Bedside breath tests in children with abdominal pain: a prospective pilot feasibility study

David C Wong, Samuel D Relton, Victoria Lane, Mohamed Ismail, Victoria Goss, Jane Bytheway, Robert M West, Jim Deuchars, Jonathan Sutcliffe, David C Wong, Samuel D Relton, Victoria Lane, Mohamed Ismail, Victoria Goss, Jane Bytheway, Robert M West, Jim Deuchars, Jonathan Sutcliffe

Abstract

Background: There is no definitive method of accurately diagnosing appendicitis before surgery. We evaluated the feasibility of collecting breath samples in children with abdominal pain and gathered preliminary data on the accuracy of breath tests.

Methods: We conducted a prospective pilot study at a large tertiary referral paediatric hospital in the UK. We recruited 50 participants with suspected appendicitis, aged between 5 and 15 years. Five had primary diagnosis of appendicitis. The primary outcome was the number of breath samples collected. We also measured the number of samples processed within 2 h and had CO2 ≥ 3.5%. Usability was assessed by patient-reported pain pre- and post-sampling and user-reported sampling difficulty. Logistic regression analysis was used to predict appendicitis and evaluated using the area under the receiver operator characteristic curve (AUROC).

Results: Samples were collected from all participants. Of the 45 samples, 36 were processed within 2 h. Of the 49 samples, 19 had %CO2 ≥ 3.5%. No difference in patient-reported pain was observed (p = 0.24). Sampling difficulty was associated with patient age (p = 0.004). The logistic regression model had AUROC = 0.86.

Conclusions: Breath tests are feasible and acceptable to patients presenting with abdominal pain in clinical settings. We demonstrated adequate data collection with no evidence of harm to patients. The AUROC was better than a random classifier; more specific sensors are likely to improve diagnostic performance.

Trial registration: ClinicalTrials.gov, NCT03248102. Registered 14 Aug 2017.

Keywords: Appendicitis; Biomarkers; Breathomics; Child; Exhalation; Volatile organic compounds.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s). 2019.

Figures

Fig. 1
Fig. 1
Example of a single VOC signature with 12 sensors. The time captured includes three phases: a a small warm-up phase (0–2 s), b the sensor readings as the sample is passed through the device (2–13 s) and c a post-sample phase consisting of noise in the sensors whilst the device is reset (17–30 s)
Fig. 2
Fig. 2
Study enrolment flow diagram
Fig. 3
Fig. 3
Negative correlation between age and difficulty of sample collection (y = 7.6–0.03x, Pearson R = − 0.396)

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