A clinical decision rule to identify children at low risk for appendicitis
A clinical decision rule to identify children at low risk for appendicitis
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DOI：
10.1542/peds.2005-0094
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发表时间：
2005-09-01
期刊：
影响因子：
8
通讯作者：
Bachur, RG
中科院分区：
文献类型：
--
作者：
Kharbanda, AB;Taylor, GA;Bachur, RG
Objective. Computed tomography (CT) has gained widespread acceptance in the evaluation of children with suspected appendicitis. Concern has been raised regarding the long-term effects of ionizing radiation. Other means of diagnosing appendicitis, such as clinical scores, are lacking in children. We sought to develop a clinical decision rule to predict which children with acute abdominal pain do not have appendicitis.Methods. Prospective cohort study was conducted of children and adolescents who aged 3 to 18 years, had signs and symptoms suspicious for appendicitis, and presented to the emergency department between April 2003 and July 2004. Standardized data-collection forms were completed on eligible patients. Two low-risk clinical decision rules were created and validated using logistic regression and recursive partitioning. The sensitivity, negative predictive value (NPV), and negative likelihood ratio of each clinical rule were compared.Results. A total of 601 patients were enrolled. Using logistic regression, we created a 6-part score that consisted of nausea ( 2 points), history of focal right lower quadrant pain ( 2 points), migration of pain ( 1 point), difficulty walking ( 1 point), rebound tenderness/pain with percussion ( 2 points), and absolute neutrophil count of > 6.75 x 10(3)/mu L ( 6 points). A score
