title: Diagnosing perforated appendicitis in pediatric patients: a new model.
abstract: OBJECTIVE
  Studies have investigated sensitivity and specificity of symptoms and tests for diagnosing appendicitis in children. Less is known with regard to the predictive value of these symptoms and tests with respect to the severity of appendicitis. The aim of this study was to determine the predictive value of patient's characteristics and tests for discriminating between perforated and nonperforated appendicitis in children.
  
  
  METHODS
  Pediatric patients who underwent an appendectomy at Spaarne Hospital Hoofddorp, the Netherlands, between January 1, 2009 and December 31, 2013, were included. Baseline patient's characteristics, history, physical examination, laboratory data and results of ultrasounds were collected. Univariate and multivariate logistic regressions were used to determine predictors of perforation.
  
  
  RESULTS
  In total, 375 patients were included in this study of which 97 children (25.9%) had significant signs of perforation. Univariate analysis showed that age, duration of complaints, temperature, vomiting, CRP, WBC, different findings on ultrasound and the diameter of the appendix were good predictors of a perforated appendicitis. The final multivariate prediction model included temperature, CRP, clearly visible appendix and free fluids on ultrasound and diameter of the appendix and resulted in an area under the curve (AUC) of 0.91 showing sensitivity and specificity of respectively 85.2% and 81.2%.
  
  
  CONCLUSIONS
  This prediction model can be used for identification of 'high-risk' children for a perforated appendicitis and might be helpful to prevent complications and longer hospitalization by bringing these children to theater earlier.
authors.affiliation: Department of Pediatrics, Spaarne Hospital, Hoofddorp, the Netherlands. Electronic address: appendicitis.studie@gmail.com.
authors.forename: Veerle A B
authors.initials: VA
authors.lastname: van den Bogaard
authors.affiliation: Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands.
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Euser
authors.affiliation: Foreest Medical School, Alkmaar Medical Centre, Alkmaar, the Netherlands.
authors.forename: Tjeerd
authors.initials: T
authors.lastname: van der Ploeg
authors.affiliation: Department of Surgery, Spaarne Hospital, Hoofddorp, the Netherlands.
authors.forename: Niels
authors.initials: N
authors.lastname: de Korte
authors.affiliation: Department of Radiology, Spaarne Hospital, Hoofddorp, the Netherlands.
authors.forename: Dave G M
authors.initials: DG
authors.lastname: Sanders
authors.affiliation: Department of Pediatrics, Spaarne Hospital, Hoofddorp, the Netherlands.
authors.forename: Derek
authors.initials: D
authors.lastname: de Winter
authors.affiliation: Department of Pediatrics, Spaarne Hospital, Hoofddorp, the Netherlands.
authors.forename: Diederik
authors.initials: D
authors.lastname: Vergroesen
authors.affiliation: Department of Pathology, Spaarne Hospital, Hoofddorp, the Netherlands.
authors.forename: Krijn
authors.initials: K
authors.lastname: van Groningen
authors.affiliation: Department of Pediatrics, Spaarne Hospital, Hoofddorp, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Winter
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity
keywords: Appendicitis; Children; Diagnosis; Perforated appendicitis; Predictors; Severe appendicitis