 15, 2021. Keywords included enhanced recovery after surgery, fast track surgery, ERAS, FTS, child, infant, and appendicitis. The quality of the literature was evaluated according to the RevMan 5.3 software provided by the Cochrane Collaboration., Results: Five randomized controlled trials on ERAS in children with acute appendicitis were finally included. The heterogeneity of postoperative stay time was tested in 4 studies using continuous variables, with Chi-squared test (Chi 2 ) =221.52, degree of freedom (df) =3, I 2 =99%>50%. An overall analysis using a random effects model showed that the ERAS group was significantly different compared to the control group [Z=5.26; mean difference (MD) =-1.65; 95% CI: -2.27 to -1.03; P<0.00001]. The heterogeneity of the readmission rate was tested in 5 studies using dichotomous variables, with Chi 2 =5.11, df =3, I 2 =41%<50%, P=0.91. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group [Z=0.80; odds ratio (OR) =1.16; 95% CI: 0.81 to 1.66; P=0.42]. The heterogeneity of the recurrence rate was tested in 4 studies using dichotomous variables, with Chi 2 =3.73, df =3, I 2 =20%<50%, P=0.29. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group (Z=1.14; OR =0.76; 95% CI: 0.47 to 1.22; P=0.26)., Discussion: The results of the meta-analysis confirmed that perioperative application of the ERAS concept in children with acute appendicitis can promote the rehabilitation of children, reduce the postoperative stay time, and reduce the readmission rate and reoperation rate., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tp-21-457). The authors have no conflicts of interest to declare., (2021 Translational Pediatrics. All rights reserved.)