Diagnostic prediction of complicated appendicitis by combined clinical and radiological appendicitis severity index (APSI)
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Diagnostic prediction of complicated appendicitis by combined clinical and radiological appendicitis severity index (APSI). / Avanesov, Maxim; Wiese, Nis Jesper; Karul, Murat; Guerreiro, Helena; Keller, Sarah; Busch, Philip; Jacobsen, Frank; Adam, Gerhard; Yamamura, Jin.
in: EUR RADIOL, Jahrgang 28, Nr. 9, 09.2018, S. 3601-3610.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Diagnostic prediction of complicated appendicitis by combined clinical and radiological appendicitis severity index (APSI)
AU - Avanesov, Maxim
AU - Wiese, Nis Jesper
AU - Karul, Murat
AU - Guerreiro, Helena
AU - Keller, Sarah
AU - Busch, Philip
AU - Jacobsen, Frank
AU - Adam, Gerhard
AU - Yamamura, Jin
PY - 2018/9
Y1 - 2018/9
N2 - OBJECTIVES: To develop a routinely applicable severity index for the management of acute appendicitis in adults using combined clinical and radiological parameters and retroperitoneal space planes (RSP).METHODS: Two hundred consecutive patients with histologically proven acute appendicitis and available presurgical CT scans were analysed retrospectively. Two radiologists assessed all CT scans for morphologic sings of appendicitis and six RSP. Clinical parameters were age, body temperature, C-reactive protein (CRP), white blood cell count, and duration of symptoms. Radiological parameters were appendix diameter and wall thickness, periappendiceal fat stranding and fluid, intraluminal and extraluminal air, thinning of appendiceal wall, caecal wall thickening, appendicolith and abscess formation.RESULTS: One hundred and three patients (51%) had histologically proven complicated appendicitis. Based on three clinical (age ≥52 years, body temperature ≥37.5°C, duration of symptoms ≥48 h) and four computed tomography (CT) findings (appendix diameter ≥14 mm, presence of periappendiceal fluid, extraluminal air, perityphlitic abscess), the APSI was developed using regression coefficients of multivariate logistic regression analyses with a maximum of 10 points. A score of ≥4 points predicted complicated appendicitis with a positive predictive value of 92% and a negative predictive value of 83%. Substantial to excellent interobserver agreement was found for the four radiological parameters of the APSI [intraclass correlation coefficient (ICC), 0.78-0.83]. The RSP evaluation presented no added value for the diagnosis of complicated appendicitis.CONCLUSIONS: Using APSI, an accurate and simple prediction of complicated appendicitis in adults was possible. The RSP count was not useful for the diagnosis of complicated appendicitis.KEY POINTS: • Appendicitis severity score provides an accurate and simple prediction of complicated appendicitis • Appendicitis severity score ≥4 accurately predicted complicated appendicitis (PPV 92%;NPV 83%) • Evaluation of retroperitoneal space planes was not useful in diagnosing complicated appendicitis.
AB - OBJECTIVES: To develop a routinely applicable severity index for the management of acute appendicitis in adults using combined clinical and radiological parameters and retroperitoneal space planes (RSP).METHODS: Two hundred consecutive patients with histologically proven acute appendicitis and available presurgical CT scans were analysed retrospectively. Two radiologists assessed all CT scans for morphologic sings of appendicitis and six RSP. Clinical parameters were age, body temperature, C-reactive protein (CRP), white blood cell count, and duration of symptoms. Radiological parameters were appendix diameter and wall thickness, periappendiceal fat stranding and fluid, intraluminal and extraluminal air, thinning of appendiceal wall, caecal wall thickening, appendicolith and abscess formation.RESULTS: One hundred and three patients (51%) had histologically proven complicated appendicitis. Based on three clinical (age ≥52 years, body temperature ≥37.5°C, duration of symptoms ≥48 h) and four computed tomography (CT) findings (appendix diameter ≥14 mm, presence of periappendiceal fluid, extraluminal air, perityphlitic abscess), the APSI was developed using regression coefficients of multivariate logistic regression analyses with a maximum of 10 points. A score of ≥4 points predicted complicated appendicitis with a positive predictive value of 92% and a negative predictive value of 83%. Substantial to excellent interobserver agreement was found for the four radiological parameters of the APSI [intraclass correlation coefficient (ICC), 0.78-0.83]. The RSP evaluation presented no added value for the diagnosis of complicated appendicitis.CONCLUSIONS: Using APSI, an accurate and simple prediction of complicated appendicitis in adults was possible. The RSP count was not useful for the diagnosis of complicated appendicitis.KEY POINTS: • Appendicitis severity score provides an accurate and simple prediction of complicated appendicitis • Appendicitis severity score ≥4 accurately predicted complicated appendicitis (PPV 92%;NPV 83%) • Evaluation of retroperitoneal space planes was not useful in diagnosing complicated appendicitis.
KW - Abscess
KW - Acute Disease
KW - Adolescent
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Appendicitis
KW - Appendix
KW - Biomarkers
KW - C-Reactive Protein
KW - Female
KW - Humans
KW - Leukocyte Count
KW - Male
KW - Middle Aged
KW - Observer Variation
KW - Predictive Value of Tests
KW - Retroperitoneal Space
KW - Retrospective Studies
KW - Severity of Illness Index
KW - Tomography, X-Ray Computed
KW - Young Adult
KW - Journal Article
U2 - 10.1007/s00330-018-5339-9
DO - 10.1007/s00330-018-5339-9
M3 - SCORING: Journal article
C2 - 29541911
VL - 28
SP - 3601
EP - 3610
JO - EUR RADIOL
JF - EUR RADIOL
SN - 0938-7994
IS - 9
ER -