{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T16:38:40Z","timestamp":1775666320476,"version":"3.50.1"},"reference-count":24,"publisher":"Medknow","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["smedj"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:p>INTRODUCTION This study aimed to investigate the ultrasonographic features of paediatric acute appendicitis and incorporate them into a scoring algorithm that will quantify the risk of complications and the strength of recommendation for surgical intervention.  METHODS 179 patients with suspected appendicitis who had undergone ultrasonographic examination were included in this study. Based on their medical evaluation and post-surgical histopathological results, patients were categorised into confirmed appendicitis (n = 101) and non-appendicitis (n = 78) groups.  RESULTS In the appendicitis group, the appendix was visualised in 66 (65.3%) patients. In cases where the appendix was not visualised, we looked out for secondary inflammatory signs, which were present in 32 (31.7%) patients. Using stepwise logistic regression, Blumberg\u2019s sign, free fluid or collection, hyperaemia, non-compressible appendix and an appendix diameter &gt; 7 mm were found to be significant predictive factors for appendicitis. A new scoring system called POPs was developed, combining inflammatory predictors and ultrasonography findings, with an area under the receiver operating characteristic curve of 0.958 (95% confidence interval 0.929\u20130.986).  CONCLUSION The newly developed POPs-based diagnosis scheme proved a promising alternative to existing scoring systems such as the Alvarado score. Although further calibration would be beneficial, the proposed scoring scheme is simple and easy to understand, memorise and apply in the emergency room.<\/jats:p>","DOI":"10.11622\/smedj.2020102","type":"journal-article","created":{"date-parts":[[2020,7,15]],"date-time":"2020-07-15T01:24:29Z","timestamp":1594776269000},"page":"35-41","source":"Crossref","is-referenced-by-count":14,"title":["Ultrasonographic findings of child acute appendicitis incorporated into a scoring system"],"prefix":"10.4103","volume":"63","author":[{"given":"GN","family":"Pop","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"FO","family":"Costea","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Lungeanu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ER","family":"Iacob","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CM","family":"Popoiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2581","published-online":{"date-parts":[[2022,1]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.jpedsurg.2015.10.002","article-title":"Outcome after introduction of laparoscopic appendectomy in children: a cohort study","volume":"51","author":"Svensson","year":"2016","unstructured":"1. Svensson JF, Patkova B, Almstr\u00f6m M, Eaton S, Wester T. Outcome after introduction of laparoscopic appendectomy in children: a cohort study. J Pediatr Surg 2016; 51:449-53.","journal-title":"J Pediatr Surg"},{"key":"ref1","doi-asserted-by":"publisher","first-page":"82","DOI":"10.12816\/0047554","article-title":"Positive and negative rates in children with acute appendicitis","volume":"40","author":"Zaidan","year":"2018","unstructured":"2. Zaidan H, Khalfan F, Ahmed H, Corbally MT. Positive and negative rates in children with acute appendicitis. Bahrain Med Bull 2018; 40:82-5.","journal-title":"Bahrain Med Bull"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"4810730","DOI":"10.1155\/2018\/4810730","article-title":"Retrospective multivariate analysis of data from children with suspected appendicitis: a new tool for diagnosis","volume":"2018","author":"Dokumcu","year":"2018","unstructured":"3. Dokumcu Z, Toker Kurtmen B, Divarci E, et al. Retrospective multivariate analysis of data from children with suspected appendicitis: a new tool for diagnosis. Emerg Med Int 2018; 2018:4810730.","journal-title":"Emerg Med Int"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1016\/S0196-0644(86)80993-3","article-title":"A practical score for the early diagnosis of acute appendicitis","volume":"15","author":"Alvarado","year":"1986","unstructured":"4. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15:557-64.","journal-title":"Ann Emerg Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1053\/jpsu.2002.32893","article-title":"Pediatric appendicitis score","volume":"37","author":"Samuel","year":"2002","unstructured":"5. Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002; 37:877-81.","journal-title":"J Pediatr Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1007\/s00268-008-9649-y","article-title":"The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score","volume":"32","author":"Andersson","year":"2008","unstructured":"6. Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg 2008; 32:1843-9.","journal-title":"World J Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2051","DOI":"10.1016\/j.jpedsurg.2015.08.028","article-title":"A new 2-step risk-stratification clinical score for suspected appendicitis in children","volume":"50","author":"Yap","year":"2015","unstructured":"7. Yap TL, Chen Y, Low WW, et al. A new 2-step risk-stratification clinical score for suspected appendicitis in children. J Pediatr Surg 2015; 50:2051-5.","journal-title":"J Pediatr Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1148\/radiology.161.3.3538138","article-title":"Mesenteric adenitis and acute terminal ileitis: US evaluation using graded compression","volume":"161","author":"Puylaert","year":"1986","unstructured":"8. Puylaert JB. Mesenteric adenitis and acute terminal ileitis: US evaluation using graded compression. Radiology 1986; 161:691-5.","journal-title":"Radiology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1148\/radiol.2017162755","article-title":"Effectiveness of a staged US and unenhanced MR imaging algorithm in the diagnosis of pediatric appendicitis","volume":"286","author":"Dibble","year":"2018","unstructured":"9. Dibble EH, Swenson DW, Cartagena C, Baird GL, Herliczek TW. Effectiveness of a staged US and unenhanced MR imaging algorithm in the diagnosis of pediatric appendicitis. Radiology 2018; 286:1022-9.","journal-title":"Radiology"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"9784565","DOI":"10.1155\/2017\/9784565","article-title":"Acute nonspecific mesenteric lymphadenitis: more than \"no need for surgery","volume":"2017","author":"Helbling","year":"2017","unstructured":"10. Helbling R, Conficconi E, Wyttenbach M, et al. Acute nonspecific mesenteric lymphadenitis: more than \"no need for surgery.