Development and validation of a novel pediatric appendicitis risk calculator (pARC)

Anupam B. Kharbanda, Gabriela Vazquez-Benitez, Dustin W. Ballard, David R. Vinson, Uli K. Chettipally, Mamata V. Kene, Steven P. Dehmer, Richard G. Bachur, Peter S. Dayan, Nathan Kuppermann, Patrick J. O'Connor, Elyse O. Kharbanda

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVES: We sought to develop and validate a clinical calculator that can be used to quantify risk for appendicitis on a continuous scale for patients with acute abdominal pain. METHODS: The pediatric appendicitis risk calculator (pARC) was developed and validated through secondary analyses of 3 distinct cohorts. The derivation sample included visits to 9 pediatric emergency departments between March 2009 and April 2010. The validation sample included visits to a single pediatric emergency department from 2003 to 2004 and 2013 to 2015. Variables evaluated were as follows: Age, sex, temperature, nausea and/or vomiting, pain duration, pain location, pain with walking, pain migration, guarding, white blood cell count, and absolute neutrophil count. We used stepwise regression to develop and select the best model. Test performance of the pARC was compared with the Pediatric Appendicitis Score (PAS). RESULTS: The derivation sample included 2423 children, 40% of whom had appendicitis. The validation sample included 1426 children, 35% of whom had appendicitis. The final pARC model included the following variables: Sex, age, duration of pain, guarding, pain migration, maximal tenderness in the right-lower quadrant, and absolute neutrophil count. In the validation sample, the pARC exhibited near perfect calibration and a high degree of discrimination (area under the curve: 0.85; 95% confidence interval: 0.83 to 0.87) and outperformed the PAS (area under the curve: 0.77; 95% confidence interval: 0.75 to 0.80). By using the pARC, almost half of patients in the validation cohort could be accurately classified as at <15% risk or .85% risk for appendicitis, whereas only 23% would be identified as having a comparable PAS of <3 or >8. CONCLUSIONS: In our validation cohort of patients with acute abdominal pain, the pARC accurately quantified risk for appendicitis.

Original languageEnglish (US)
Article numbere20172699
JournalPediatrics
Volume141
Issue number4
DOIs
StatePublished - Apr 1 2018

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Appendicitis
Pediatrics
Pain
Acute Pain
Abdominal Pain
Area Under Curve
Hospital Emergency Service
Neutrophils
Confidence Intervals
Leukocyte Count
Nausea
Calibration
Walking
Vomiting

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Kharbanda, A. B., Vazquez-Benitez, G., Ballard, D. W., Vinson, D. R., Chettipally, U. K., Kene, M. V., ... Kharbanda, E. O. (2018). Development and validation of a novel pediatric appendicitis risk calculator (pARC). Pediatrics, 141(4), [e20172699]. https://doi.org/10.1542/peds.2017-2699

Development and validation of a novel pediatric appendicitis risk calculator (pARC). / Kharbanda, Anupam B.; Vazquez-Benitez, Gabriela; Ballard, Dustin W.; Vinson, David R.; Chettipally, Uli K.; Kene, Mamata V.; Dehmer, Steven P.; Bachur, Richard G.; Dayan, Peter S.; Kuppermann, Nathan; O'Connor, Patrick J.; Kharbanda, Elyse O.

In: Pediatrics, Vol. 141, No. 4, e20172699, 01.04.2018.

Research output: Contribution to journalArticle

Kharbanda, AB, Vazquez-Benitez, G, Ballard, DW, Vinson, DR, Chettipally, UK, Kene, MV, Dehmer, SP, Bachur, RG, Dayan, PS, Kuppermann, N, O'Connor, PJ & Kharbanda, EO 2018, 'Development and validation of a novel pediatric appendicitis risk calculator (pARC)', Pediatrics, vol. 141, no. 4, e20172699. https://doi.org/10.1542/peds.2017-2699
Kharbanda AB, Vazquez-Benitez G, Ballard DW, Vinson DR, Chettipally UK, Kene MV et al. Development and validation of a novel pediatric appendicitis risk calculator (pARC). Pediatrics. 2018 Apr 1;141(4). e20172699. https://doi.org/10.1542/peds.2017-2699
Kharbanda, Anupam B. ; Vazquez-Benitez, Gabriela ; Ballard, Dustin W. ; Vinson, David R. ; Chettipally, Uli K. ; Kene, Mamata V. ; Dehmer, Steven P. ; Bachur, Richard G. ; Dayan, Peter S. ; Kuppermann, Nathan ; O'Connor, Patrick J. ; Kharbanda, Elyse O. / Development and validation of a novel pediatric appendicitis risk calculator (pARC). In: Pediatrics. 2018 ; Vol. 141, No. 4.
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abstract = "OBJECTIVES: We sought to develop and validate a clinical calculator that can be used to quantify risk for appendicitis on a continuous scale for patients with acute abdominal pain. METHODS: The pediatric appendicitis risk calculator (pARC) was developed and validated through secondary analyses of 3 distinct cohorts. The derivation sample included visits to 9 pediatric emergency departments between March 2009 and April 2010. The validation sample included visits to a single pediatric emergency department from 2003 to 2004 and 2013 to 2015. Variables evaluated were as follows: Age, sex, temperature, nausea and/or vomiting, pain duration, pain location, pain with walking, pain migration, guarding, white blood cell count, and absolute neutrophil count. We used stepwise regression to develop and select the best model. Test performance of the pARC was compared with the Pediatric Appendicitis Score (PAS). RESULTS: The derivation sample included 2423 children, 40{\%} of whom had appendicitis. The validation sample included 1426 children, 35{\%} of whom had appendicitis. The final pARC model included the following variables: Sex, age, duration of pain, guarding, pain migration, maximal tenderness in the right-lower quadrant, and absolute neutrophil count. In the validation sample, the pARC exhibited near perfect calibration and a high degree of discrimination (area under the curve: 0.85; 95{\%} confidence interval: 0.83 to 0.87) and outperformed the PAS (area under the curve: 0.77; 95{\%} confidence interval: 0.75 to 0.80). By using the pARC, almost half of patients in the validation cohort could be accurately classified as at <15{\%} risk or .85{\%} risk for appendicitis, whereas only 23{\%} would be identified as having a comparable PAS of <3 or >8. CONCLUSIONS: In our validation cohort of patients with acute abdominal pain, the pARC accurately quantified risk for appendicitis.",
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AU - Vinson, David R.

