Pediatric appendicitis score

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Abstract

Background/Purpose: Morbidity in children treated with appendicitis results either from late diagnosis or negative appendectomy. A Prospective analysis of efficacy of Pediatric Appendicitis Score for early diagnosis of appendicitis in children was conducted. Methods: In the last 5 years, 1,170 children aged 4 to 15 years with abdominal pain suggestive of acute appendicitis were evaluated prospectively. Group 1 (734) were patients with appendicitis and group 2 (436) nonappendicitis. Multiple linear logistic regression analysis of all clinical and investigative parameters was performed for a model comprising 8 variables to form a diagnostic score. Results: Logistic regression analysis yielded a model comprising 8 variables, all statistically significant, P <.001. These variables in order of their diagnostic index were (1) cough/percussion/hopping tenderness in the right lower quadrant of the abdomen (0.96), (2) anorexia (0.88), (3) pyrexia (0.87), (4) nausea/emesis (0.86), (5) tenderness over the right iliac fossa (0.84), (6) leukocytosis (0.81), (7) polymorphonuclear neutrophilia (0.80) and (8) migration of pain (0.80). Each of these variables was assigned a score of 1, except for physical signs (1 and 5), which were scored 2 to obtain a total of 10. The Pediatric Appendicitis Score had a sensitivity of 1, specificity of 0.92, positive predictive value of 0.96, and negative predictive value of 0.99. Conclusion: Pediatric appendicitis score is a simple, relatively accurate diagnostic tool for accessing an acute abdomen and diagnosing appendicitis in children. J Pediatr Surg 37:877-881. Copyright 2002, Elsevier Science (USA). All rights reserved.

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Materials and methods

In the last 5 years, 1,170 children aged 4 to 15 years with abdominal pain suggestive of acute appendicitis at Southampton General Hospital, Southampton and St George's Hospital, London were analyzed prospectively. A uniform prospective data form was completed, which included. (1) demographic data (age and sex); (2) duration of symptoms: (a) anorexia, (b) nausea/vomiting, and (c) migration of pain from umbilical area to right lower quadrant; (3) physical signs: (a) right iliac fossa tenderness

Age and sex

Mean age of patients with appendicitis was 9.9 ± 3.3 versus 11 ± 2.7 years in those without appendicitis (P >.05). Sex ratio (male to female) of children with appendicitis was (471:263) 1.7:1 versus 1.8:1 (281:155) without appendicitis (P >.05). There was a good correlation between the 2 groups regarding age and sex (r = 0.84).

Group 1

Sixty-three percent (734 of 1,170) had appendicitis confirmed by histology. Pathologic stages of acute appendicitis were inflamed, 35% (acute inflammatory infiltrate is

Discussion

PAS specifically addresses symptomatology and physical signs unique to children. Physical signs, such as cough, percussion tenderness, and hopping tenderness in the right iliac fossa had significant correlation and, hence, were assigned as a single variable with a score of 2. Tenderness in the right iliac fossa especially over the McBurney's point in combination with the above physical sign had a good diagnostic index with a high probability of predicting true prevalence of appendicitis (P

Acknowledgements

The author thanks all the Pediatric Surgical Consultants at Southampton General Hospital, Southampton and St George's Hospital, London, for the use of their patients in this study. Special thanks to the Department of Pathology and Microbiology.

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Address reprint requests to Madan Samuel, Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, England.

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