TY - JOUR
T1 - Accuracy of surgeon prediction of appendicitis severity in pediatric patients
AU - Yu, Yangyang R.
AU - Rosenfeld, Eric H.
AU - Dadjoo, Shaahin
AU - Orth, Robert C.
AU - Lopez, Monica E.
AU - Shah, Sohail R.
AU - Naik-Mathuria, Bindi J.
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/11
Y1 - 2019/11
N2 - Purpose: Clinical prediction of disease severity is important as one considers nonoperative management of simple appendicitis. This study assesses the accuracy of surgeons' prediction of appendicitis severity. Methods: From February to August 2016, pediatric surgeons at a single institution were asked to predict whether patients had simple or complex appendicitis preoperatively based on clinical data, imaging, and general assessment. Receiver operating characteristic curves were generated to determine area under the curve (AUC) and optimal cutoff points of clinical findings for diagnosing simple appendicitis. Outcomes included sensitivity and specificity of variables to identify simple appendicitis. Predictions were compared to operative findings using χ2. A p-value < 0.05 was considered statistically significant. Results: Of 125 cases (median age 9 years [IQR 7–13], 58% male), simple appendicitis was predicted in 77 (62%) and complex appendicitis in 48 (38%). Predictions were accurate in 59 (77%) simple cases and 45 (94%) complex cases. Although surgeon prediction was more accurate than individual imaging or clinical findings and was highly sensitive (95%) for diagnosing simple appendicitis, specificity was only 71%. Lower WBC (< 15.5 × 103/μL, AUC 0.61, p = 0.05), afebrile (< 100.4 °F, AUC 0.86, p < 0.01), and shorter symptom duration (≤ 1.5 days, AUC 0.71, p < 0.001) were associated with simple appendicitis. Of 18 complex cases (14%) inaccurately predicted as simple, 17 (94%) lacked diffuse tenderness, 15 (83%) were well-appearing, 11 (61%) had ultrasound findings of simple appendicitis, 11 (61%) had ≤ 2 days of symptoms, and 8 (44%) were afebrile (< 100.4 °F). Conclusion: While surgeon prediction of simple appendicitis is more accurate than ultrasound or clinical data alone, diagnostic accuracy is still limited. Type of study: Prospective survey.
AB - Purpose: Clinical prediction of disease severity is important as one considers nonoperative management of simple appendicitis. This study assesses the accuracy of surgeons' prediction of appendicitis severity. Methods: From February to August 2016, pediatric surgeons at a single institution were asked to predict whether patients had simple or complex appendicitis preoperatively based on clinical data, imaging, and general assessment. Receiver operating characteristic curves were generated to determine area under the curve (AUC) and optimal cutoff points of clinical findings for diagnosing simple appendicitis. Outcomes included sensitivity and specificity of variables to identify simple appendicitis. Predictions were compared to operative findings using χ2. A p-value < 0.05 was considered statistically significant. Results: Of 125 cases (median age 9 years [IQR 7–13], 58% male), simple appendicitis was predicted in 77 (62%) and complex appendicitis in 48 (38%). Predictions were accurate in 59 (77%) simple cases and 45 (94%) complex cases. Although surgeon prediction was more accurate than individual imaging or clinical findings and was highly sensitive (95%) for diagnosing simple appendicitis, specificity was only 71%. Lower WBC (< 15.5 × 103/μL, AUC 0.61, p = 0.05), afebrile (< 100.4 °F, AUC 0.86, p < 0.01), and shorter symptom duration (≤ 1.5 days, AUC 0.71, p < 0.001) were associated with simple appendicitis. Of 18 complex cases (14%) inaccurately predicted as simple, 17 (94%) lacked diffuse tenderness, 15 (83%) were well-appearing, 11 (61%) had ultrasound findings of simple appendicitis, 11 (61%) had ≤ 2 days of symptoms, and 8 (44%) were afebrile (< 100.4 °F). Conclusion: While surgeon prediction of simple appendicitis is more accurate than ultrasound or clinical data alone, diagnostic accuracy is still limited. Type of study: Prospective survey.
KW - Accuracy
KW - Appendicitis
KW - Diagnostic study
KW - Nonoperative management
KW - Pediatric
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U2 - 10.1016/j.jpedsurg.2019.04.007
DO - 10.1016/j.jpedsurg.2019.04.007
M3 - Article
C2 - 31097307
AN - SCOPUS:85065389681
SN - 0022-3468
VL - 54
SP - 2274
EP - 2278
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 11
ER -