ABSTRACT
Objective: To determine the diagnostic accuracy of Pediatric Appendicitis Score (PAS) in predicting appendicitis in children presenting with acute abdominal pain to the Emergency Department (ED) of a private hospital in Pakistan. Methods: This validation study was through retrospective chart review of children between 4-18 years of age with clinical suspicion of acute appendicitis, presenting to the pediatric ED. Diagnostic accuracy was determined using sensitivity, specificity, predictive values, and area under the curve (AUC). Results: 104 children (76% boys) with mean (SD) age of 10.9 (3.5) years met the eligibility criteria. 91% (n=95) patients had moderate to high PAS (score ?4), and 95% (n=99) had biopsy-proven appendicitis. The likelihood ratio calculated for low, equivocal and high-risk PAS was 0.10, 2.17 and 2.53, respectively. An equivocal PAS (score 4-6) showed a sensitivity of 96.8%, specificity of 80%, positive predictive value of 98.9% and AUC of 0.84 for predicting acute appendicitis. Conclusion: PAS showed good diagnostic accuracy in predicting acute appendicitis in children presenting to the ED.
ABSTRACT
@#BACKGROUND: Motor vehicle crash (MVC) related injury has been identified as a major public health concern. Child restrain (CR) seat belts can minimize the mortality and morbidity from MVC. The use for seat belts is substantially low in developing countries like Pakistan even though its use has been shown to decrease morbidity and mortality by a significant extent. METHODS: This was a case control study with cases from the general population (GP) and controls from the Aga Khan University (AKU) employees in a 3:1 ratio. The study questionnaire was based on parameters like gender, education level, awareness and presence of CR and also assessed the frequency of usage, reasons for not using CR and the source of knowledge regarding CR use. RESULTS: Out of 848 respondents, 212 were from AKU and 636 were from the GP. 96.7% from AKU had at least a bachelor's degree while less than half (42.6%) of those from the GP were graduate or above (P<0.001). A statistically significant difference was found between the two groups with drivers from AKU being generally more aware about CR and its use. 81.1% of the group from AKU compared to 59.7% from the general population were found to be aware of child restraint use (P<0.001). Media (40.6%) was found to be the most common source of information amongst the AKU employees. CONCLUSION: Most motor vehicle related injuries in children can be prevented or their severity may be reduced by the use of appropriate child restraint seat belts.