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master's thesis
Usporedba kliničkih sustava bodovanja ˝Alvarado˝ i ˝Pedijatrijskog sustava bodovanja˝ u dijagnostici akutnog apendicitisa u dječjoj dobi
2013. urn:nbn:hr:171:823265
Rak, Stella
University of Split
School of Medicine

Cite this document

Rak, S. (2013). Usporedba kliničkih sustava bodovanja ˝Alvarado˝ i ˝Pedijatrijskog sustava bodovanja˝ u dijagnostici akutnog apendicitisa u dječjoj dobi (Master's thesis). Split: University of Split, School of Medicine. Retrieved from https://urn.nsk.hr/urn:nbn:hr:171:823265

Rak, Stella. "Usporedba kliničkih sustava bodovanja ˝Alvarado˝ i ˝Pedijatrijskog sustava bodovanja˝ u dijagnostici akutnog apendicitisa u dječjoj dobi." Master's thesis, University of Split, School of Medicine, 2013. https://urn.nsk.hr/urn:nbn:hr:171:823265

Rak, Stella. "Usporedba kliničkih sustava bodovanja ˝Alvarado˝ i ˝Pedijatrijskog sustava bodovanja˝ u dijagnostici akutnog apendicitisa u dječjoj dobi." Master's thesis, University of Split, School of Medicine, 2013. https://urn.nsk.hr/urn:nbn:hr:171:823265

Rak, S. (2013). 'Usporedba kliničkih sustava bodovanja ˝Alvarado˝ i ˝Pedijatrijskog sustava bodovanja˝ u dijagnostici akutnog apendicitisa u dječjoj dobi', Master's thesis, University of Split, School of Medicine, accessed 14 November 2024, https://urn.nsk.hr/urn:nbn:hr:171:823265

Rak S. Usporedba kliničkih sustava bodovanja ˝Alvarado˝ i ˝Pedijatrijskog sustava bodovanja˝ u dijagnostici akutnog apendicitisa u dječjoj dobi [Master's thesis]. Split: University of Split, School of Medicine; 2013 [cited 2024 November 14] Available at: https://urn.nsk.hr/urn:nbn:hr:171:823265

S. Rak, "Usporedba kliničkih sustava bodovanja ˝Alvarado˝ i ˝Pedijatrijskog sustava bodovanja˝ u dijagnostici akutnog apendicitisa u dječjoj dobi", Master's thesis, University of Split, School of Medicine, Split, 2013. Available at: https://urn.nsk.hr/urn:nbn:hr:171:823265

