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Vol. 99. Issue 4.
Pages 282-288 (April 2021)
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Vol. 99. Issue 4.
Pages 282-288 (April 2021)
Original article
Evaluation of preoperative clinical and serological determinations in complicated acute appendicitis: A score for predicting complicated appendicitis
Valoración de parámetros clínicos y analíticos preoperatorios en apendicitis aguda complicada. Score para predecir apendicitis complicada
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Cristina García-Amadora,
Corresponding author
cgamador@sescam.jccm.es

Corresponding author.
, Vladimir Arteaga Peraltaa, Roberto de la Plaza Llamasa, Miguel Torralbab, Anibal Medina Velascoa, José Manuel Ramiaa
a Servicio de Cirugía General, Hospital Universitario de Guadalajara, Guadalajara, Spain
b Servicio de Medicina Interna, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Tables (3)
Table 1. Comparison of uncomplicated and complicated AA groups.
Table 2. Variables included in the formula for the predictive clinical model.
Table 3. ROC curve of statistically significant variables and the predictive model.
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Abstract
Background

To analyze whether clinical and analytical parameters differ according to histopathology in cases of acute appendicitis (AA).

Methods

This is a retrospective, observational study including patients (>14 years of age) admitted for suspicion of AA from 1 April 2014 to 31 July 2016. Histopathology was divided into complicated (including perforated and gangrenous AA) and uncomplicated appendicitis (phlegmonous). Sex, age, temperature of patients on admission to the Emergency Department, symptom duration, preoperative white blood cell (WBC) count, neutrophil percentage, mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP) and hospital stay were compared in the two groups.

Results

Three hundred and thirty-five patients were analyzed, and 284 were included. Appendicitis was uncomplicated in 194 (68.3%) and complicated in 90 (31.7%). Age, symptom duration, neutrophil percentage, CRP and hospital stay were higher in the complicated AA group (P < .05). The mean differences between uncomplicated and complicated AA were: age 13.2 years (95% CI: 8.2–18.2), symptom duration 14.1 h (95% CI: 6.3–21.9), neutrophil percentage 5.0% (95% CI: 3.2–6.8), CRP 73.6 mg/l (95% CI: 50.0–97.2) and hospital stay 2.2 days (95% CI: 1.4–3.0), with p < 0.05 for all these variables. A model based on the preoperative parameters (age, symptom duration, neutrophil percentage and CRP) was calculated to predict the likelihood of complicated AA. The receiver operating characteristic (ROC) of the model had an area under the curve of 0.80 (95% CI 0.75−0.85).

Conclusion

This model is able to diagnose complicated AA without the need for imaging techniques, although it must be validated with prospective analysis.

Keywords:
Appendicitis
Appendix
Diagnosis
Scoring system
Prediction model
Resumen
Introducción

Los parámetros clínicos y analíticos de la apendicitis aguda (AA) son la base diagnóstica. Se analiza la diferencia de sus valores según la histología para distinguir las AA simples de las complicadas.

Métodos

Análisis observacional retrospectivo que incluye pacientes (>14 años) que ingresan con diagnóstico de AA desde el 1 abril 2014 al 31 julio 2016. Histopatológicamente se dividen en AA complicada (perforada y/o gangrenada) y AA no complicada (flemonosa). Entre los 2 grupos se compara sexo, edad, temperatura al ingreso, duración de sintomatología, recuento leucocitario preoperatorio (WBC), porcentaje de neutrófilos, volumen plaquetario medio (VPM), índice de distribución de plaquetas (PDW), proteína C-reactiva (PCR) y estancia hospitalaria.

Resultados

Se analizan 335 pacientes y se incluyen 284, de los cuales 194 (68,3%) tienen AA no complicada (AAnc) y 90 (31,7%) AA complicada (AAc). La edad, la duración de sintomatología, el porcentaje de neutrófilos, la PCR y la estancia hospitalaria son mayores en la AAc (p < 0,05). Las diferencias de las medias entre AAnc y AAc son: edad 13,2 años (IC 95%: 8,2-18,2), duración de sintomatología 14,1 h (IC 95%: 6,3-21,9), porcentaje de neutrófilos 5,0% (IC 95%: 3,2-6,8), PCR 73,6 mg/l (IC 95%: 50,0-97,2) y estancia hospitalaria 2,2 días (IC 95%: 1,4-3,0), con p < 0,05. Un modelo basado en parámetros preoperatorios (edad, duración de sintomatología, porcentaje de neutrófilos y PCR) se calcula para predecir la posibilidad de AAc. El área bajo la curva del modelo es 0,80 (IC 95%: 0,75-0,85).

Conclusiones

El modelo predice la posibilidad de desarrollar AAc, pero debe validarse de manera prospectiva.

Palabras clave:
Apendicitis
Apéndice
Diagnóstico
Sistema de puntuación
Modelo predictivo

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