Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department

on behalf of PREDICT

Research output: Contribution to journalArticle

Abstract

Objective: Abdominal pain is a common paediatric presentation to the ED. Accurate diagnosis of acute appendicitis is challenging, with the best-performing clinical scoring systems having sensitivities between 72% and 100%. The aim of this study is to assess the diagnostic accuracy of clinician gestalt according to seniority in diagnosing paediatric acute appendicitis in ED. Methods: This is a prospective multi-centre observational study of clinician's prediction of appendicitis in children under the age of 16 years presenting to four EDs with abdominal pain over a 1 month period at each site. Clinician-estimated likelihood of acute appendicitis was compared with the final diagnosis determined by histopathology or operative findings and supplemented by telephone follow up for those without an operation. The primary outcome was diagnostic accuracy of clinician gestalt according to clinician seniority in diagnosing appendicitis. Results: There were 381 children enrolled with completed clinician questionnaires, and 224 children had complete follow up or underwent appendicectomy. The median age was 9 years (interquartile range 6–12) and the incidence of appendicitis was 31/224 (13.8%, 95% confidence interval 9.3–18.4). The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value of clinician gestalt were 0.84 (0.76–0.91), 81% (63–93%), 76% (69–82%), 35% (28–42%) and 96% (92–98%), respectively, giving an overall diagnostic accuracy of 76% (70–82%). AUC stratified by clinician seniority (junior, intermediate and senior) were 0.89 (0.80–0.98), 0.82 (0.69–0.95) and 0.76 (0.56–0.96), respectively. Conclusions: The diagnostic accuracy of ED clinician gestalt in paediatric appendicitis is comparable to current clinical scoring systems irrespective of seniority.

Original languageEnglish
Pages (from-to)612-618
Number of pages7
JournalEMA - Emergency Medicine Australasia
Volume31
Issue number4
DOIs
Publication statusPublished - 1 Aug 2019

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Appendicitis
Hospital Emergency Service
Pediatrics
Abdominal Pain
Area Under Curve
Telephone
Observational Studies
Confidence Intervals
Sensitivity and Specificity
Incidence

Cite this

@article{a15b50bba67943868cf0ac2a8dfbc231,
title = "Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department",
abstract = "Objective: Abdominal pain is a common paediatric presentation to the ED. Accurate diagnosis of acute appendicitis is challenging, with the best-performing clinical scoring systems having sensitivities between 72{\%} and 100{\%}. The aim of this study is to assess the diagnostic accuracy of clinician gestalt according to seniority in diagnosing paediatric acute appendicitis in ED. Methods: This is a prospective multi-centre observational study of clinician's prediction of appendicitis in children under the age of 16 years presenting to four EDs with abdominal pain over a 1 month period at each site. Clinician-estimated likelihood of acute appendicitis was compared with the final diagnosis determined by histopathology or operative findings and supplemented by telephone follow up for those without an operation. The primary outcome was diagnostic accuracy of clinician gestalt according to clinician seniority in diagnosing appendicitis. Results: There were 381 children enrolled with completed clinician questionnaires, and 224 children had complete follow up or underwent appendicectomy. The median age was 9 years (interquartile range 6–12) and the incidence of appendicitis was 31/224 (13.8{\%}, 95{\%} confidence interval 9.3–18.4). The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value of clinician gestalt were 0.84 (0.76–0.91), 81{\%} (63–93{\%}), 76{\%} (69–82{\%}), 35{\%} (28–42{\%}) and 96{\%} (92–98{\%}), respectively, giving an overall diagnostic accuracy of 76{\%} (70–82{\%}). AUC stratified by clinician seniority (junior, intermediate and senior) were 0.89 (0.80–0.98), 0.82 (0.69–0.95) and 0.76 (0.56–0.96), respectively. Conclusions: The diagnostic accuracy of ED clinician gestalt in paediatric appendicitis is comparable to current clinical scoring systems irrespective of seniority.",
keywords = "appendicitis, clinical scoring system, clinician gestalt, emergency department, paediatric",
author = "{on behalf of PREDICT} and Lee, {Wei Hao} and Sharon O'Brien and Dmitry Skarin and Cheek, {John A.} and Jessica Deitch and Ramesh Nataraja and Simon Craig and Borland, {Meredith L.}",
year = "2019",
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doi = "10.1111/1742-6723.13220",
language = "English",
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publisher = "John Wiley & Sons",
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Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department. / on behalf of PREDICT.

