• Niki Oikonomopoulou, Concepción Míguez-Navarro, Arístides Rivas-García, Mercedes García Gamiz, Rosario López-López, Paloma Oliver-Sáez, Bibiana Riaño-Méndez, Tamara Farfan-Orte, Zulema Lobato-Salinas, Júlia Rúbies-Olives, Priscila Llena-Isla, Encarnación María Lancho-Monreal, and PROADM-DOLOR ABDOMINAL of the research net of the Spanish Society of Pediatric Emergencies (RISEUP-SPERG).
• Pediatric Emergency Department, General and University Hospital Gregorio Marañón, Calle de O'Donnell, 48, 28009 Madrid, Spain. Electronic address: nik.oik87@gmail.com.
• Am J Emerg Med. 2019 Jul 1; 37 (7): 1289-1294.

BackgroundAcute appendicitis (AA) is one of the most frequent surgical pathologies in pediatrics.ObjectivesTo investigate the utility of proadrenomedullin (pro-ADM) for the diagnosis of AA.MethodsProspective, analytical, observational, and multicenter study conducted in 6 pediatric emergency departments. Children up to 18 years of age with suspected AA were included. Clinical, epidemiological, and analytical data were collected.ResultsWe studied 285 children with an average age of 9.5 years (95% confidence interval [CI], 9.1-9.9). AA was diagnosed in 103 children (36.1%), with complications in 10 of them (9.7%). The mean concentration of pro-ADM (nmol/L) was higher in children with AA (0.51 nmol/L, SD 0.16) than in children with acute abdominal pain (AAP) of another etiology (0.44 nmol/L, SD 0.14; p < 0.001). This difference was greater in complicated cases compared with uncomplicated AA (0.64 nmol/L, SD 0.17 and 0.50 nmol/L, SD 0.15, respectively; p = 0.005). The areas under the receiver-operating characteristic curves were 0.66 (95% CI, 0.59-0.72) for pro-ADM, 0.70 (95% CI, 0.63-0.76) for C-reactive protein (CRP), 0.84 (95% CI, 0.79-0.89) for neutrophils, and 0.84 (95% CI, 0.79-0.89) for total leukocytes. The most reliable combination to rule out AA was CRP ≤1.25 mg/dL and pro-ADM ≤0.35 nmol/L with a sensitivity of 96% and a negative predictive value of 93%.ConclusionChildren with AA presented higher pro-ADM values than children with AAP of other etiologies, especially in cases of complicated AA. The combination of low values of pro-ADM and CRP can help to select children with low risk of AA.Copyright © 2018 Elsevier Inc. All rights reserved.

25 keywords...

hide…