Classifying patients suspected of appendicitis with regard to likelihood
We sought to develop a clinical predictive model for acute appendicitis and contrast it with current clinical practice. A prospective observational study of patients presenting with signs or symptoms consistent with acute appendicitis. Random-partition modeling was used to develop an appendicitis li...
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| Veröffentlicht in: | The American journal of surgery 2006-04, Vol.191 (4), p.497-502 |
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| container_title | The American journal of surgery |
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| creator | Birkhahn, Robert H. Briggs, Matthew Datillo, Paris A. Van Deusen, Shawn K. Gaeta, Theodore J. |
| description | We sought to develop a clinical predictive model for acute appendicitis and contrast it with current clinical practice.
A prospective observational study of patients presenting with signs or symptoms consistent with acute appendicitis. Random-partition modeling was used to develop an appendicitis likelihood model (ALM).
Four hundred thirty-nine patients were enrolled, 101 with appendicitis, and 338 with other diagnoses. The ALM classified patients as “low likelihood” if they had a white blood cell count 82%. The ALM outperformed actual clinical practice with regard to “missed” appendicitis, negative laparotomies, and total number of imaging studies.
The ALM may permit more judicious use of advanced radiographic imaging with lower nontherapuetic laparotomy rates. |
| doi_str_mv | 10.1016/j.amjsurg.2005.08.031 |
| format | Article |
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A prospective observational study of patients presenting with signs or symptoms consistent with acute appendicitis. Random-partition modeling was used to develop an appendicitis likelihood model (ALM).
Four hundred thirty-nine patients were enrolled, 101 with appendicitis, and 338 with other diagnoses. The ALM classified patients as “low likelihood” if they had a white blood cell count <9,500 and either no right lower–quadrant tenderness or a neutrophil count <54%. Patients were classified as “high likelihood” if they had a white blood cell count >13,000 with rebound tenderness or both voluntary guarding and neutrophil count >82%. The ALM outperformed actual clinical practice with regard to “missed” appendicitis, negative laparotomies, and total number of imaging studies.
The ALM may permit more judicious use of advanced radiographic imaging with lower nontherapuetic laparotomy rates.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2005.08.031</identifier><identifier>PMID: 16531143</identifier><identifier>CODEN: AJSUAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Abdomen ; Accuracy ; Adolescent ; Adult ; Age ; Aged ; Aged, 80 and over ; Appendicitis ; Appendicitis - diagnosis ; Biological and medical sciences ; Blood ; Child ; Child, Preschool ; Clinical medicine ; Clinical scoring ; Confidence intervals ; Diagnosis ; Diagnosis, Differential ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; General aspects ; Humans ; Leukocyte Count ; Likelihood Functions ; Male ; Medical diagnosis ; Medical imaging ; Medical sciences ; Middle Aged ; Other diseases. Semiology ; Pain ; Pathology ; Predictive Value of Tests ; Prospective Studies ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Teaching hospitals ; Tomography ; Ultrasonic imaging</subject><ispartof>The American journal of surgery, 2006-04, Vol.191 (4), p.497-502</ispartof><rights>2006 Excerpta Medica Inc.</rights><rights>2006 INIST-CNRS</rights><rights>Copyright Elsevier Limited Apr 2006</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c449t-fe4cba891c4b1de9acf220ecf9d80443f6079325fd0047ea424237620747a2dd3</citedby><cites>FETCH-LOGICAL-c449t-fe4cba891c4b1de9acf220ecf9d80443f6079325fd0047ea424237620747a2dd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002961005007415$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17646348$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16531143$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Birkhahn, Robert H.</creatorcontrib><creatorcontrib>Briggs, Matthew</creatorcontrib><creatorcontrib>Datillo, Paris A.</creatorcontrib><creatorcontrib>Van Deusen, Shawn K.</creatorcontrib><creatorcontrib>Gaeta, Theodore J.</creatorcontrib><title>Classifying patients suspected of appendicitis with regard to likelihood</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>We sought to develop a clinical predictive model for acute appendicitis and contrast it with current clinical practice.