AU - Chettipally, Uli K.

AU - Kene, Mamata V.

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N2 - OBJECTIVES: We sought to develop and validate a clinical calculator that can be used to quantify risk for appendicitis on a continuous scale for patients with acute abdominal pain. METHODS: The pediatric appendicitis risk calculator (pARC) was developed and validated through secondary analyses of 3 distinct cohorts. The derivation sample included visits to 9 pediatric emergency departments between March 2009 and April 2010. The validation sample included visits to a single pediatric emergency department from 2003 to 2004 and 2013 to 2015. Variables evaluated were as follows: Age, sex, temperature, nausea and/or vomiting, pain duration, pain location, pain with walking, pain migration, guarding, white blood cell count, and absolute neutrophil count. We used stepwise regression to develop and select the best model. Test performance of the pARC was compared with the Pediatric Appendicitis Score (PAS). RESULTS: The derivation sample included 2423 children, 40% of whom had appendicitis. The validation sample included 1426 children, 35% of whom had appendicitis. The final pARC model included the following variables: Sex, age, duration of pain, guarding, pain migration, maximal tenderness in the right-lower quadrant, and absolute neutrophil count. In the validation sample, the pARC exhibited near perfect calibration and a high degree of discrimination (area under the curve: 0.85; 95% confidence interval: 0.83 to 0.87) and outperformed the PAS (area under the curve: 0.77; 95% confidence interval: 0.75 to 0.80). By using the pARC, almost half of patients in the validation cohort could be accurately classified as at <15% risk or .85% risk for appendicitis, whereas only 23% would be identified as having a comparable PAS of <3 or >8. CONCLUSIONS: In our validation cohort of patients with acute abdominal pain, the pARC accurately quantified risk for appendicitis.

AB - OBJECTIVES: We sought to develop and validate a clinical calculator that can be used to quantify risk for appendicitis on a continuous scale for patients with acute abdominal pain. METHODS: The pediatric appendicitis risk calculator (pARC) was developed and validated through secondary analyses of 3 distinct cohorts. The derivation sample included visits to 9 pediatric emergency departments between March 2009 and April 2010. The validation sample included visits to a single pediatric emergency department from 2003 to 2004 and 2013 to 2015. Variables evaluated were as follows: Age, sex, temperature, nausea and/or vomiting, pain duration, pain location, pain with walking, pain migration, guarding, white blood cell count, and absolute neutrophil count. We used stepwise regression to develop and select the best model. Test performance of the pARC was compared with the Pediatric Appendicitis Score (PAS). RESULTS: The derivation sample included 2423 children, 40% of whom had appendicitis. The validation sample included 1426 children, 35% of whom had appendicitis. The final pARC model included the following variables: Sex, age, duration of pain, guarding, pain migration, maximal tenderness in the right-lower quadrant, and absolute neutrophil count. In the validation sample, the pARC exhibited near perfect calibration and a high degree of discrimination (area under the curve: 0.85; 95% confidence interval: 0.83 to 0.87) and outperformed the PAS (area under the curve: 0.77; 95% confidence interval: 0.75 to 0.80). By using the pARC, almost half of patients in the validation cohort could be accurately classified as at <15% risk or .85% risk for appendicitis, whereas only 23% would be identified as having a comparable PAS of <3 or >8. CONCLUSIONS: In our validation cohort of patients with acute abdominal pain, the pARC accurately quantified risk for appendicitis.

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