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Yazici H, Ugurlu O, Aygul Y, Ugur MA, Sen YK, Yildirim M. Predicting severity of acute appendicitis with machine learning methods: a simple and promising approach for clinicians. BMC Emerg Med 2024; 24:101. [PMID: 38886641 PMCID: PMC11184860 DOI: 10.1186/s12873-024-01023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUNDS Acute Appendicitis (AA) is one of the most common surgical emergencies worldwide. This study aims to investigate the predictive performances of 6 different Machine Learning (ML) algorithms for simple and complicated AA. METHODS Data regarding operated AA patients between 2012 and 2022 were analyzed retrospectively. Based on operative findings, patients were evaluated under two groups: perforated AA and none-perforated AA. The features that showed statistical significance (p < 0.05) in both univariate and multivariate analysis were included in the prediction models as input features. Five different error metrics and the area under the receiver operating characteristic curve (AUC) were used for model comparison. RESULTS A total number of 1132 patients were included in the study. Patients were divided into training (932 samples), testing (100 samples), and validation (100 samples) sets. Age, gender, neutrophil count, lymphocyte count, Neutrophil to Lymphocyte ratio, total bilirubin, C-Reactive Protein (CRP), Appendix Diameter, and PeriAppendicular Liquid Collection (PALC) were significantly different between the two groups. In the multivariate analysis, age, CRP, and PALC continued to show a significant difference in the perforated AA group. According to univariate and multivariate analysis, two data sets were used in the prediction model. K-Nearest Neighbors and Logistic Regression algorithms achieved the best prediction performance in the validation group with an accuracy of 96%. CONCLUSION The results showed that using only three input features (age, CRP, and PALC), the severity of AA can be predicted with high accuracy. The developed prediction model can be useful in clinical practice.
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Affiliation(s)
- Hilmi Yazici
- General Surgery Department, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey.
| | - Onur Ugurlu
- Faculty of Engineering and Architecture, Izmir Bakircay University, Izmir, Turkey
| | - Yesim Aygul
- Department of Mathematics, Ege University, Izmir, Turkey
| | - Mehmet Alperen Ugur
- General Surgery Department, University of Health Sciences Izmir Bozyaka Research and Training Hospital, Izmir, Turkey
| | - Yigit Kaan Sen
- General Surgery Department, University of Health Sciences Izmir Bozyaka Research and Training Hospital, Izmir, Turkey
| | - Mehmet Yildirim
- General Surgery Department, University of Health Sciences Izmir Bozyaka Research and Training Hospital, Izmir, Turkey
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Díaz López MI, Crespo Álvarez E, Martínez Manzano Á, Urrechaga E, Orgaz Morales MT, González Morales M, Martín García E, de Guadiana-Romualdo LG. Usefulness of extended inflammatory parameters related to neutrophil activation reported by Sysmex XN-1000 hematology analyzer for predicting complicated acute appendicitis. Comparison with canonical inflammatory laboratory tests. Cir Esp 2024; 102:300-306. [PMID: 38342139 DOI: 10.1016/j.cireng.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/20/2023] [Indexed: 02/13/2024]
Abstract
AIM Accurate diagnosis of complicated appendicitis is of importance to ensure that patients receive early and effective treatment, minimizing the risk of postoperative complications to promote successful recovery. Biochemical markers are a promising tool to identify complicated appendicitis. We aimed to evaluate the potential role of novel parameters related with neutrophil activation, known as "Extended Inflammation Parameters" (EIP), included in blood cell count reported by Sysmex XN-Series analyzers, compared to other canonical biomarkers in identifying complicated appendicitis. METHOD Prospective observational study including patients with confirmed diagnosis of acute appendicitis. C-reactive protein (CRP), procalcitonin, cell blood count, including white blood cell (WBC), absolute neutrophil (ANC) and immature granulocyte (IG) count and EIP (neutrophil reactivity [NEUT-RI] and granularity intensity [NEUT-GI]) were analyzed before surgery. Their accuracy to diagnose complicated appendicitis was tested in an ROC curve analysis. RESULTS Our population study included 119 patients, and appendicitis was complicated in 58 (48.7%). NLR, CRP and procalcitonin levels, ANC and IG count and NEUT-RI and NEUT-GI were higher in patients with complicated appendicitis. Regarding accuracy for complicated appendicitis, CRP was the biomarker with the highest performance (ROC AUC: 0.829), with an optimal cutoff of 73.1 mg/L (sensitivity: 63.8%, specificity: 88.5%). NEUT-RI and NEUT-GI achieved both significant but poor accuracy, with ROC AUC of 0.606 and 0.637, respectively. CONCLUSIONS Novel laboratory tests reported by Sysmex XN-Series analyzers have poor accuracy for identifying complicated appendicitis. In this study, CRP was the biomarker with the highest performance and may be useful as predictor of the severity of acute appendicitis.
