The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital
Autor(a) principal: | |
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Data de Publicação: | 2011 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.23/315 |
Resumo: | Introduction: Acute appendicitis (AA) is the leading cause of emergency abdominal surgery in children. The diagnosis is essentially clinical, but some methodologies, such as Alvarado score (AS), have been developed in order to avoid non-therapeutic laparotomy (15-30%). AS = 5 or 6 is compatible with AA and is an indication for the patient to remain on observations, if AS = 7 a laparotomy procedure may be indicated. Objective: To validate the AS for the AA diagnosis of children admitted at Braga Hospital. Methods: A validation study of diagnostic method (AS) using the histological examination as a gold standard. The study population consisted of 192 children (4-17 years) with abdominal pain that underwent appendectomy in the last 20 months (December 2008 to July 2010). It was determined the values of sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and the ROC curve for three different cut-off points (SA =5, 6 and 7). Results: We found that as the cut-off point of AS decreases progressively the sensitivity and specificity increases and reduces the VPN and VPP. Assuming a cut-off value of 5, only 18 children would be false negatives, instead of the 67 children if the cut-off point was 7 points. The analysis of ROC curves demonstrated a greater area under the curve for a cut-off equal to or greater than 5 (AUC = 70%). Discussion: We recommend using a cut-off value of 5 points, since only 18 children with AA were initially classified as appendicitis unlikely, this value would increase to 67 patients for the SA value of = 7. The AS is a valuable tool in screening children with abdominal pain for the diagnosis of AA. Nonetheless the diagnosis and final decision must be based on clinical and systematic reassessment of patients. |
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The Alvarado score validation in diagnosing acute appendicitis in children at Braga HospitalValidação do score de Alvarado no diagnóstico de apendicite aguda em crianças e adolescentes no Hospital de BragaAdolescenteCriançaApendiciteÍndice de Gravidade da DoençaIntroduction: Acute appendicitis (AA) is the leading cause of emergency abdominal surgery in children. The diagnosis is essentially clinical, but some methodologies, such as Alvarado score (AS), have been developed in order to avoid non-therapeutic laparotomy (15-30%). AS = 5 or 6 is compatible with AA and is an indication for the patient to remain on observations, if AS = 7 a laparotomy procedure may be indicated. Objective: To validate the AS for the AA diagnosis of children admitted at Braga Hospital. Methods: A validation study of diagnostic method (AS) using the histological examination as a gold standard. The study population consisted of 192 children (4-17 years) with abdominal pain that underwent appendectomy in the last 20 months (December 2008 to July 2010). It was determined the values of sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and the ROC curve for three different cut-off points (SA =5, 6 and 7). Results: We found that as the cut-off point of AS decreases progressively the sensitivity and specificity increases and reduces the VPN and VPP. Assuming a cut-off value of 5, only 18 children would be false negatives, instead of the 67 children if the cut-off point was 7 points. The analysis of ROC curves demonstrated a greater area under the curve for a cut-off equal to or greater than 5 (AUC = 70%). Discussion: We recommend using a cut-off value of 5 points, since only 18 children with AA were initially classified as appendicitis unlikely, this value would increase to 67 patients for the SA value of = 7. The AS is a valuable tool in screening children with abdominal pain for the diagnosis of AA. Nonetheless the diagnosis and final decision must be based on clinical and systematic reassessment of patients.Repositório Científico do Hospital de BragaGonçalves, JPCerqueira, AMartins, S2012-08-10T15:12:56Z2011-01-01T00:00:00Z2011-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.23/315porActa Med Port. 2011 Dec;24 Suppl 2:583-8.info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2022-09-21T09:01:54Zoai:repositorio.hospitaldebraga.pt:10400.23/315Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T15:54:44.184226Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital Validação do score de Alvarado no diagnóstico de apendicite aguda em crianças e adolescentes no Hospital de Braga |
title |
The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital |
spellingShingle |
The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital Gonçalves, JP Adolescente Criança Apendicite Índice de Gravidade da Doença |
title_short |
The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital |
title_full |
The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital |
title_fullStr |
The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital |
title_full_unstemmed |
The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital |
title_sort |
The Alvarado score validation in diagnosing acute appendicitis in children at Braga Hospital |
author |
Gonçalves, JP |
author_facet |
Gonçalves, JP Cerqueira, A Martins, S |
author_role |
author |
author2 |
Cerqueira, A Martins, S |
author2_role |
author author |
dc.contributor.none.fl_str_mv |
Repositório Científico do Hospital de Braga |
dc.contributor.author.fl_str_mv |
Gonçalves, JP Cerqueira, A Martins, S |
dc.subject.por.fl_str_mv |
Adolescente Criança Apendicite Índice de Gravidade da Doença |
topic |
Adolescente Criança Apendicite Índice de Gravidade da Doença |
description |
Introduction: Acute appendicitis (AA) is the leading cause of emergency abdominal surgery in children. The diagnosis is essentially clinical, but some methodologies, such as Alvarado score (AS), have been developed in order to avoid non-therapeutic laparotomy (15-30%). AS = 5 or 6 is compatible with AA and is an indication for the patient to remain on observations, if AS = 7 a laparotomy procedure may be indicated. Objective: To validate the AS for the AA diagnosis of children admitted at Braga Hospital. Methods: A validation study of diagnostic method (AS) using the histological examination as a gold standard. The study population consisted of 192 children (4-17 years) with abdominal pain that underwent appendectomy in the last 20 months (December 2008 to July 2010). It was determined the values of sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and the ROC curve for three different cut-off points (SA =5, 6 and 7). Results: We found that as the cut-off point of AS decreases progressively the sensitivity and specificity increases and reduces the VPN and VPP. Assuming a cut-off value of 5, only 18 children would be false negatives, instead of the 67 children if the cut-off point was 7 points. The analysis of ROC curves demonstrated a greater area under the curve for a cut-off equal to or greater than 5 (AUC = 70%). Discussion: We recommend using a cut-off value of 5 points, since only 18 children with AA were initially classified as appendicitis unlikely, this value would increase to 67 patients for the SA value of = 7. The AS is a valuable tool in screening children with abdominal pain for the diagnosis of AA. Nonetheless the diagnosis and final decision must be based on clinical and systematic reassessment of patients. |
publishDate |
2011 |
dc.date.none.fl_str_mv |
2011-01-01T00:00:00Z 2011-01-01T00:00:00Z 2012-08-10T15:12:56Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.23/315 |
url |
http://hdl.handle.net/10400.23/315 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
Acta Med Port. 2011 Dec;24 Suppl 2:583-8. |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
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reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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