We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Development and Validation of the Scoring System of Appendicitis Severity 2.0.
- Authors
Scheijmans, Jochem C. G.; Bom, Wouter J.; Ghori, Umme Habiba; van Geloven, Anna A. W.; Hannink, Gerjon; van Rossem, Charles C.; van de Wouw, Lieke; Huisman, Peter M.; van Hemert, Annemiek; Franken, Rutger J.; Oosterling, Steven J.; Rosman, Camiel; Koens, Lianne; Stoker, Jaap; Dijkgraaf, Marcel G. W.; Boermeester, Marja A.
- Abstract
Key Points: Question: How can complicated appendicitis be accurately ruled out when considering nonoperative treatment in patients with acute appendicitis? Findings: This multicenter study of 1360 patients with imaging-confirmed appendicitis found that the previously designed Scoring System of Appendicitis Severity (SAS) fell short in accurately ruling out complicated appendicitis. The newly developed SAS 2.0 was able to assess an individual patient's probability of having complicated appendicitis with high accuracy among patients with acute appendicitis. Meaning: In this study, the SAS 2.0 provided a safe basis for when to consider and discuss nonoperative treatment of uncomplicated appendicitis with patients. This study evaluates the validity of the Scoring System of Appendicitis Severity and proposes improvements. Importance: When considering nonoperative treatment in a patient with acute appendicitis, it is crucial to accurately rule out complicated appendicitis. The Atema score, also referred to as the Scoring System of Appendicitis Severity (SAS), has been designed to differentiate between uncomplicated and complicated appendicitis but has not been prospectively externally validated. Objective: To externally validate the SAS and, in case of failure, to develop an improved SAS (2.0) for estimating the probability of complicated appendicitis. Design, Setting, and Participants: This prospective study included adult patients who underwent operations for suspected acute appendicitis at 11 hospitals in the Netherlands between January 2020 and August 2021. Main Outcomes and Measures: Appendicitis severity was predicted according to the SAS in 795 patients and its sensitivity and negative predictive value (NPV) for complicated appendicitis were calculated. Since the predefined targets of 95% for both were not met, the SAS 2.0 was developed using the same cohort. This clinical prediction model was developed with multivariable regression using clinical, biochemical, and imaging findings. The SAS 2.0 was externally validated in a temporal validation cohort consisting of 565 patients. Results: In total, 1360 patients were included, 463 of whom (34.5%) had complicated appendicitis. Validation of the SAS resulted in a sensitivity of 83.6% (95% CI, 78.8-87.6) and an NPV of 85.0% (95% CI, 80.6-88.8), meaning that the predefined targets were not achieved. Therefore, the SAS 2.0 was developed, internally validated (C statistic, 0.87; 95% CI, 0.84-0.89), and subsequently externally validated (C statistic, 0.86; 95% CI, 0.82-0.89). The SAS 2.0 was designed to calculate a patient's individual probability of having complicated appendicitis along with a 95% CI. Conclusions and Relevance: In this study, external validation of the SAS fell short in accurately distinguishing complicated from uncomplicated appendicitis. The newly developed and externally validated SAS 2.0 was able to assess an individual patient's probability of having complicated appendicitis with high accuracy in patients with acute appendicitis. Use of this patient-specific risk assessment tool can be helpful when considering and discussing nonoperative treatment of acute appendicitis with patients.
- Publication
JAMA Surgery, 2024, Vol 159, Issue 6, p642
- ISSN
2168-6254
- Publication type
Article
- DOI
10.1001/jamasurg.2024.0235