| Objective: Analyze and compare the advantages and disadvantages of Alvarado,PAS and AIR scoring system in the diagnosis of acute appendicitis in children,combining with the clinical experience treats,to establish a new scoring system for diagnosis of acute appendicitis in children and compare the difference of the sensitivity,the specificity,positive and negative likelihood ratio,positive predictive value,negative predictive value,negative appendectomy ratio and missed diagnosis ratio with Alvarado,PAS and AIR scoring system,apply the SAC in clinic to verify its validity.Methods: 165 children with admitting diagnosis is acute abdomen,underwent laparoscopic abdominal exploration in Tianjin Children's Hospital during May 2012 to August 2012,were studied retrospectively and graded with Alvarado,PAS,AIR and SAC Individually.According to the intraoperative findings or postoperative pathological results,they were divided into two groups: positive and negativ.Used Med Calc 17.2 to draw the ROC curve,contrasted AUC value size.According to the Youden index to determine the optimal cutoff value,calculated and compared the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive and negative values,negative appendectomy ratio and missed diagnosis ratio.Then divided the data into four groups according to the non appendicitis,appendicitis,suppurative appendicitis and gangrene appendicitis,compared the results of different scoring systems for different types of appendicitis,SPSS 22.0 was used for analysis of variance and pairwise comparison.Then,from January 2013 to March 2013,a prospective study was performed to apply the SAC to the clinical diagnosis of 109 children with acute abdomen.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value,negative predictive value,negative appendectomy ratio and missed diagnosis ratio were retested to verify its validity.Results: A total of 165 children with acute abdomen underwent laparoscopic abdominal exploration were studied,112 male children(69.14%)and 53 female children(30.86%)with a median age of 7 years(range 7months-16 years).There are 40 children with simple appendicitis(24.24%),84 children with suppurative appendicitis(50.91%),27 children gangrenous with gangrene appendicitis 27 children(16.36%),and 14 children were exclude acute appendicitis by postoperative pathological diagnosis(8.48%).The ROC curve of Alvarado scoring system AUC was 0.884(95%CI,0.825-0.929),the Jorden index was 0.58,and the best diagnostic value was about 7.There were 147 children scoring more than or equal to 7 and 18 children scoring less than 7.There were 142 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 147 scoring more than or equal to 7.There were 9 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 18 scoring less than 7.The sensitivity was 94.04%(95%CI,89.0%-97.2%),the specificity was 64.29%(95%CI,35.1%-87.2%),the positive likelihood ratio was 2.63,the negative likelihood ratio was 0.093,the positive predictive value was 0.97,the negative predictive value was 0.5,the negative appendectomy ratio was 3.40%,the missed diagnosis ratio was 5.96%.The ROC curve of PAS scoring system AUC was 0.919(95%CI,0.867-0.956),the Jorden index was 0.71,and the best diagnostic value was about 8.There were 107 children scoring more than or equal to 8 and 58 children scoring less than 7.There were 107 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 107 scoring more than or equal to 8.There were 44 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 58 scoring less than 8.The sensitivity was 70.86%(95%CI,62.9%-78.0%),the specificity was 100.00%(95%CI,76.8%-100.00%),the positive likelihood ratio was infinity,negative likelihood ratio was 0.29,the positive predictive value was 1,the negative predictive value was 0.24,the negative appendectomy ratio was 0.00%,the missed diagnosis ratio was 29.14%.The ROC curve of AIR scoring system AUC was 0.766(95%CI,0.694-0.828),the Jorden index was 0.46,and the best diagnostic value was about 5.There were 116 children scoring more than or equal to 5 and 49 children scoring less than 7.There were 112 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 116 scoring more than or equal to 5.There were 39 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 49 scoring less than 5.The sensitivity was 74.17%(95%CI,66.4%-80.9%),the specificity was71.43%(95%CI,41.9%-91.6%),the positive likelihood ratio was 2.60,the negative likelihood ratio was 0.36,the positive predictive value was 0.97,the negative predictive value was 0.20,the negative appendectomy ratio was 0.00%,the missed diagnosis ratio was 25.83%.The ROC curve of SAC AUC was 0.980(95%CI,0.945-0.995),the Jorden index was 0.95,and the best diagnostic value was about 8.There were 143 children scoring more than or equal to 8 and 22 children scoring less than 8.There were 142 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 143 scoring more than or equal to 5.There were 8 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 22 scoring less than 8.The sensitivity was 94.70%(95%CI,89.8%-97.7%),the specificity was100.00%(95%CI,76.8%-100.0%),the positive likelihood ratio was infinity,negative likelihood ratio was 0.053,the positive predictive value was 1,the negative predictive value was 0.64,the negative appendectomy ratio was 0.00%,the missed diagnosis ratio was 5.30%.During the comgparing the scores of different scoring systems in comparison with different types of appendicitis,we found that there was no statistical discrepancy between the score of Alvarado and PAS scoring system about suppurative appendicitis and gangrene appendicitis.There was no statistical discrepancy between the score of AIR scoring system about simple appendicitis and non-appendicitis.There were statistical discrepancies between the score of SAC between all the groups.There were 109 children with admitting diagnosis is acute abdomen about clinical applications with SAC.Gave the result as follows: AUC was 0.973(95%CI,0.923-0.995),the Jorden index was 0.8842,and the best diagnostic value was about 8.There were 83 children scoring more than or equal to 8 and 26 children scoring less than 8.There were 82 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 83 scoring more than or equal to 8.There were 6 children whose postoperative pathological diagnosis diagnosis is acute appendicitis in the 26 scoring less than 8.The sensitivity was 93.18%(95%CI,85.7%-97.5%),the specificity was 95.24%(95%CI,76.2%-99.9%),the positive likelihood ratio was 19.57,the negative likelihood ratio was 0.072,the positive predictive value was 0.99,the negative predictive value was 0.77,the negative appendectomy ratio was 1.20%,the missed diagnosis ratio was 6.82%.It is superior to Alvarado,PAS,AIR scoring systems.Conclusion: All of the Alvarado scoring system,PAS scoring system and SAC can be used in the diagnosis of acute appendicitis in children.But the SAC scoring system is superior to the former scoring systems in sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value and negative predictive value,and the negative appendectomy ratio is lower than Alvarado scoring system,missed diagnosis rate is significantly lower than PAS scoring system.And according to the results of SAC score,it can help clinicians to judge the severity of appendicitis in children. |
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