Added value of CRP to clinical features when assessing appendicitis in children.

IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL European Journal of General Practice Pub Date : 2022-12-01 DOI:10.1080/13814788.2022.2067142
Guus C G H Blok, Eelke D Nikkels, Johan van der Lei, Marjolein Y Berger, Gea A Holtman
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Abstract

Background: The diagnostic value of C-reactive protein (CRP) for appendicitis in children has not been evaluated in primary care. As biochemical responses and differential diagnoses vary with age, separate evaluation in children and adults is needed.

Objectives: To determine whether adding CRP to symptoms and signs improves the diagnosis of appendicitis in children with acute abdominal pain in primary care.

Methods: A retrospective cohort study in Dutch general practice. Data was collected from the Integrated Primary Care Information database between 2010 and 2016. We included children aged 4-18 years, with no history of appendicitis, presenting with acute abdominal pain, and having a CRP test. Initial CRP levels were related to the specialist's diagnosis of appendicitis, and the test's characteristics were calculated for multiple cut-offs. The value of adding CRP to signs and symptoms was analysed by logistic regression.

Results: We identified 1076 eligible children, among whom 203 were referred for specialist evaluation and 70 had appendicitis. The sensitivity and specificity of a CRP cut-off ≥10 mg/L were 0.87 (95%CI, 0.77-0.94) and 0.77 (95%CI, 0.74-0.79), respectively. When symptoms lasted > 48 h, this sensitivity increased to 1.00. Positive predictive values for CRP alone were low (0.18-0.38) for all cut-off values (6-100 mg/L). Adding CRP increased the area under the curve from 0.82 (95%CI, 0.78-0.87) to 0.88 (95%CI, 0.84-0.91), and decision curve analysis confirmed that its addition provided the highest net benefit.

Conclusion: CRP adds value to history and physical examination when diagnosing appendicitis in children presenting acute abdominal pain in primary care. Appendicitis is least likely if the CRP value is < 10 mg/L and symptoms have been present for > 48 h.

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在评估儿童阑尾炎时,CRP 对临床特征的附加值。
背景:儿童阑尾炎的 C 反应蛋白 (CRP) 诊断价值尚未在初级保健中进行评估。由于生化反应和鉴别诊断因年龄而异,因此需要对儿童和成人分别进行评估:目的:确定将 CRP 添加到症状和体征中是否能改善初级医疗机构对急性腹痛儿童阑尾炎的诊断:方法:对荷兰全科医生进行回顾性队列研究。数据收集自 2010 年至 2016 年间的综合初级医疗信息数据库。我们纳入了年龄在 4-18 岁、无阑尾炎病史、出现急性腹痛并进行过 CRP 检测的儿童。最初的 CRP 水平与专科医生对阑尾炎的诊断有关,并计算了多个临界值的检测特征。通过逻辑回归分析了在症状和体征基础上增加 CRP 的价值:结果:我们确定了 1076 名符合条件的儿童,其中 203 名转诊至专科医生进行评估,70 名患有阑尾炎。CRP ≥10 mg/L 临界值的敏感性和特异性分别为 0.87(95%CI,0.77-0.94)和 0.77(95%CI,0.74-0.79)。当症状持续时间大于 48 小时时,灵敏度升至 1.00。在所有临界值(6-100 毫克/升)中,仅 CRP 的阳性预测值较低(0.18-0.38)。加入 CRP 可使曲线下面积从 0.82(95%CI,0.78-0.87)增加到 0.88(95%CI,0.84-0.91),决策曲线分析证实,加入 CRP 可提供最高的净收益:结论:在基层医疗机构对出现急性腹痛的儿童进行阑尾炎诊断时,CRP 可增加病史和体格检查的价值。如果 CRP 值小于 10 mg/L,且症状出现时间超过 48 小时,则阑尾炎的可能性最小。
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来源期刊
European Journal of General Practice
European Journal of General Practice PRIMARY HEALTH CARE-MEDICINE, GENERAL & INTERNAL
CiteScore
5.10
自引率
5.90%
发文量
31
审稿时长
>12 weeks
期刊介绍: The EJGP aims to: foster scientific research in primary care medicine (family medicine, general practice) in Europe stimulate education and debate, relevant for the development of primary care medicine in Europe. Scope The EJGP publishes original research papers, review articles and clinical case reports on all aspects of primary care medicine (family medicine, general practice), providing new knowledge on medical decision-making, healthcare delivery, medical education, and research methodology. Areas covered include primary care epidemiology, prevention, diagnosis, pharmacotherapy, non-drug interventions, multi- and comorbidity, palliative care, shared decision making, inter-professional collaboration, quality and safety, training and teaching, and quantitative and qualitative research methods.
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