In: EMA - Emergency Medicine Australasia, Vol. 31, No. 4, 01.08.2019, p. 612-618.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Accuracy of clinician gestalt in diagnosing appendicitis in children presenting to the emergency department

AU - on behalf of PREDICT

AU - Lee, Wei Hao

AU - O'Brien, Sharon

AU - Skarin, Dmitry

AU - Cheek, John A.

AU - Deitch, Jessica

AU - Nataraja, Ramesh

AU - Craig, Simon

AU - Borland, Meredith L.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Objective: Abdominal pain is a common paediatric presentation to the ED. Accurate diagnosis of acute appendicitis is challenging, with the best-performing clinical scoring systems having sensitivities between 72% and 100%. The aim of this study is to assess the diagnostic accuracy of clinician gestalt according to seniority in diagnosing paediatric acute appendicitis in ED. Methods: This is a prospective multi-centre observational study of clinician's prediction of appendicitis in children under the age of 16 years presenting to four EDs with abdominal pain over a 1 month period at each site. Clinician-estimated likelihood of acute appendicitis was compared with the final diagnosis determined by histopathology or operative findings and supplemented by telephone follow up for those without an operation. The primary outcome was diagnostic accuracy of clinician gestalt according to clinician seniority in diagnosing appendicitis. Results: There were 381 children enrolled with completed clinician questionnaires, and 224 children had complete follow up or underwent appendicectomy. The median age was 9 years (interquartile range 6–12) and the incidence of appendicitis was 31/224 (13.8%, 95% confidence interval 9.3–18.4). The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value of clinician gestalt were 0.84 (0.76–0.91), 81% (63–93%), 76% (69–82%), 35% (28–42%) and 96% (92–98%), respectively, giving an overall diagnostic accuracy of 76% (70–82%). AUC stratified by clinician seniority (junior, intermediate and senior) were 0.89 (0.80–0.98), 0.82 (0.69–0.95) and 0.76 (0.56–0.96), respectively. Conclusions: The diagnostic accuracy of ED clinician gestalt in paediatric appendicitis is comparable to current clinical scoring systems irrespective of seniority.

AB - Objective: Abdominal pain is a common paediatric presentation to the ED. Accurate diagnosis of acute appendicitis is challenging, with the best-performing clinical scoring systems having sensitivities between 72% and 100%. The aim of this study is to assess the diagnostic accuracy of clinician gestalt according to seniority in diagnosing paediatric acute appendicitis in ED. Methods: This is a prospective multi-centre observational study of clinician's prediction of appendicitis in children under the age of 16 years presenting to four EDs with abdominal pain over a 1 month period at each site. Clinician-estimated likelihood of acute appendicitis was compared with the final diagnosis determined by histopathology or operative findings and supplemented by telephone follow up for those without an operation. The primary outcome was diagnostic accuracy of clinician gestalt according to clinician seniority in diagnosing appendicitis. Results: There were 381 children enrolled with completed clinician questionnaires, and 224 children had complete follow up or underwent appendicectomy. The median age was 9 years (interquartile range 6–12) and the incidence of appendicitis was 31/224 (13.8%, 95% confidence interval 9.3–18.4). The area under the curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value of clinician gestalt were 0.84 (0.76–0.91), 81% (63–93%), 76% (69–82%), 35% (28–42%) and 96% (92–98%), respectively, giving an overall diagnostic accuracy of 76% (70–82%). AUC stratified by clinician seniority (junior, intermediate and senior) were 0.89 (0.80–0.98), 0.82 (0.69–0.95) and 0.76 (0.56–0.96), respectively. Conclusions: The diagnostic accuracy of ED clinician gestalt in paediatric appendicitis is comparable to current clinical scoring systems irrespective of seniority.

KW - appendicitis

KW - clinical scoring system

KW - clinician gestalt

KW - emergency department

KW - paediatric

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U2 - 10.1111/1742-6723.13220

DO - 10.1111/1742-6723.13220

M3 - Article

VL - 31

SP - 612

EP - 618

JO - Emergency Medicine

JF - Emergency Medicine

SN - 1742-6723

IS - 4

ER -