| Objective:Combining with the analysis of the existing scoring indexes of Pediatric Appendicitis Score and clinical experience,a new scoring indicator--Ameliorated Pediatric Appendicitis Score(APAS)is added to the field.A single center value study is conducted to observe its feasibility.Methods:Evaluating PAS,a scoring method commonly used internationally in the past for acute appendicitis in children.Combine clinical experience,improve the original scoring indicators and add new indicators,and conduct binary logistics regression analysis for meaningful indicators to determine their status as risk factors.Then,multiple ordered logistics regression analysis was carried out to determine the impact value of different indicators on different degrees of acute appendicitis.By assigning different scores to each indicator,improved children acute appendicitis scoring method APAS was obtained.Two different scoring methods were used to compare and analyze the collected data of 108 children.The ROC curve was drawn to compare the AUC values.The optimal diagnostic threshold was determined by Yoden index,and the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value and negative predictive value were calculated.To compare the difference between PAS and APAS in the diagnosis of acute and complex appendicitis in children.Finally,the modified pediatric appendicitis scoring method APAS was re-validated in children treated for acute abdomen and undergoing surgical treatment.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value and negative predictive value were calculated to evaluate the diagnostic value of APAS in a single center.Results:1.Basic data analysis :The data of 108 children treated for acute abdomen were collected.Among them,85 patients were pathologically consistent with the diagnosis of acute appendicitis(85/108,78.70%)and 23 patients were excluded from the diagnosis(23/108,21.30%).In the cases of children with appendicitis,30 cases(30/85,35.29%)of acute simple appendicitis,55 cases(55/85,64.71%)of complex appendicitis(suppurative appendicitis and gangrenous appendicitis),including 21 cases(21/85,24.71%)of suppurative appendicitis,34 cases(34/85 of gangrenous appendicitis,40.00%).2.Establishment of Ameliorated Pediatric Appendicitis Score: Based on literature review and clinical experience,it was determined whether abdominal muscle tension,fibrinogen count > 5g/L,CRP/ALB > 1.305 were added to the improved scoring method APAS,and whether appendicular prolith,thickening or peripheral abscess were found on ultrasound.A binary logistics regression analysis was carried out to determine the independent risk factor status of each factor(regression analysis significance of each index P < 0.05),whether there were indicators such as appendicose,thickness or peripheral abscess found on CT and the original retention indicators of PAS.Then,multiple ordered logistics regression analysis was carried out on the indicators of APAS,and it was found that ultrasound showed appendicular prolith,thickening or peripheral abscess,and the diagnosis value of fibrinogen count > 5g/L was higher.Moreover,the ultrasound results and fibrinogen count index were assigned higher scores to obtain the specific content of APAS scoring method.The data of 108 children with acute abdominal disease were analyzed using the modified pediatric acute appendicitis scoring method APAS.The receiver operating curve(ROC operating curve)was drawn from the scoring results.The optimal diagnostic threshold was determined to be 4.Children with acute appendicitis above the diagnostic threshold were used to draw the ROC curve with APAS method,the optimal diagnostic threshold was determined to be 7,so as to distinguish the diagnosis of acute simple appendicitis from acute complex appendicitis.According to this,the total score description and risk grouping of APAS were obtained: the total score of APAS 1-3 was divided into low-risk group,without considering appendicitis for the time being.4 to 6 were divided into moderate risk group,considering simple appendicitis or other types of acute abdomen,combined with the situation of the children and the wishes of their families,can be timely anti-infection conservative treatment or surgical treatment;7-14 classified as high risk,complex appendicitis(suppurative appendicitis or gangrenous appendicitis)was considered,and emergency surgical treatment was recommended.3.The value analysis of APAS: APAS scoring method was used to analyze the data of 108 children: there were 25 patients