#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Diagnosis and classification of pediatric acute appendicitis by artificial intelligence methods: An investigator-independent approach


Autoři: Josephine Reismann aff001;  Alessandro Romualdi aff002;  Natalie Kiss aff001;  Maximiliane I. Minderjahn aff001;  Jim Kallarackal aff002;  Martina Schad aff002;  Marc Reismann aff001
Působiště autorů: Department of Pediatric Surgery, Charité –Universitätsmedizin Berlin, Augustenburger Platz, Berlin, Germany aff001;  OakLabs GmbH, Hennigsdorf, Germany aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222030

Souhrn

Acute appendicitis is one of the major causes for emergency surgery in childhood and adolescence. Appendectomy is still the therapy of choice, but conservative strategies are increasingly being studied for uncomplicated inflammation. Diagnosis of acute appendicitis remains challenging, especially due to the frequently unspecific clinical picture. Inflammatory blood markers and imaging methods like ultrasound are limited as they have to be interpreted by experts and still do not offer sufficient diagnostic certainty. This study presents a method for automatic diagnosis of appendicitis as well as the differentiation between complicated and uncomplicated inflammation using values/parameters which are routinely and unbiasedly obtained for each patient with suspected appendicitis. We analyzed full blood counts, c-reactive protein (CRP) and appendiceal diameters in ultrasound investigations corresponding to children and adolescents aged 0–17 years from a hospital based population in Berlin, Germany. A total of 590 patients (473 patients with appendicitis in histopathology and 117 with negative histopathological findings) were analyzed retrospectively with modern algorithms from machine learning (ML) and artificial intelligence (AI). The discovery of informative parameters (biomarker signatures) and training of the classification model were done with a maximum of 35% of the patients. The remaining minimum 65% of patients were used for validation. At clinical relevant cut-off points the accuracy of the biomarker signature for diagnosis of appendicitis was 90% (93% sensitivity, 67% specificity), while the accuracy to correctly identify complicated inflammation was 51% (95% sensitivity, 33% specificity) on validation data. Such a test would be capable to prevent two out of three patients without appendicitis from useless surgery as well as one out of three patients with uncomplicated appendicitis. The presented method has the potential to change today’s therapeutic approach for appendicitis and demonstrates the capability of algorithms from AI and ML to significantly improve diagnostics even based on routine diagnostic parameters.

Klíčová slova:

Biomarkers – Blood counts – Diagnostic medicine – Inflammation – Neutrophils – Ultrasound imaging – White blood cells – Appendicitis


Zdroje

1. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132: 910–925. doi: 10.1093/oxfordjournals.aje.a115734 2239906

2. Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Ann Emerg Med. 2007;49: 778–784. doi: 10.1016/j.annemergmed.2006.12.016 17383771

3. Huckins DS, Simon HK, Copeland K, Spiro DM, Gogain J, Wandell M. A novel biomarker panel to rule out acute appendicitis in pediatric patients with abdominal pain. Am J Emerg Med. 2013;31: 1368–1375. doi: 10.1016/j.ajem.2013.06.016 23891596

4. Glass CC, Rangel SJ. Overview and diagnosis of acute appendicitis in children. Sem Ped Surg. 2016;25: 198–203.

5. Kwan KY, Nager AL. Diagnosing pediatric appendicitis: usefulness of laboratory markers. Am J Emerg Med. 2010;28: 1009–1015. doi: 10.1016/j.ajem.2009.06.004 20825931

6. Cayrol J, Miguez MC, Guerrero G, Tomatis C, Simal I, Maranon R. Diagnostic accuracy and prognostic utility of D dimer in acute appendicitis in children. Eur J Pediatr. 2016;175: 313–320. doi: 10.1007/s00431-015-2632-3 26362537

7. Minderjahn MI, Schädlich D, Radtke J, Rothe K, Reismann M. Phlegmonous appendicitis in children is characterized by eosinophilia in white blood cells counts. World J Pediatr. 2018;14: 504–509. doi: 10.1007/s12519-018-0173-3 30043224

8. Reismann J, Schädlich D, Minderjahn MI, Rothe K, Reismann M. Eosinophilia in pediatric uncomplicated appendicitis is a time stable pattern. Ped Surg Int. 2019;35: 335–340.