\" Biomed Res Int 2017; 2017:9784565.","journal-title":"\" Biomed Res Int"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"859","DOI":"10.5811\/westjem.2014.9.21568","article-title":"Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014","volume":"15","author":"Shogilev","year":"2014","unstructured":"11. Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med 2014; 15:859-71.","journal-title":"West J Emerg Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1016\/j.ajem.2013.06.027","article-title":"Different urinalysis appearances in children with simple and perforated appendicitis","volume":"31","author":"Chen","year":"2013","unstructured":"12. Chen CY, Zhao LL, Lin YR, Wu KH, Wu HP. Different urinalysis appearances in children with simple and perforated appendicitis. Am J Emerg Med 2013; 31:1560-3.","journal-title":"Am J Emerg Med"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"13. Inal M, Unal B, Bilgili YK. Better visualization of vermiform appendix with tissue harmonic imaging compared to conventional sonography. Iran J Radiol 2014; 11:e18114.","DOI":"10.5812\/iranjradiol.18114"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","unstructured":"14. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44:837-45.","journal-title":"Biometrics"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.asjsur.2013.04.004","article-title":"Acute appendicitis: diagnostic accuracy of Alvarado scoring system","volume":"36","author":"Memon","year":"2013","unstructured":"15. Memon ZA, Irfan S, Fatima K, Iqbal MS, Sami W. Acute appendicitis: diagnostic accuracy of Alvarado scoring system. Asian J Surg 2013; 36:144-9.","journal-title":"Asian J Surg"},{"key":"ref15","unstructured":"16. Mekeres F, Voita GF, Mekeres GM, Bodog FD. Psychosocial impact of scars in evaluation of aesthetic prejudice. Rom J Leg Med 2017; 25:435-8."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.amsu.2018.11.019","article-title":"To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard","volume":"38","author":"Khan","year":"2018","unstructured":"17. Khan U, Kitar M, Krichen I, et al. To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard. Ann Med Surg (Lond) 2018; 38:22-7.","journal-title":"Ann Med Surg (Lond)"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1148\/radiol.10100984","article-title":"Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA","volume":"259","author":"Krishnamoorthi","year":"2011","unstructured":"18. Krishnamoorthi R, Ramarajan N, Wang NE, et al. Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA. Radiology 2011; 259:231-9.","journal-title":"Radiology"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1111\/acem.12161","article-title":"Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort","volume":"20","author":"Mittal","year":"2013","unstructured":"19. Mittal MK, Dayan PS, Macias CG, et al. Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Acad Emerg Med 2013; 20:697-702.","journal-title":"Acad Emerg Med"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"20. Trout AT, Sanchez R, Ladino-Torres MF, Pai DR, Strouse PJ. A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography? Pediatr Radiol 2012; 42:813-23.","DOI":"10.1007\/s00247-012-2358-6"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"849","DOI":"10.2214\/AJR.14.13026","article-title":"Improvement in diagnostic accuracy of ultrasound of the pediatric appendix through the use of equivocal interpretive categories","volume":"204","author":"Larson","year":"2015","unstructured":"21. Larson DB, Trout AT, Fierke SR, Towbin AJ. Improvement in diagnostic accuracy of ultrasound of the pediatric appendix through the use of equivocal interpretive categories. AJR Am J Roentgenol 2015; 204:849-56.","journal-title":"AJR Am J Roentgenol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1007\/s00247-015-3443-4","article-title":"Development and validation of an ultrasound scoring system for children with suspected acute appendicitis","volume":"45","author":"Fallon","year":"2015","unstructured":"22. Fallon SC, Orth RC, Guillerman RP, et al. Development and validation of an ultrasound scoring system for children with suspected acute appendicitis. Pediatr Radiol 2015; 45:1945-52.","journal-title":"Pediatr Radiol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1136\/bmj.39500.677199.AE","article-title":"Grading quality of evidence and strength of recommendations for diagnostic tests and strategies","volume":"336","author":"Sch\u00fcnemann","year":"2008","unstructured":"23. Sch\u00fcnemann HJ, Oxman AD, Brozek J, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 2008; 336:1106-10.","journal-title":"BMJ"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"24. Moons KG, Altman DG, Reitsma JB, et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med 2015; 162:W1-73.","DOI":"10.7326\/M14-0698"}],"container-title":["Singapore Medical Journal"],"original-title":[],"link":[{"URL":"http:\/\/www.smj.org.sg\/article\/ultrasonographic-findings-child-acute-appendicitis-incorporated-scoring-system","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T10:52:29Z","timestamp":1660042349000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.smj.org.sg\/article\/ultrasonographic-findings-child-acute-appendicitis-incorporated-scoring-system"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]},"published-print":{"date-parts":[[2022,1]]}},"URL":"https:\/\/doi.org\/10.11622\/smedj.2020102","relation":{},"ISSN":["0037-5675","2737-5935"],"issn-type":[{"value":"0037-5675","type":"print"},{"value":"2737-5935","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1]]}}}