in the low-risk group with a score of 1-3,33 in the medium-risk group with a score of 4-6,and 50 in the high-risk group with a score of 7-14.At the same time,the original PAS scoring method was used to analyze the data of 108children: There were 20 people in the low-risk group with a score of 1-3,57 in the moderate-risk group with a score of 4-7,and 31 in the high-risk group with a score of8-10.The collected data of 108 children were incorporated into PAS and APAS scoring methods according to pathological results and the grouping of each scoring method,and the statistical values of true positive and false positive were obtained.Diagnostic tests were conducted in Medcalc software,and the reliability of the two scoring methods in the diagnosis of acute appendicitis and acute complex appendicitis was obtained: The diagnostic sensitivity of APAS for acute appendicitis was 83.53%(95%CI,73.91-90.70%),the specificity was 47.83%(95%CI,26.82-69.41%),and the positive likelihood ratio was 1.6011(95%CI,1.077-2.3940).Negative likelihood ratio was 0.3443(95%CI,0.1810-0.6540),positive predictive value was 85.54%(95%CI,79.82-89.85%),and negative predictive value was 44.00%(95%CI,29.26%-59.88%).The sensitivity and specificity of PAS score for the diagnosis of acute appendicitis were 85.88%(95%CI,76.64%-92.49%),34.78%(95%CI,16.38%-57.27%),and positive likelihood ratio was1.3168(95%CI,0.9650-1.7970).Negative likelihood ratio was 0.4060(95%CI,0.1890-0.8740),positive predictive value was 82.95%(95%CI,78.10%-86.91%),and negative predictive value was 40%(95%CI,23.64%-58.94%).The diagnostic sensitivity of APAS for acute complex appendicitis was 79.63%(95%CI,66.47%-89.37%),specificity 75.86%(95%CI,56.46%-89.70%),positive likelihood ratio 3.2990(95%CI,1.7060-6.376).Negative likelihood ratio was 0.2685(95%CI,0.1520-0.4730),positive predictive value was 86.00%(95%CI,76.06%-92.23%),and negative predictive value was 66.67%(95%CI,53.18%-77.89%).The sensitivity and specificity of PAS score for the diagnosis of acute complex appendicitis were 46.00%(95%CI,31.82-60.68%)and78.95%(95%CI,62.68%-90.45%).The specificity of APAS in the diagnosis of acute appendicitis was higher than that of PAS,but its sensitivity was slightly lower than that of PAS.In the diagnosis of complex appendicitis,the sensitivity of APAS was higher than that of PAS,but the specificity was slightly lower than that of PAS.The positive likelihood ratio,negative likelihood ratio,positive predictive value and negative predictive value of APAS scoring method were superior to PAS scoring method.4.Verification experiment results of APAS: The confirmability of APAS score was applied to 33 children treated for acute abdomen.The diagnostic sensitivity of APAS score for acute appendicitis was 91.67%(95%CI,73.00%-98.97%),and the specificity was 55.56%(95%CI,21.20%-86.30%).Positive likelihood ratio was 2.0628(95%CI,0.9840-4.3240),negative likelihood ratio was 0.1500(95%CI,0.0350-0.6390),positive predictive value was 84.62%(95%CI,72.40%-92.02%),negative predictive value was71.43%(95%CI,36.97%-91.42%);The sensitivity and specificity of PAS score for acute appendicitis were 70.83%(95%CI,48.91-87.39%)and 22.22%(95%CI,2.81-60.01%).The diagnostic sensitivity of APAS for acute complex appendicitis was 68.42%(95%CI,43.45%-87.42%),specificity 85.71%(95%CI,42.13%-99.64%),positive likelihood ratio4.7890(95%CI,0.7610-30.1610).Negative likelihood ratio was 0.3680(95%CI,0.1780-0.7630),positive predictive value was 92.86%(95%CI,67.37%-98.80%),and negative predictive value was 50.00%(95%CI,32.57%-67.43%).The sensitivity and specificity of PAS score for acute complex appendicitis were 13.33%(95%CI,1.66%-40.46%)and 55.56%(95%CI,21.20%-86.30%).The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value and negative predictive value of APAS score were superior to PAS score in the diagnosis of acute appendicitis and acute complex appendicitis in children.Conclusion:APAS can be used in the preoperative diagnosis of acute appendicitis in children.It can specifically identify non-appendicitis in low-risk groups with low scores,and sensitively identify acute complex appendicitis in high-risk groups with high scores.APAS can reduce the misdiagnosis rate of appendicitis and the negative removal rate of appendicitis,and can quickly identify the serious condition of suppurative appendicitis and gangrenous appendicitis,guide the surgical treatment,improve the prognosis of children and alleviate the pain of children. |
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