9. Rawolle T, Reismann M, Minderjahn MI, Bassir C, Hauptmann K, Rothe K, et al. Sonographic differentiation of complicated from uncomplicated appendicitis. Br J Radiol. 2019 May 29. pii: 92(1099):20190102. doi: 10.1259/bjr.20190102 31112397

10. Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2017;24: 523–551. doi: 10.1111/acem.13181 28214369

11. Kulik DM, Uleryk EM, Maguire JL. Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. J Clin Epidem. 2013;66: 95–104.

12. Hall NJ, Eaton S, Abbo O, Arnaud AP, Beaudin M, Brindle M, et al. Appendectomy versus non-operative treatment for acute uncomplicated appendicitis in children: study protocol for a multicentre, open-label, non- inferiority, randomised controlled trial. BMJ Paediatr Open. 2017 May 18. pii: bmjpo-2017–000028. doi: 10.1136/bmjpo-2017-000028 29637088

13. Pham XBD, Sullins VF, Kim DY, Range Blake, Kaji AH, de Virgilio CM, et al. Factors predictive of complicated appendicitis in children. J Surg Res. 2016;206: 62–66. doi: 10.1016/j.jss.2016.07.023 27916376

14. Romano A, Parikh P, Byers P, Namias N. Simple acute appendicitis versus non-perforated gangrenous appendicitis: is there a difference in the rate of post-operative infectious complications. Surg Infect. 2014;15: 517–520.

15. Fallon SC, Kim ME, Hallmark CA, Carpenter JL, Eldin KW, Lopez ME. Correlating surgical and pathological diagnoses in pediatric appendicitis. J Pediatr Surg. 2015;50: 638–641. doi: 10.1016/j.jpedsurg.2014.11.001 25840078

16. Coyne SM, Zhang B. Does appendiceal diameter change with age? A sonographic study. Am J Roentgen. 2014;203: 1120–1126.

17. Rettenbacher T, Hollerweger A, Macheiner P, Rettenbacher L, Tomaselli F, Schneider B, et al. Outer diameter of the vermiform appendix as a sign of acute appendicitis: evaluation at US. Radiology. 2001;218: 757–752. doi: 10.1148/radiology.218.3.r01fe20757 11230651

18. Fletcher R. Practical methods of optimization. 2nd ed. John Wiley & Sons; 2000.

19. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3: 32–35. doi: 10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>3.0.co;2-3 15405679

20. Park SH, Han K. Methodological guide for evaluating clinical performance and effect of artificial intelligence technology for medical diagnosis and prediction. Radiology. 2018 Mar;286: 800–809. doi: 10.1148/radiol.2017171920 29309734

21. Kessler N, Cyteval C, Gallix B, Lesnik A, Blayac PM, Pujol J, et al. Appendicitis: evaluation of sensitivity, specificity, and predictive values of us, doppler us, and laboratory findings. Radiology. 2004;230: 472–478. doi: 10.1148/radiol.2302021520 14688403

22. Hsieh CH, Lu RH, Lee NH, Chiu WT, Hsu MH, Li YC. Novel solutions for an old disease: Diagnosis of acute appendicitis with random forest, support vectors machines, and artificial neural networks. Surgery. 2011;149: 87–93. doi: 10.1016/j.surg.2010.03.023 20466403

23. Prabhudesai SG, Gould S, Rekhraj S, Tekkis PP, Glazer G, Ziprin P. Artificial neural networks: useful aid in diagnosing acute appendicitis. World J Surg. 2008;32: 305–309. doi: 10.1007/s00268-007-9298-6 18043966


Článek vyšel v časopise

PLOS One


2019 Číslo 9
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#