Diagnostic Value of the Pediatric Appendicitis Score in Pediatric Appendicitis

Shul, Young Man; Kim, Gab Teug

Abstract

PURPOSE
This study was performed to evaluate the pediatric appendicitis score (PAS) and to propose diagnostic criteria for acute appendicitis in children.
METHODS
The medical records of 194 patients who underwent appendectomies for clinically suspected acute appendicitis and the preoperative evaluations of those patients in our emergency room were, respectively, reviewed. Each of 8 clinical variables, hopping tendereness in the right lower quadrant (RLQ), anorexia, pyrexia, nausea/vomiting, RLQ tenderness, leukocytosis, neutrophilia, and migration of pain, was assigned a score of 1 or 2 to obtain a total of 10. The PAS, ultrasound (US), and combination of the PAS and US were evaluated for sensitivity, specificity, predictive value, and accuracy.
RESULTS
Negative appendectomies were performed in 11.3% (22 of 194 patients) of the cases. A PAS > or = 6 was compatible with the diagnosis of appendicitis. However, in cases with a PAS< or =5, US was necessary for the diagnosis of appendicitis. Analysis of the data for the PAS and for combined PAS and US method revealed, respectively sensitivities of 73.8% and 94.6%, specificities of 86.4% and 70.6%, positive predictive values of 97.7% and 96.6%, negative predictive values of 29.7% and 60.0%, and accuracies of 75.3% and 92.1%.
CONCLUSION
The PAS is a simple and good diagnostic test for assessing an acute abdomen and diagnosing acute appendicitis in children. However, a combination of the PAS and US is more accurate than the PAS alone in diagnosing acute appendicitis.