Browsing by Author "Nikolov, Marko (59347555400)"

Introduction/Objective The objective was to evaluate sonographic and laboratory findings as predic-tors of complicated and uncomplicated appendicitis in order to decide on further treatment options. Methods This is a retrospective cohort study of 174 pediatric patients who had laboratory tests and ultrasound done before appendectomy during a one-year period. Results were compared with the intra-operative and histopathological findings of complicated (gangrenous or perforated) or uncomplicated (phlegmonous) appendicitis and assessed by binary logistic regression with backward elimination. The initial model included eight predictors. After backward elimination four remained: periappendiceal fluid, hyperechoic periappendiceal fat, white blood cell (WBC) count and C-reactive protein (CRP). The final model included the interaction between periappendiceal fluid and hyperechoic periappendiceal fat. Diagnostic performance of each parameter was presented with sensitivity and specificity. Results Out of all patients, 86 had uncomplicated and 88 had complicated appendicitis (37 gangrenous, and 51 perforated). In the final model three predictors were significantly associated with complicated appendicitis: interaction between periappendiceal fluid and hyperechoic periappendiceal fat, WBC count > 11 × 109 /l, and CRP > 100 mg/l. Inclusion of interaction between periappendiceal fluid and hyper-echoic periappendiceal fat excluded them as individual predictors. The maximum outside appendiceal diameter of more than 6 mm had the highest sensitivity (93.2%), while wall thickness > 3 mm was the most specific (95.2%). Conclusion Using periappendiceal fluid and hyperechoic periappendiceal fat as sonographic predictors and WBC and CRP as laboratory predictors can differentiate uncomplicated from complicated appendicitis in children and help a physician decide on antibiotic or surgical treatment. © 2024, Serbia Medical Society. All rights reserved.