ABSTRACT
INTRODUCTION: Early differentiation between perforated and nonperforated acute appendicitis (AA) in children is of major benefit for the selection of proper treatment. Based on pilot study data, we hypothesized that plasma sodium concentration at hospital admission is a diagnostic marker for perforation in children with AA. MATERIALS AND METHODS: This was a prospective diagnostic accuracy study, including previously healthy children, 1 to 14 years of age, with AA. Blood sampling included plasma sodium concentration, plasma glucose, base excess, white blood cell count, plasma arginine vasopressin (AVP), and C-reactive protein. RESULTS: Eighty children with histopathologically confirmed AA were included in the study. Median plasma sodium concentration on admission in patients with perforated AA (134 mmol/L, [interquartile range 132-136]) was significantly lower than in children with nonperforated AA (139 mmol/L, [137-140]). The receiver operating characteristic curve of plasma sodium concentration identifying patients with perforated AA showed an area under the curve of 0.93 (95% confidence interval, 0.87-0.99), with a sensitivity and specificity of 0.82 (0.70-0.90) and 0.87 (0.60-0.98), respectively. Plasma sodium concentrations ≤136 mmol/L resulted in an odds ratio of 31.9 (6.3-161.9) for perforation. The association between low plasma sodium concentration and perforated AA was confirmed in a multivariate logistic regression analysis. Median plasma AVP on admission was higher in patients with perforated (8.6 pg/mL [5.0-14.6]) as compared with nonperforated AA (3.4 pg/mL [2.5-6.6]). CONCLUSION: In children with AA, there is a strong association between low plasma sodium concentration and perforation, a novel and not previously described finding.
Subject(s)
Appendicitis/diagnosis , Sodium/blood , Acute Disease , Adolescent , Appendicitis/blood , Biomarkers/blood , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Infant , Logistic Models , Male , Prospective Studies , ROC Curve , Sensitivity and SpecificitySubject(s)
Appendectomy/methods , Appendicitis/blood , Appendicitis/surgery , Homeostasis , Sodium Chloride/blood , Water/chemistry , Acute Disease , Aldosterone/blood , Appendicitis/diagnosis , Arginine Vasopressin/blood , Child , Extracellular Fluid/chemistry , Female , Fluid Therapy , Hospitalization , Humans , Male , Muscle Hypotonia/metabolism , Operative Time , Prospective Studies , Renin/blood , Sweden , Treatment OutcomeABSTRACT
More than 90% of the world population receives emergency medical care from different types of practitioners with little or no specific training in the field and with variable guidance and oversight. Emergency medical care is being recognized by actively practicing physicians around the world as an increasingly important domain in the overall health services package for a community. The know-do gap is well recognized as a major impediment to high-quality health care in much of the world. Knowledge translation principles for application in this highly varied young domain will require investigation of numerous aspects of the knowledge synthesis, exchange, and application domains in order to bring the greatest benefit of both explicit and tacit knowledge to increasing numbers of the world's population. This article reviews some of the issues particular to knowledge development and transfer in the international domain. The authors present a set of research proposals developed from a several-month online discussion among practitioners and teachers of emergency medical care in 16 countries from around the globe and from all economic strata, aimed at improving the flow of knowledge from developers and repositories of knowledge to the front lines of clinical care.
