Management of Acute Appendicitis in Children in a University Hospital.

OBJECTIVE: Little is known about the positive predictive value of diagnostic tools for severe acute appendicitis (AA). Our objective was to study a retrospective cohort of patients with AA, emphasizing its laboratory and radiologic features, to establish risk factors for more severe cases of AA. METHODS: A retrospective cohort study with patients with AA confirmed by biopsy was performed. In each case, examinations were reviewed, data were compared, and laboratory and radiologic findings were established to identify risk factors for severe AA. RESULTS: During the studied period, 405 children, with a mean age of 120 months, were evaluated. Most of the patients were boys (63.2%). C-reactive protein was the best parameter for the diagnosis of perforated AA, with a sensitivity of 88% for values above 173 mg/dL. A total of 64.4% of the patients underwent abdominal ultrasound, and 26% had normal results. CONCLUSIONS: Acute appendicitis is a disease with a wide spectrum of complications; thus, it is important to recognize the markers associated with severe cases of AA. High levels of C-reactive protein were the best markers associated with perforated appendicitis, and ultrasound was requested in most of the cases but was not helpful in most of them.

Cerebrospinal fluid lactate level as a diagnostic biomarker for bacterial meningitis in children.

BACKGROUND: Cerebrospinal fluid (CSF) lactate is a potential biomarker for bacterial meningitis in children. To this end, we performed a single-center retrospective cohort study of children from Sao Paulo, Brazil, with CSF pleocytosis to evaluate the ability of CSF lactate to distinguish between children with bacterial and aseptic meningitis. We determined the optimum cutoff point for CSF lactate using receiver-operator curve (ROC) analysis. FINDINGS: We identified 451 children of whom 40 (9%) had bacterial meningitis. Children with bacterial meningitis had a higher median CSF lactate level [9.6 mmol/l, interquartile range (IQR) 3.2-38.5 mmol/l bacterial meningitis vs. 2.0 mmol/l, IQR 1.2-2.8 mmol/l aseptic meningitis]. A CSF lactate cutoff point of 3.0 mmol/l had a sensitivity of 95% [95% confidence interval (CI) 83-99%), specificity of 94% (95% CI 90-96%) and negative predictive value of 99.3% (95% CI 97.7-99.9%) for bacterial meningitis. CONCLUSIONS: In combination with a validated meningitis clinical prediction rule, the CSF lactate level can be used to distinguish between bacterial and aseptic meningitis in children with CSF pleocytosis.

The bacterial meningitis score to distinguish bacterial from aseptic meningitis in children from Sao Paulo, Brazil.

In a retrospective cohort of 494 children with meningitis in Sao Paulo, Brazil, the Bacterial Meningitis Score identified all the children with bacterial meningitis (sensitivity 100%, 95% confidence interval: 92-100% and negative predictive value 100%, 95% confidence interval: 98-100%). Addition of cerebrospinal fluid lactate to the score did not improve clinical prediction rule performance.

Uso de albumina serica e contagem linfocitaria como indice prognostico em criancas internadas em unidade de terapia intensiva. / Serum albumin use and lymphocyte count as criteria for prognosis in children hospitalized in intensive care unit

Os autores apresentam os resultados do estudo de 110 criancas admitidas em um periodo de seis meses na Unidade de Terapia Intensiva do Instituto da Crianca da Faculdade de Medicina da Universidade de Sao Paulo. Foram excluidos os pacientes portadores de disturbios primarios do numero total de linfocitos (leucemias) ou da albumina serica (nefroticas e cirroticos).Atraves da avaliacao do numero total de linfocitos e da albumina serica foi possivel estabelecer um criterio para o prognostico de mortalidade para tres grupos distintos: 1. albumina serica baixa e linfocitos baixos = 70,58%; 2. albumina baixa ou linfocitos baixos = 41,50% e 3.albumina normal e linfocitos normais = 15,00% de mortalidade