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Prospective validation of a biomarker panel to identify pediatric ED patients with abdominal pain who are at low risk for acute appendicitis

, : Prospective validation of a biomarker panel to identify pediatric ED patients with abdominal pain who are at low risk for acute appendicitis. American Journal of Emergency Medicine 34(8): 1373-1382

The objective of the study is to prospectively validate the diagnostic accuracy of a biomarker panel consisting of white blood cell, C-reactive protein, and myeloid-related protein 8/14 levels in identifying pediatric patients with abdominal pain who are at low risk for appendicitis. This prospective observational study enrolled subjects aged 2 to 20 years presenting to 29 US emergency departments with abdominal pain suggesting possible acute appendicitis. Blood samples were analyzed for white blood cell, C-reactive protein, and myeloid-related protein 8/14 levels from which the composite biomarker panel results were calculated, then correlated with the final diagnosis either positive or negative for acute appendicitis. A total of 2201 patients were enrolled, with 1887 completing all aspects of the study. Prevalence of appendicitis in this cohort was 25.3%. The biomarker panel exhibited a sensitivity of 97.1% (95% confidence interval [CI], 95.1%-98.2%), negative predictive value of 97.4% (95% CI, 95.8%-98.5%), negative likelihood ratio of 0.08 (95% CI, 0.05-0.13), with a specificity of 37.9% (95% CI, 35.4%-40.4%) for appendicitis. The panel correctly identified 534 (37.8%) of 1410 patients who did not have appendicitis with 14 false negatives (2.9%). Overall, 23.7% (132/557) of computed tomographic (CT) scans were done for patients with negative biomarker panel results, including 31.2% (131/420) of patients who had CT but did not have appendicitis. This biomarker panel exhibited high sensitivity and negative predictive value for acute appendicitis in this large prospective cohort. This panel may be useful in identifying pediatric patients who are at low risk for appendicitis and might be followed clinically, potentially reducing the dependence on CT in the evaluation for acute appendicitis.


PMID: 27133536

DOI: 10.1016/j.ajem.2016.03.066

Other references

Timashov, P.; Braginets, V., 1977: Purchasing milk from households. Molochnaia promyshlennost': (12) 33-34

Swan, G.E., 2003: Parental smoking cessation and children's daily smoking: public health implications? commentary on Bricker et al. Addiction 98(5): 596-7; Discussion 598-9

Hemmingsen, A.M., 1977: Studies on worm lions. Behavior of the larvae of Vermileoninae (worm-lions) which make ant-lion-like sand or dust traps were reported. No differences were found in postures, movements, pit constructions, prey capture and method of throwing out carcasses and foreign bodi...

Bayer, R.; Kaufmann, R.; Mannhold, R., 1975: Inotropic and electrophysiological actions of verapamil and D 600 in mammalian myocardium. II. Pattern of inotropic effects of the optical isomers. On isotonically contracting cat papillary muscles analysis, a comparison of the effects of the optical isomers of verapamil and D 600 and the racemic drugs was performed. 1. (-)-verapamil (0.2-3.0 mug/mo) and (-)-D-600 (0.1 mug/ml-3.0 mug/ml) leav...

Markle, A.; Rinn, R.C.; Bell, C., 1984: Eye color as a predictor of outcomes in behavior therapy. Eye color research has centered primarily on the dimension of self-paced vs. reactive performance. Self-paced activities are those in which the individual may initiate the activity when he/she chooses while the stimulus situation remains relativel...

Boesch Donald F., 1983: Interactions of the Mississippi River with the Gulf of Mexico; issues for science and management. Eos, Transactions, American Geophysical Union 64(52): 1020

Chen, C-Yu.; Wang, K-Gon.; Wang, S-Meei.; Chen, C-Pein., 2014: Two-year neurological outcome of very-low-birth-weight children with prenatal absent or reversed end-diastolic flow velocity in the umbilical artery. The aim of this study was to investigate the 2-year neurological outcome of very-low-birth-weight (VLBW) children who had abnormal umbilical blood flow velocity prenatally. We performed a prospective collection of infants prenatally diagnosed with...

Anderson, K.R.; Keetch, D.W.; Albala, D.M.; Chandhoke, P.S.; Mcclennan, B.L.; Clayman, R.V., 1993: Optimal therapy for the distal ureteral stone Lithotripsy vs ureteroscopy. Journal of Endourology 7(SUPPL 1): S86

Nguyen, P.V.; Atwood, H.L., 1992: Electrical stimulation reprograms the metabolic and synaptic phenotypes of crayfish motoneurons. Society for Neuroscience Abstracts 18(1-2): 1131

Smoliak, S.; Peters, H.F., 1955: Climatic effects on foraging performance of beef cows on winter range. A study on the effect of climatic factors on foraging performance of Hereford, Angus, Shorthorn, half-bison Cattalo and quarter-bison Cattalo breeds was conducted at the Range Experiment Station, Many-berries, Alberta, Canada. Relationships among...