Prospective Evaluation of the Pediatric Appendicitis Score with Right Lower Quadrant Abdominal Pain Registry

ABSTRACT

PURPOSE: Acute appendicitis is one of the most common surgical emergencies in the emergency department (ED) and various scoring systems such as the Alvarado score or the pediatric appendicitis score (PAS) have been developed to aid diagnosis. This study was designed to evaluate the diagnostic value of PAS in South Korea children, prospectively. METHODS: All patients visiting our ED with right lower quadrant (RLQ) abdominal pain or RLQ tenderness were enrolled in our registry. Patients under age of 18, whose guardian agreed with the informed consent were included in this study. Those who were diagnosed at previous hospitals were excluded. Appendicitis was confirmed by operative and histopathological findings. A follow up call was made to verify final outcome within 14 days. RESULTS: We collected data on 1648 patients and a total of 512 patients participated in the study. The mean age was 11.9 years. Seventy four patients (14.5%) had pathology-proven appendicitis and negative appendectomy was performed in three patients (3.9%). Statistical analysis showed that with PAS > or =4, sensitivity 70.1%, specificity 60.4%, and area under curve (AUC) 0.708. With the Alvarado score > or =5, sensitivity 72.7%, specificity 67.2%, and AUC 0.748. CONCLUSION: Usefulness of PAS in diagnosis of pediatric acute appendicitis is limited. PAS showed no significant superiority over the Alvarado score. Therefore, it seems reasonable to use both scores for evaluation of pediatric acute appendicitis in South Korea.