Clinical prediction rules for appendicitis in young patients with acute abdominal pain in primary care

clinical diagnostics child Appendicitis

Prof. dr. M.Y. Berger
Dr. G.A. Holtman

Nature of the research:
Retrospective cohort study using primary care registration data from the Integrated Primary Care Information (IPCI) database

Fields of study:
GP medicine pediatrics gastroenterology

Background / introduction
Acute abdominal pain is a common presentation in primary care. It is a diagnostic challenge for the general practitioner (GP) to differentiate appendicitis from other common gastrointestinal conditions in children and young adults, because the clinical
presentation is often atypical and shows overlap. This diagnostic uncertainty coupled with the difficult trade-off between on the
one hand avoiding unnecessary investigations and abdominal surgery and on the other hand not missing a case of appendicitis, implies that additional tests or clinical prediction rules might be of help to the GP in doubt. However, none of the
existing prediction rules (with or without CRP test) is externally validated in patients presenting with acute abdominal pain in
primary care. The access to in general practice routinely collected data, is an opportunity to validate these clinical prediction
Research question / problem definition
To validate and update seven existing diagnostic clinical prediction rules (with and without CRP) for appendicitis in children and young adults aged 5-23 years presenting with acute abdominal pain to their GP.
We will perform a retrospective cohort study using primary care registration data from the Integrated Primary Care Information
(IPCI) database. The study group consist of all children and young adults aged 5-23 years with an episode of acute abdominal pain (<8 days). The presence or absence of appendicitis will be based on the letter of the specialist including information on reference tests or a follow-up of 6 weeks. We
assess external validity with calibration and discrimination. The optimal model will be updated and we will construct a clinically
applicable prediction score.

This project may result in a MD PhD traject.
Shogilev D, Duus N, Odom S, Shapiro N. Diagnosing Appendicitis: Evidence-Based Review of the Diagnostic Approach in
2014, Western Journal of Emergency Medicine. 2014;15 (7): 859–871
Kulik DM, Uleryk EM, Maguire JL. Does this child have appendicitis? A systematic review of clinical prediction rules for children
with acute abdominal pain, Journal of Clinical Epidemiology, 2013;66 (1): 95–104. doi:10.1016/j.jclinepi.2012.09.004.
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