• Using mathematical modeling in the differential diagnosis of acute abdominal syndrome in children
en To content Full text of article

Using mathematical modeling in the differential diagnosis of acute abdominal syndrome in children

PAEDIATRIC SURGERY.UKRAINE.2019.1(62):47-52; DOI 10.15574/PS.2019.62.47

Stoyeva T. V., Dzhahiashvili O. V., Melnychenko M. H., Hudz V. A.
Odessa National Medical University, Ukraine
MI «Odessa Regional Children’s Clinical Hospital», Ukraine

The choice of the most perfect method for differential diagnosis of abdominal syndrome in children is still under discussion. It is known that primary examination and physical examination are the fastest, accessible and well-informed studies of the child’s condition.

The purpose of our work was to improve the differential diagnosis of acute appendicitis and functional disorders of the digestive tract in children with acute abdominal syndrome by determining the informativeness of clinical signs and their combination by multivariate logistic regression.

Material and methods. We have carried out a retrospective analysis of the history of illnesses of 649 children, who applied for medical aid for abdominal syndrome at MI «Odessa Regional Children’s Clinical Hospital» in the period of 2014–2016 yy. One third of children (248 persons (38.2 % (95% CI 34.4–42.0)) after the examination was diagnosed with surgical pathology.

Results. As a result of mathematical modeling, it was possible to differentiate the group membership of children with abdominal syndrome according to certain features, which made it possible to quickly and easily make a diagnosis of functional and surgical pathology of the patient’s digestive system at the stage of the primary examination with a general accuracy of 93.4% and to decide on the amount of urgent treatment (at acute appendicitis) or additional examination (at irritable bowel syndrome).

Conclusions. The proposed differential diagnosis using the multivariate logistic regression method, taking into account the integrated assessment of the combination of clinical signs, greatly speeds up the diagnosis of functional intestinal pathology, suggests the presence of syntopeia and helps to decide more quickly on the scope of additional examination and therapeutic tactics by the primary care physician.

Key words: mathematical modeling, diagnostics, acute abdominal syndrome, children.

REFERENCES

1. Karaseva OV. (2011). Acute abdominal pain in pediatric practice. Pediatric pharmacology. 8(5):21–27.

2. Rusak PS. (2011). Innovative technologies in diagnostics, treatment and prevention of urgent surgical abdominal pathology in children. Kyiv:32.

3. Rusak PS. (2015). Problem of acute abdomen in pediatrics. Zhytomyr: Polissya:167p.

4. Senatorova АS, Osipenko EV, Ermolaev MN. (2009). Differential diagnosis of abdominal pain in pediatric practice. Dytiachyi likar. 1 (1):29–40.

5. Ursova NI. (2017). Tactics of peditry in abdominal pain in children. Meditsinskij sovet. 9:80–84.

6. Shutova EV. (2018). Abdominal pain syndrome in children and adolescents: treatment options. Zdorov’e rebenka. 13(5):495–501. https://doi.org/10.22141/2224-0551.13.5.2018.141567

7. Yankovoj АG. (2001). Mnogomernyj analiz v sisteme STATISTICA. Odessa: OPTIMUM: 216.

8. Hijaz N, Friesen C. (2017). Managing acute abdominal pain in pediatric patients: current perspectives. Pediatric Health, Medicine And Therapeutics. 8:83–91. https://doi.org/10.2147/PHMT.S120156; PMid:29388612 PMCid:PMC5774593

9. Kim J. (2013). Acute Abdominal Pain in Children. Pediatric Gastroenterology, Hepatology & Nutrition. 16(4):219–224. https://doi.org/10.5223/pghn.2013.16.4.219; PMid:24511517 PMCid:PMC3915729

10. Kulik D, Uleryk E, Maguire J. (2013). Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. Journal Of Clinical Epidemiology. 66(1):95–104. https://doi.org/10.1016/j.jclinepi.2012.09.004; PMid:23177898

Article received: Oct 28, 2018. Accepted for publication: Mar 15, 2019.