A prospective observational study of patients presenting with signs or symptoms consistent with acute appendicitis. Random-partition modeling was used to develop an appendicitis likelihood model (ALM).
Four hundred thirty-nine patients were enrolled, 101 with appendicitis, and 338 with other diagnoses. The ALM classified patients as “low likelihood” if they had a white blood cell count <9,500 and either no right lower–quadrant tenderness or a neutrophil count <54%. Patients were classified as “high likelihood” if they had a white blood cell count >13,000 with rebound tenderness or both voluntary guarding and neutrophil count >82%. The ALM outperformed actual clinical practice with regard to “missed” appendicitis, negative laparotomies, and total number of imaging studies.
The ALM may permit more judicious use of advanced radiographic imaging with lower nontherapuetic laparotomy rates.</description><subject>Abdomen</subject><subject>Accuracy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Appendicitis</subject><subject>Appendicitis - diagnosis</subject><subject>Biological and medical sciences</subject><subject>Blood</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical medicine</subject><subject>Clinical scoring</subject><subject>Confidence intervals</subject><subject>Diagnosis</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>General aspects</subject><subject>Humans</subject><subject>Leukocyte Count</subject><subject>Likelihood Functions</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Pain</subject><subject>Pathology</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. 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Liver. Pancreas. Abdomen</topic><topic>General aspects</topic><topic>Humans</topic><topic>Leukocyte Count</topic><topic>Likelihood Functions</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Pain</topic><topic>Pathology</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Teaching hospitals</topic><topic>Tomography</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Birkhahn, Robert H.</creatorcontrib><creatorcontrib>Briggs, Matthew</creatorcontrib><creatorcontrib>Datillo, Paris A.</creatorcontrib><creatorcontrib>Van Deusen, Shawn K.</creatorcontrib><creatorcontrib>Gaeta, Theodore J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Birkhahn, Robert H.</au><au>Briggs, Matthew</au><au>Datillo, Paris A.</au><au>Van Deusen, Shawn K.</au><au>Gaeta, Theodore J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Classifying patients suspected of appendicitis with regard to likelihood</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2006-04-01</date><risdate>2006</risdate><volume>191</volume><issue>4</issue><spage>497</spage><epage>502</epage><pages>497-502</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><coden>AJSUAB</coden><abstract>We sought to develop a clinical predictive model for acute appendicitis and contrast it with current clinical practice.
A prospective observational study of patients presenting with signs or symptoms consistent with acute appendicitis. Random-partition modeling was used to develop an appendicitis likelihood model (ALM).
Four hundred thirty-nine patients were enrolled, 101 with appendicitis, and 338 with other diagnoses. The ALM classified patients as “low likelihood” if they had a white blood cell count <9,500 and either no right lower–quadrant tenderness or a neutrophil count <54%. Patients were classified as “high likelihood” if they had a white blood cell count >13,000 with rebound tenderness or both voluntary guarding and neutrophil count >82%. The ALM outperformed actual clinical practice with regard to “missed” appendicitis, negative laparotomies, and total number of imaging studies.
The ALM may permit more judicious use of advanced radiographic imaging with lower nontherapuetic laparotomy rates.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16531143</pmid><doi>10.1016/j.amjsurg.2005.08.031</doi><tpages>6</tpages></addata></record> |
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| subjects | Abdomen Accuracy Adolescent Adult Age Aged Aged, 80 and over Appendicitis Appendicitis - diagnosis Biological and medical sciences Blood Child Child, Preschool Clinical medicine Clinical scoring Confidence intervals Diagnosis Diagnosis, Differential Female Gastroenterology. Liver. Pancreas. Abdomen General aspects Humans Leukocyte Count Likelihood Functions Male Medical diagnosis Medical imaging Medical sciences Middle Aged Other diseases. Semiology Pain Pathology Predictive Value of Tests Prospective Studies Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Teaching hospitals Tomography Ultrasonic imaging |
| title | Classifying patients suspected of appendicitis with regard to likelihood |
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