Validation of an electronic medical computer application to study acute appendicitis in paediatric patients
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Abstract
DOI: 10.1016/j.rcpe.2016.02.003
Antecedents
The use of electronic medical record software for the diagnosis of the acute appendicitis has not been reported in our media.
Objective
To validate the use of medical record software, designed by the authors, that guides the management of patients with abdominal pain with suspected acute appendicitis.
Methodology
A prospective, longitudinal and observational study was performed in the Emergency Service of the Hospital Erasmo Meoz, between 30 May 2013, and May 2014, on patients between 5 and 14 years old, who came to the paediatric emergency department with acute abdominal pain and the general doctor suspected acute appendicitis.
Appendicitis was defined as the presence of a positive cytology report. Interobserver assessments were performed, and the sensitivity, specificity and the positive and negative value.
Results
Of 130 patients, 30 were excluded due to faulty inclusion criteria. The calculated kappa coefficient was 0.7 (95% confidence interval: 0.43-0.76). The cut-off points with the highest sensitivity were 1 and 2 (98.63% [95% CI; 92.6-99.7]), but with a specificity of 0% (95% CI; 0.0-12.4). The highest specificity was found between 9 and 10 (100% [95% CI; 43.8 - 100])), being the same for the lowest sensitivity (4.11% [CI 95%1.4-11.4]). By historic report, 100% of the operated patients had acute appendicitis.
Conclusions
The development of the electronic medical record software provides a valuable tool in the diagnostic process of a patient with pain, as it classifies patients with and without appendicitis
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References
Imaging for suspected appendicitis
Am Fam Physician., 71 (2005), pp. 71-78
Medline
2 Rodríguez Fernández Zenén
Complicaciones de la apendicectomía por apendicitis aguda
Rev Cubana Cir [revista en la Internet]., 49 (2010),
3 Rodríguez Fernández Zenén
Consideraciones actuales sobre el diagnóstico de la apendicitis aguda: Current criteria
Rev Cubana Cir [revista en la Internet]., 48 (2009),
4 K.C. Leung,Alexander,L. Sigalet David
Acute abdominal pain in children
Am Fam Physician., 67 (2003), pp. 11
5 D. Stringer Mark
Pledger Leeds Gordon. Childhood appendicitis in the United Kingdom: Fifty years of progress
J Pediatr Surg., 38 (2003), pp. 65-69
Medline
6 Discharges of inpatients from nonfederal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM. [citado 2013 mayo 15] Disponible en: http://www.cdc.gov/nchs/data/nhds/2average/2009ave2_firstlist.pdf.
7 D.G. Addis,N. Shaffer,B.S. Fowler,R.V. Tauxe
The epidemiology of appendicitis and appendectomy in the United States
Am J Epidemiol., 132 (1990), pp. 910-925
Medline
8 M.S. Irish,R.H. Pearl,M.G. Caty,P.L. Glick
The approach to common abdominal diagnoses in infants and children
Pediatr Clin North Am., 45 (1998), pp. 729-772
Medline
9 10 V. Pepper,A. Stenfill,R. Pearl
Diagnosis and management of pediatric appendicitis, intussusceptions, and Meckel's diverticulum
Surg Clin N Am, 92 (2012), pp. 505-526 http://dx.doi.org/10.1016/j.suc.2012.03.011
Medline
11 Ibid p506.
12 Lin YL, Op. cit.p.1.
13 M. McCollough,G. Sharieff
Abdominal pain in children
Pediatr Clin North Am., 53 (2006), pp. 107-137 http://dx.doi.org/10.1016/j.pcl.2005.09.009
Medline
14 J. D’Agostino
Common abdominal emergencies in children
Emerg Med Clin North Am., 20 (2002), pp. 139-151
Medline
15 S.E. Morrow,K.D. Newman
Current management of appendicitis
Semin Pediatr Surg., 16 (2007), pp. 34-40 http://dx.doi.org/10.1053/j.sempedsurg.2006.10.005
Medline
16 A.H. Shera,F.A. Nizami,A.A. Malik,Z.A. Naikoo,M.A. Wani
Clinical scoring system for diagnosis of acute appendicitis in children
Indian J Pediatr, 78 (2011), pp. 287-290 http://dx.doi.org/10.1007/s12098-010-0285-9
Medline
17 H. Sitter,S. Hoffmann,I. Hassan,A. Zielke
Diagnostic score in appendicitis: Validation of a diagnostic score (Eskelinen Score) in patients in whom acute appendicitis is suspected
Langenbecks Arch Surg., 389 (2004), pp. 213-218 http://dx.doi.org/10.1007/s00423-003-0436-9
Medline
18 J.M. Howell,L.E. Orin,T.W. Lukens,M.E. Thiessen,S.D. Weingart,W.W. Decker
Clinical policy: Critical issues in the evaluation and management of emergency department patients with suspected appendicitis
Ann Emerg Med., 55 (2010), pp. 71-116 http://dx.doi.org/10.1016/j.annemergmed.2009.10.004
Medline
19 D.G. Bundy,J. Byerley,S.L. Allen,E.M. Perrin,J. Katznelson,H.E. Rice
Does this child have appendicitis?
JAMA., 298 (2007), pp. 438-451 http://dx.doi.org/10.1001/jama.298.4.438
Medline
20 R.D. Goldman,Carters,D. Stephens,R. Antoon,W. Mounstephen,J. Langer
Prospective validation of the pediatric appendicitis score
J Pediatr., 153 (2008), pp. 278-282 http://dx.doi.org/10.1016/j.jpeds.2008.01.033
Medline
21 T.L. Yap,Y. Chen,Wei Xin Low Wilson,Choo Phaik Ong Caroline,S.A. Nah,A.S. Jacobsen,L. Shen,Y. Low
A new 2-step risk-stratification clinical score for suspected appendicitis in children
J Pediatr Surg., 5 (2015), pp. 2051-2055
22 R. Fernández Valadés
Utilización de escalas diagnósticas para el diagnóstico de apendicitis aguda en niños
Evid Pediatr., 11 (2015), pp. 49
23 M. Beltrán,J. Almonacid,J. Gutiérrez,K. Cruce
Puntuación diagnóstica de apendicitis aguda en niños realizada por pediatras de las unidades de emergencia
Arch Pediatric Urug., 80 (2009), pp. 229-236
24 M. Samuel
Pediatric appendicitis score
J Pediatric Surg., 37 (2002), pp. 877-881
25 C. Schneider,A. Kharbanda,R. Bachur
Evaluating appendicitis scoring systems using a prospective pediatric cohort
Ann Emerg Med., 49 (2007), pp. 778-784 http://dx.doi.org/10.1016/j.annemergmed.2006.12.016
Medline
26 Beltrán. Op. cit. p. 230.
27 Ibid. p330.
28 Schneider. Op. cit. p. 780.
29 S.F. Polites,M.I. Mohamed,E.B. Habermann,J.L. Homme,J.L. Anderson,R.M. Christopher
A simple algorithm reduces computed tomography use in the diagnosis of appendicitis in children
Surgery., 156 (2014), pp. 448-454 http://dx.doi.org/10.1016/j.surg.2014.04.001
Medline
30 J.D. Mathews,A.V. Forsythe,Z. Brady,M.W. Butler,S.K. Goergen,G.B. Byrnes
Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians
BMJ., 346 (2013), pp. 2360