RT info:eu-repo/semantics/doctoralThesis
T1 Rendimiento de los signos ecográficos indirectos para el diagnóstico de apendicitis aguda en pacientes pediátricos en los que no se visualiza el apéndice.
A1 Pernía Sánchez, Juan Ventura
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Pediatría
K1 Appendicitis
K1 Apendicitis
K1 Pediatrics
K1 Pediatría
K1 Ultrasound
K1 Ecografía
K1 32 Ciencias Médicas
AB Introduction and objectivesAcute appendicitis is the most common surgical pathology in pediatric patients attending to the Emergency Department for abdominal pain. At this age, both the clinical and physi-cal examination are usually inconclusive. Therefore, in order to take a therapeutic decision, we must rely on complementary tests. The most commonly used in our environment are blood tests and abdominal ultrasound. The latter has demonstrated a high diagnostic per-formance. However, in up to half of the patients, the appendix may not be visualized, mak-ing it difficult to take decisions regarding patient management. The presence or absence of indirect signs of appendicitis in these ultrasounds appears to be useful in helping us to determine the best possible treatment.The main objective of this work is to analyse, in these ultrasounds in which the appendix is not visualized, whether the absence of those indirect ultrasound signs allows us to rule out acute appendicitis with an appropriate degree of certainty in the pediatric population.MethodsAn observational, retrospective and single-center study was conducted. Patients between 3 and 13 years of age attending to the Pediatric Emergency Department of the Hospital Uni-versitario Río Hortega in Valladolid (Spain) with clinical suspicion of acute appendicitis were included. The study period was from January 1st, 2013, to December 31st, 2019. Epide-miologic, clinical, analytical and ultrasound data were collected from the discharge reports for subsequent analysis. The diagnosis of appendicitis was based on histologic analysis of the surgical specimen in patients who underwent appendectomy. Since no patient with appendicitis was treated conservatively, if surgery was not performed in the following sev-en days, the patient was considered not to have acute appendicitis. In those patients in whom abdominal ultrasound was performed but the appendix was not visualized, the as-sociation of ultrasound signs with the anatomopathological diagnosis of appendicitis was analyzed by logistic regression. In addition, the diagnostic performance of the different biomarkers and the differences between biological sexes during the diagnostic and thera-peutic process were evaluated.Results1756 visits out of a total of 1611 episodes were eventually included. The median age of the episodes was 10.1 years (P25-P75 7.7-11.9) and there were 923 (57.3%) male patients. Al-varado score was calculated retrospectively and we found that 730 (41.6%) of the visits had a score ≤3 points, 695 (39.6%) between 4 and 6 points, and 331 (18.8%) ≥7 points. Ab-dominal ultrasound was performed in 1075 (61.2%) of the visits, with visualization of the appendix in 579 (53.9%) of them. Indirect ultrasound signs that showed an independent association with the final diagnosis of appendicitis in patients in whom the appendix was not visualized were inflammation of the periappendiceal fat (OR 7.2 [95%CI 1.4 - 38.0]) and free intra-abdominal fluid in small quantity (OR 5.0 [95%CI 1.7 - 14.6]) and in abundant quantity (OR 30.9 [95%CI 3.8 - 252.7]).In patients with an Alvarado score <7 points, the absence of free intra-abdominal fluid and periappendiceal fat inflammation allows to exclude acute appendicitis with a sensitivity of 84.6% (95%CI 57.8 - 95.7) and a negative predictive value of 99.4% (95%CI 97.8 - 99.8).ConclusionPediatric patients with an Alvarado score <7 points in whom an ultrasound is performed without visualization of the appendix but have no free intra-abdominal fluid or inflamma-tion of the periappendiceal fat are at very low risk for acute appendicitis.
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/76280
UL https://uvadoc.uva.es/handle/10324/76280
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 17-jul-2025