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. 2023 Apr 10;39(1):175.
doi: 10.1007/s00383-023-05463-5.

The BIDIAP index: a clinical, analytical and ultrasonographic score for the diagnosis of acute appendicitis in children

Javier Arredondo Montero  1   2 , Carlos Bardají Pascual  3 , Giuseppa Antona  3 , Raquel Ros Briones  3 , Natalia López-Andrés  4 , Nerea Martín-Calvo  5   6   7
Affiliations

The BIDIAP index: a clinical, analytical and ultrasonographic score for the diagnosis of acute appendicitis in children

Javier Arredondo Montero et al. Pediatr Surg Int. .

Abstract

Background: Pediatric acute appendicitis (PAA) continues to be a diagnostic challenge today. The diagnostic performance of classical indices is only moderate, especially in pediatric population. This study aimed to define a clinical, radiological and analytical index for the diagnosis of PAA.

Materials and methods: This prospective study included 151 patients divided into two groups: (1) 53 patients with non-surgical abdominal pain (NSAP) and (2) 98 patients with a confirmed PAA. Sociodemographic and clinical characteristics were compared between groups using the Mann-Whitney U test and the Fisher exact test. To identify the predictors of PAA, we performed a multivariable logistic regression using a forward stepwise analysis and we assigned multiples of integer values to the selected variables. The diagnostic performance of the index was assessed by calculating the area under the receiver operating characteristic curve. Intra-cohort calibration was assessed with the Hosmer-Lemeshow test.

Results: We developed the BIDIAP index (BIomarkers for the DIagnosis of Appendicitis in Pediatrics), which included three variables that independently predicted higher odds of PAA: appendiceal caliber (≥ 6.9 mm), systemic immune-inflammation index (≥ 890) and peritoneal irritation, which scored 4, 3 and 2 points, respectively. Mean (SD) score of the participants was 2.38 (2.06) in group 1 and 7.89 (1.50) in group 2. The area under the ROC was 0.97 (95% CI 0.95-0.99). The cut-off point was established at 4 points, resulting in a sensitivity of 98.98% and a specificity of 77.78%.

Conclusions: The BIDIAP index has an exceptional diagnostic performance in PAA. The importance of these results lies in its novelty and in the simplicity of the index. Although external validation will be necessary, initial results look promising.

Keywords: Appendicular caliber; BIDIAP index; Collinearity; Pediatric acute appendicitis; Peritoneal irritation; Score; Systemic immune-inflammation index.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Algorithmic box plot representation of SII values in the two study groups
Fig. 2
Fig. 2
ROC curve for SII (group 1 vs 2)
Fig. 3
Fig. 3
ROC curve for BIDIAP score (group 1 vs 2)
Fig. 4
Fig. 4
Calibration model for the SCORE (Hosmer–Lemeshow test)
See this image and copyright information in PMC

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