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TitleUsporedba kliničkih sustava bodovanja ˝Alvarado˝ i ˝Pedijatrijskog sustava bodovanja˝ u dijagnostici akutnog apendicitisa u dječjoj dobi
Title (english)Comparison of Clinical scoring systems ˝Alvarado˝ and ˝Pediatric scoring system˝ in the diagnosis of acute appendicitis in children
AuthorStella Rak
MentorZenon Pogorelić (mentor)
GranterUniversity of Split
School of Medicine
Split
Defense date and country2013, Croatia
Scientific / art field,
discipline and subdiscipline		BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Surgery
Abstract
Cilj istraživanja: Rana dijagnoza akutnog apendicitisa je vrlo bitna. Ako se ne postavi na vrijeme može doći do razvoja komplikacija te do teškog morbiditeta i smrti. Isto tako pogrešna dijagnoza izlaže djecu nepotrebnom kirurškom zahvatu i mogućim komplikacija tijekom operacije i u poslijeoperacijskom razdoblju. Cilj ove studije je usporediti rezultate ALVARADO i PAS kliničkih sustava bodovanja te utvrditi koja od njih je pouzdanija u postavljanju dijagnoze akutnog apendicitisa u djece. Ispitanici i metode: Ispitanici su svi bolesnici koji su bili primljeni u bolnicu i operirani zbog simptoma akutnog apendicitisa od listopada 2011. do svibnja 2013. u Kliničkom odjelu za dječju kirurgiju KBC Split. U svih bolesnika temeljem anamnestičkih podataka, kliničkog pregleda i laboratorijskih nalaza određen je ALVARADO i PAS score. Temeljem patohistološkog nalaza bolesnici su podijeljeni u dvije skupine (apendicitis i non-apendicitis). Oba klinička sustava bodovanja uspoređena su na istim bolesnicima, te su primjenom ROC analize određene tzv. ''cut-off'' vrijednosti iznad kojih se u pojedinog bolesnika proglašava akutni apendicitis. Rezultati: U studiju je uključeno 311 bolesnika (172 dječaka i 139 djevojčica). Prosječna dob bila je 11.7 (3-17) godina. Od ukupnog broja bolesnika njih 265 (85%) imalo je patohistološki dokazan akutni apendicitis. Bolesnici s pozitivnim apendicitisom imali su prosječni ALVARADO score 8.2 u odnosu na 6.7 za bolesnike u kojih apendicitis nije dokazan (P<0,001). Bolesnici s pozitivnim apendicitisom imali su prosječni PAS score 7.8 u odnosu na 6.6 za bolesnike u kojih apendicitis nije dokazan (P<0,001). Temeljem ROC analize određena je “cut off” vrijednost za ALVARADO i PAS ljestvicu i iznosila je 7. U bolesnika s akutnim apendicitisom i ALVARADO score-om ≥7 ispravna dijagnoza bila bi postavljena u 263 bolesnika (osjetljivost 89%, specifičnost 59%, PPV 93.1%), dok bi u bolesnika s akutnim apendicitisom i PAS score-om ≥7 ispravna dijagnoza bila bi postavljena u 251 bolesnika (osjetljivost 86%, specifičnost 50%, PPV 90.1%). Nije nađena statistički značajna razlika u osjetljivosti i specifičnosti između dvaju promatranih kliničkih sustava bodovanja za postavljanje dijagnoze akutnog apendicitisa u djece. Zaključak: Oba sustava bodovanja mogu biti od pomoći u postavljanju dijagnoze akutnog apendicitisa, ali nijedan nema adekvatne prediktivne vrijednosti u procjeni akutnog apendicitisa, te se ne može koristiti kao isključivi standard u postavljanju dijagnoze akutnog apendicitisa u djece. Konačna odluka o indikaciji za operacijski zahvat ipak ostaje na procjeni kirurga.
Abstract (english)
Objectives and background: Early diagnosis of acute appendicitis is essential. If it is not set on time complications, severe morbidity and death can occur. Also, a misdiagnosis can expose children to unnecessary surgical procedures and to possible complications during the operation and the post operational period. The purpose of this study was to compare the results of the ALVARADO and PAS clinical scoring systems and to establish which of them is more reliable in setting the diagnosis of acute appendicitis in children. Patients and Methods: All children operated on because of acute appendicitis at Department of Pediatric surgery from October 2011 to May 2013 were enrolled in this prospective study. Due to anamnestic data, clinical examination and laboratory tests, all patients were determined with the ALVARADO and PAS score. Based on histopathological findings, the patients were divided into two groups (appendicitis and non-appendicitis). Both clinical scoring systems have been compared over the same patients and cut-off values were determined by the ROC analysis. Results: A total of 311 patients were included in the study (172 boys and 139 girls). An average age was 11.7 years. Out of the total number of patients, 265 (85%) of them had acute appendicitis. Patients with appendicitis had mean ALVARADO score of 8.2 and those without had mean score of 6.7 (P<0,001). Patients with appendicitis had mean PAS score of 7.8 and those without had mean score of 6.6 (P<0,001). Based on the ROC analysis, a ‘’cutoff’’ value for both the ALVARADO and PAS scale was 7. In patients with acute appendicitis and ALVARADO score of ≥7 the correct diagnosis would have been set in 263 patients (sensitivity 89%, specificity 59%, PPV 93.1%), while in patients with acute appendicitis and an PAS score of ≥7 the correct diagnosis would have been set in 251 patients (sensitivity 86%, specificity 50%, PPV 90.1%). No significant difference was found in sensitivity and specificity between the observed clinical scoring systems. Conclusion: Both scoring systems can be of assistance in setting the diagnosis of acute appendicitis, but none have the adequate predictive values in assessing acute appendicitis and none can be used as an exclusive standard in setting the diagnosis of acute appendicitis in children. The final decision on the indication for a surgical procedure is still left to the assessment of the surgeon.
Keywords
Keywords (english)
Languagecroatian
URN:NBNurn:nbn:hr:171:823265
Study programmeTitle: Medicine
Study programme type: university
Study level: integrated undergraduate and graduate
Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resourceText
File originBorn digital
Access conditionsAccess restricted to students and staff of home institution
Terms of useLicence In copyright icon
Created on2016-05-03 11:55:49