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Model of van den Bogaard et al for Predicting Risk of Appendiceal Perforation in a Pediatric Patient with Appendicitis

Description

van den Bogaard et al reported a model for predicting how likely appendiceal rupture is in a pediatric patient with acute appendicitis. This can help to identify a patient who may benefit from more aggressive management. The authors are from Spaarne Hospital, Alkmaar Medical Centerand Regional Public Health Laboratory Kennemerland in the Netherlands.


 

Patient selection: pediatric patient with appendicitis from 3 to 18 years of age

 

Outcome: appendiceal perforation

 

Parameters"

(1) temperature in °C

(2) serum CRP in mg/L

(3) appendix visible on ultrasound

(4) if visible, diameter of the appendix on ultrasound in mm

(5) free fluid on ultrasound

Parameter

Finding

Points

temperature in °C

 

0.75 * (temperature)

serum CRP

 

0.024 * (CRP)

appendix

not visible

0

 

visible

-2.466

appendix diameter

not visible

0

 

visible

0.281 * (diameter)

free fluid

absent

0

 

present

1.79

 

X =

= SUM(points for the 5 parameters) - 32.452

 

probability of appendiceal rupture =

= 1 / (1 + EXP((-1) * X))

 

Performance:

• The area under the ROC curve was 0.91.

• Using a cutoff of 15% for rupture risk the sensitivity was 85% and specificity 81%.

 


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