Pediatr Emerg Med J.
2018 Dec;5(2):54-61. 10.22470/pemj.2018.00255.
Development of a clinical scoring system for appendicitis in children with presumed appendicitis
- Affiliations
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- 1Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
- 2Kangwon National University Graduate School of Medicine, Chuncheon, Korea.
- 3Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. 77saja@hanmail.net
- 4Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
- KMID: 2435121
- DOI: http://doi.org/10.22470/pemj.2018.00255
Abstract
- PURPOSE
To develop a clinical scoring system for children with presumed appendicitis who visit the emergency department.
METHODS
A registry based-retrospective study was conducted in the pediatric emergency department between September 2015 and December 2016. Patients aged 4 to 17 years who had a > 1 of 5 Likert scale for possibility of appendicitis were included. Multiple logistic regressions based on Akaike information criterion were performed using variables regarding clinical features and inflammatory markers to develop the clinical scoring system.
RESULTS
A total of 233 patients were included, and 93 (39.9%) had the final diagnosis of appendicitis. The final model with the lowest Akaike information criterion (171.7) consisted of 5 variables, including vomiting (1 point), absence of watery diarrhea (1 point), duration of symptoms ≤ 3 days (1 point), rebound tenderness (1 point), and white blood cell count > 10.0 × 109/L (2 points). If the clinical score was ≥ 4 of 6 points, the area under the receiver operating characteristic curve was 0.78 (95% confidence interval, 0.71-0.86) with a 78.9% sensitivity, 66.7% specificity, positive and negative predictive values of 70.0% and 76.2%, respectively, and positive and negative likelihood ratios of 2.4 and 0.3, respectively.
CONCLUSION
The 5-item clinical scoring system shows a fair performance for prediction of pediatric appendicitis. This simple tool could be applied to predict the pediatric appendicitis, and to avoid the use of potentially unnecessary computed tomography.
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