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Affiliation(s)
| | - Elena Crespo Álvarez
- General Surgery Department, Hospital Universitario Santa Lucía, Cartagena, Spain
| | | | - Eloísa Urrechaga
- Biocruces Bizkaia Health Research Institute, Baracaldo, Spain; Laboratory Medicine Department, Hospital Galdakao-Usansolo, Galdakao, Spain
| | | | | | - Elena Martín García
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain
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Clifford S, McGuire A, Dhannoon A, Daly G, Tong E, O'Grady S, Abdulhadi A, Sorensen J, Morrin M, Hill A. Validation and comparison of two new scoring systems for the prediction of complicated versus uncomplicated appendicitis. Ir J Med Sci 2024; 193:1435-1440. [PMID: 38127189 DOI: 10.1007/s11845-023-03594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To validate the Atema and APSI scoring systems in the diagnosis of complicated vs uncomplicated appendicitis. To compare these scoring systems with computed tomography (CT) imaging alone to establish which method provides most accurate prediction of complicated vs uncomplicated appendicitis. METHODS This was a retrospective review of a sample of 160 patients that underwent appendicectomy and CT imaging for suspected appendicitis between 2018 and 2021 in a tertiary university teaching hospital. Each scoring system was applied to all patients and results analysed and compared with the effectiveness of CT imaging, RESULTS: 32.5% (n = 52) were found to have complicated appendicitis and 67.5% (n = 108) uncomplicated appendicitis. Application of the Atema score to our cohort of patients resulted in a sensitivity 76.9% [CI (64.2, 87.5), specificity 58.7% [CI (48.9, 68.1)], PPV 47.1% [CI (40.5, 53.8) and NPV 84.2% [CI (76.0, 89.9)]. By comparison, the APSI yielded a sensitivity 50.9% [CI (36.6, 65.4)], specificity 76.1% [CI (67.0, 87.8)], PPV 50% [CI (39.2, 60.6)] and NPV 76% [CI (71.1, 81.7)]. Radiology prediction of complicated vs uncomplicated appendicitis with CT imaging showed sensitivity 46% [CI (32.2, 60.5)], specificity 79%; [CI (69.8, 86)], PPV 51% [CI (39.6, 62.5)] and NPV 75% [CI (69.8, 79.9)]. CONCLUSION By comparing the APSI and Atema et al. scoring systems with CT reporting in our hospital, it appears that the Atema may confer some benefit in stratifying patient risk of complicated versus uncomplicated appendicitis. Further larger scale prospective studies are required.
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Affiliation(s)
| | | | | | - Gordon Daly
- Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Emma Tong
- Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | | | | | | | | | - Arnold Hill
- Beaumont Hospital, Beaumont, Dublin 9, Ireland
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Khatoon MA, Naeem S, Akmal U, Farid A, Ahmed Khan S. Retrocecal Ascending Appendix Attached to the Hepatic Flexure and Right Intra-abdominal Testis Identified During Open Appendicectomy: A Case Report. Cureus 2024; 16:e57484. [PMID: 38577167 PMCID: PMC10993090 DOI: 10.7759/cureus.57484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
Appendicectomy, or the removal of the appendix, is an emergency procedure following symptomatic acute appendicitis. Diagnosis is made on clinical examination but can be confirmed on imaging if other abnormalities are suspected. A few variants of appendix anatomical position exist that can be difficult to manage. In addition, secondary findings during surgery can come unexpectedly. We report a case of a 14-year-old male, who presented to the emergency department at our government institution with abdominal pain and vomiting. Examination revealed an empty right scrotum, which was unnoticed by the patient and never examined previously due to residence in an area of limited healthcare access. Ultrasound done elsewhere was inconclusive. The surgical intervention showed a retrocecal appendix attached to an ascending colon terminating at hepatic flexure. The procedure was further complicated by the presence of the right intra-abdominal testis located below the cecum. Excised samples were sent for histopathology, and the patient was followed with biopsy reports. This case highlights the challenges encountered during routine appendicectomy with unusual findings.
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Affiliation(s)
- Malik Amna Khatoon
- Orthopaedic Surgery, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
| | - Sarosh Naeem
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
| | - Urooj Akmal
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
| | - Ahsan Farid
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
| | - Salman Ahmed Khan
- Internal Medicine, Dow International Medical College, Karachi, PAK
- General Surgery, Sindh Government Qatar Hospital, Karachi, PAK
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Pogorelić Z, Čohadžić T. A Bizarre Cause of Acute Appendicitis in a Pediatric Patient: An Ingested Tooth. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010108. [PMID: 36670658 PMCID: PMC9856698 DOI: 10.3390/children10010108] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
(1) Background: Among all possible causes, foreign bodies are the rarest cause of appendicitis in the pediatric population. In the majority of cases, ingested foreign bodies pass through the gastrointestinal tract without causing symptoms. However, those foreign bodies that pass through the lumen of the vermiform appendix cannot re-enter the colon and may cause acute appendicitis. So far, various foreign bodies have been described to enter the appendix and cause acute appendicitis, such as seeds, needles, toothpicks, plant material, or even hair. Tooth or dental implants as a cause of acute appendicitis have been described in only a few cases. To our knowledge, this is the first described case of the tooth causing acute appendicitis in the pediatric population. (2) Case presentation: A 14-year-old male patient presented to the emergency department complaining of pain in the right lower quadrant of the abdomen and vomiting that persisted for approximately 24 h. Until then, the patient was healthy and had no concomitant diseases. Physical examination revealed guarding and tenderness in the right lower abdominal quadrant. The white blood cell count was 17.1 × 109/L with a neutrophil count of 91.1% and a C-reactive protein of 39.3 mg/dL. Ultrasonography of the abdomen revealed a thickened, inflamed appendix with a diameter of 11 mm and free periappendicular fluid. A 9 × 6 mm foreign body at the base of the appendix was visualized. The patient was diagnosed with acute appendicitis, and an emergency laparoscopic appendectomy was performed on the same day. Intraoperatively, gangrenous appendicitis was noted and removed without complications. Upon examination of the removed specimen, it was determined that the patient's appendicitis had been caused by an ingested tooth. As it later turned out, the patient had broken a lateral incisor while playing sports the day before admission without knowing that he had swallowed it. The patient recovered well and was discharged the day after surgery. (3) Conclusion: Although an extremely rare event, acute appendicitis can be caused by a swallowed tooth. This case highlights the importance of a thorough history in pediatric patients who present to the emergency department with suspected acute appendicitis to determine if there is a precipitating event that may have caused acute appendicitis.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21556654
| | - Tin Čohadžić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
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