Calculator to predict pediatric appendicitis may improve patient care

"We're thrilled to have developed a new way to standardize care for children and adolescents with abdominal pain," said Dr. Anupam Kharbanda, chief of critical care services at Children's Minnesota.
By Allen Cone  |  March 13, 2018 at 2:43 PM
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March 13 (UPI) -- Researchers at a children's hospital in Minnesota have developed a pediatric appendicitis risk calculator to aid in the diagnosis of the disease.

Researchers at Children's Minnesota, the seventh largest pediatric health system in the United States, and HealthPartners Institute, the largest consumer-governed, nonprofit healthcare organization, collaborated on the technique. Their findings were published Tuesday in the April issue of Pediatrics.

"This method is of great benefit to our patients and the health care system overall," Dr. Anupam Kharbanda, co-principal investigator and chief of critical care services at Children's Minnesota, said in a press release. "In addition to being able to target our care specifically to each patient, we're also reducing the use of unnecessary medical tests and expenses. We're thrilled to have developed a new way to standardize care for children and adolescents with abdominal pain."

Abdominal pain, the most common reason children visit the emergency department, is the most frequent surgical emergency in pediatrics, the researchers said.

A computed tomography scan is a common way to diagnose appendicitis, but they are costly and put pediatric patients at risk for radiation-induced injuries because their bodies are smaller and organs are more sensitive than adults.

Researchers at Children's and HealthPartners sought methods to develop a safer, more cost-efficient way to determine the risk for appendicitis when a child shows up at emergency department with abdominal pain. The calculator was developed as part of a $3.1 million, five-year grant from the National Institutes of Health.

In a study testing its efficacy, researchers used data collected from nine pediatric emergency departments from March 2009 to April 2010 to develop the risk calculator. They independently validated the score with data from a single children's hospital of 1,426 children, of which 40 percent had appendicitis.

In all, they studied 2,423 children at children's hospitals throughout the Untied States.

Variables included age, sex, temperature, nausea, vomiting, pain duration, pain location, pain with walking, pain migration, guarding, white blood cell count and absolute neutrophil count.

Test performance of the calculator was compared with the Pediatric Appendicitis Score. In the results, the calculator outperformed the PAS score. With the calculator -- called pARC -- almost half of patients in the validation group could be accurately classified as less than 15 percent risk or greater than 85 percent risk for appendicitis. Using the PAS score, just 23 percent could be correctly identified within a range of risk.

The same researchers are working with colleagues at Kaiser Permanente Northern California on a 17-center trial of the risk calculator, including the six HealthPartners-affiliated emergency departments.

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