Diagnostic Value of the Pediatric Appendicitis Score in Pediatric Appendicitis

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.