- Title
- Developing and validating of Ramathibodi Appendicitis Score (RAMA-AS) for diagnosis of appendicitis in suspected appendicitis patients
- Creator
- Wilasrusmee, Chumpon; Siribumrungwong, Boonying; Phuwapraisirisan, Samart; Poprom, Napaphat; Woratanarat, Patarawan; Lertsithichai, Panuwat; Attia, John; Thakkinstian, Ammarin
- Relation
- World Journal of Emergency Surgery Vol. 12, no. 49
- Publisher Link
- http://dx.doi.org/10.1186/s13017-017-0160-3
- Publisher
- Biomed Central
- Resource Type
- journal article
- Date
- 2017
- Description
- Background: Diagnosis of appendicitis is still clinically challenging where resources are limited. The purpose of this study was to develop and externally validate Ramathibodi Appendicitis Score (RAMA-AS) in aiding diagnosis of appendicitis. Methods: A two-phase cross-sectional study (i.e., derivation and validation) was conducted at Ramathibodi Hospital (for derivation) and at Thammasat University Hospital and Chaiyaphum Hospital (for validation). Patients with abdominal pain and suspected of having appendicitis were enrolled. Multiple logistic regression was applied to develop a parsimonious model. Calibration and discrimination performances were assessed. In addition, our RAMA-AS was compared with Alvarado’s score performances using ROC curve analysis. Results: The RAMA-AS consisted of three domains with seven predictors including symptoms (i.e., progression of pain, aggravation of pain, and migration of pain), signs (i.e., fever and rebound tenderness), and laboratory tests (i.e., white blood cell count (WBC) and neutrophil). The model fitted well with data, and it performed better discrimination than the Alvarado score with C-statistics of 0.842 (95% CI 0.804, 0.881) versus 0.760 (0.710, 0.810). Internal validation by bootstrap yielded Sommer’s D of 0.686 (0.608, 0.763) and C-statistics of 0.848 (0.846, 0.849). The C-statistics of two external validations were 0.853 (0.791, 0.915) and 0.813 (0.736, 0.892) with fair calibrations. Conclusion: RAMA-AS should be a useful tool for aiding diagnosis of appendicitis with good calibration and discrimination performances.
- Subject
- appendicitis score; derive phase; validation phase; calibration; discrimination
- Identifier
- http://hdl.handle.net/1959.13/1352626
- Identifier
- uon:30920
- Identifier
- ISSN:1749-7922
- Rights
- This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Language
- eng
- Full Text
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