急性阑尾炎
初级保健
阑尾炎
临床预测规则
医学
普通外科
内科学
家庭医学
作者
Guus Blok,Huibert Burger,Johan van der Lei,Marjolein Y. Berger,Gea A. Holtman
标识
DOI:10.6084/m9.figshare.23946956
摘要
Recognising acute appendicitis in children presenting with acute abdominal pain in primary care is challenging. General practitioners (GPs) may benefit from a clinical prediction rule. To develop and validate a clinical prediction rule for acute appendicitis in children presenting with acute abdominal pain in primary care. In a historical cohort study data was retrieved from GP electronic health records included in the Integrated Primary Care Information database. We assigned children aged 4–18 years presenting with acute abdominal pain (≤ 7 days) to development (2010–2012) and validation (2013–2016) cohorts, using acute appendicitis within six weeks as the outcome. Multiple logistic regression was used to develop a prediction model based on predictors with > 50% data availability derived from existing rules for secondary care. We performed internal and external temporal validation and derived a point score to stratify risk of appendicitis into three groups, i.e. low-risk, medium-risk and high-risk. The development and validation cohorts included 2,041 and 3,650 children, of whom 95 (4.6%) and 195 (5.3%) had acute appendicitis. The model included male sex, pain duration (<24, 24–48, > 48 h), nausea/vomiting, elevated temperature (≥ 37.3 °C), abnormal bowel sounds, right lower quadrant tenderness, and peritoneal irritation. Internal and temporal validation showed good discrimination (C-statistics: 0.93 and 0.90, respectively) and excellent calibration. In the three groups, the risks of acute appendicitis were 0.5%, 7.5%, and 41%, Combined with further testing in the medium-risk group, the prediction rule could improve clinical decision making and outcomes.
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