Comparison of Appendicitis Scoring Systems in Childhood Appendicitis

Sağ, Sefa; Başar, Dilek; Yurdadogan, Fatih; Pehlivan, Yildiz; Elemen, Levent

doi:10.5152/turkarchpediatr.2022.22076

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…In the pediatric population a prospective study was conducted on the clinical scoring systems used in reducing the negative appendectomy rates, and the conclusion was that all the scoring systems were effective in reducing this rate. The negative appendectomy rate was 14.8% in this study [27].…”

Section: Clinical Scoring Systems and Negative Appendectomy Ratesupporting

confidence: 42%

Negative Appendectomy Rates -Current Prospective- A Review

Kumar

Soma

2023

AJMAH

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The negative appendectomy rate is generally accepted in the diagnosis of acute appendicitis to prevent complications like perforation. This rate varies according to countries in western and eastern regions of the world. Clinical scoring systems, inflammatory markers and imaging have been used to reduce the negative appendectomy rate. The introduction of computerized tomography has improved the diagnostic accuracy of acute appendicitis. As this rate has been progressively decreasing over the past few years, a review article was done to look at the role of scoring systems, inflammatory markers, and imaging in diagnosing acute appendicitis and hence reduce the negative appendectomy rate.

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Section: Clinical Scoring Systems and Negative Appendectomy Ratesupporting

confidence: 42%

Negative Appendectomy Rates -Current Prospective- A Review

Kumar

Soma

2023

AJMAH

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“…As the two most popular clinical scoring systems for use in children, the Alvarado score and PAS are widely studied and appreciated in excluding acute appendicitis [4]. And the American College of Emergency Physicians approved that application of the Alvarado score as a triage clinical prediction rules that can be applied to 'rule out' appendicitis at a score below 5 points (sensitivity 94-99%) [14], while PAS has successfully detected cases of appendicitis due to its high diagnostic sensitivity [7]. In this study, with the cutoff value of 6, the sensitivity and speci city of PAS in the diagnosis of acute appendicitis were 82.67% (124/150) and 89.83% (106/118), respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Pediatric Appendicitis Score (PAS) is a scoring system developed in a prospective cohort study of 1170 patients by Madan Samuel in 2002 and contains 8 variables that are statistically signi cant for acute appendicitis [7]. Derived from visceral adipose tissue during acute in ammation, the expression of C-reactive protein (CRP) related to severity of in ammation [8].…”

Section: Introductionmentioning

confidence: 99%

The Significance of Combined Detection of Ultrasonography, Pediatric Appendicitis Score and C-reactive Protein in the Diagnosis and Pathological type of Acute Appendicitis in Children

Hu,

Lin,

et al. 2023

Preprint

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Background: As one of the most common diseases of acute abdomen, early diagnosis of acute appendicitis remains a vital issue. This study aims to explore the value of combined ultrasonography, Pediatric Appendicitis Score and C-reactive protein in the diagnosis and pathological types of appendicitis in children. Method: A total of 268 children with acute abdominal pain admitted to our center between January 2017 and January 2020 were retrospectively analyzed and divided into group acute appendicitis and group non-acute appendicitis based on the surgical findings and pathological findings. Group acute appendicitis was further divided into three groups based on the types of pathology, group simple appendicitis, group suppurative appendicitis and group gangrenous appendicitis. Results: Pediatric Appendicitis Score and level of C-reactive protein in group acute appendicitis were higher than group non-acute appendicitis (P < 0.05). The areas under the receiver operating characteristic curve of Pediatric Appendicitis Score, C-reactive protein and ultrasonography for acute appendicitis were 0.871, 0.777 and 0.897, respectively (P < 0.001). The sensitivity and negative predictive value of ultrasonography combined with Pediatric Appendicitis Score and C-reactive protein in diagnosing acute appendicitis were higher than ultrasonography and CRP, while the specificity and positive predictive value were lower (P＜0.05). The C-reactive protein in the acute complicated appendicitis was significantly higher than simple appendicitis, and the areas under the ROC curve of C-reactive protein and ultrasonography in diagnosing acute complicated appendicitis were 0.814(0.762-0.867) and 0.861(0.812-0.909). The sensitivity of ultrasonography combined with C-reactive protein in diagnosing acute complicated appendicitis was 98.21%, which was significantly higher than that of ultrasonography and CRP alone (P＜0.05). The sensibilities of ultrasonography for different pathological types of appendicitis were 78.95% for acute simple appendicitis, 81.97% for acute suppurative appendicitis and 92.16% for acute gangrenous appendicitis. The diagnostic results of ultrasonography for different pathological types of appendicitis in children were consistent with those of pathological examination (Kappa=0.888; P < 0.001). Conclusion: The combination of ultrasonography, Pediatric Appendicitis Score and C-reactive protein detection is helpful to the accurate diagnosis of acute appendicitis, and ultrasonography combined with CRP may contribute to diagnosing pathological type of appendicitis in children, providing important evidence for clinical diagnosis.

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“…Recent studies try to differentiate preoperatively AUA from ACA, since the treatment for AUA is safe and can be non-operative, while the treatment of ACA is more complicated, especially in children younger than three years, as it is reported that the perforation rate of acute appendicitis is 80–100% for them, while it is approximately 38% in older children [ 28 ]. The accurate diagnosis of AA has been improved by using various scores [ 14 ]. However, it is still a challenge, especially in children, to predict preoperatively complicated appendicitis in order to decide the right management.…”

Section: Discussionmentioning

confidence: 99%

“…The latter has been created not only to overcome the Alvarado score and PAS, but also to predict the severity of AA and the perforated appendicitis, including the C-reactive protein value (CRP) in the predictive score [ 2 ]. However, according to the literature, none of the aforementioned scoring systems may be used exclusively in establishing the diagnosis of AA in pediatric patients, and furthermore, some multicentric studies have evaluated the scores and found that none of the scores provides ideal PPV to be used in clinical practice as the method of choice for determination of the need for surgery [ 2 , 14 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score)

et al. 2023

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Background: This retrospective study aimed to combine the clinical signs, laboratory values, and ultrasound images of 199 children with acute appendicitis in order to create a new predictive score for complicated appendicitis in children. Methods: The study included children who had clinical examination of abdominal pain (description of pain, anorexia, body temperature, nausea or vomiting, duration of symptoms), laboratory findings on admission (white blood cell, platelets, neutrophils, C-reactive protein), preoperative abdominal ultrasound, and histopathological report after an operation for appendicitis in their records during the period from January 2016 to February 2022. Results: According to the statistical analysis of the values using multivariate logistic regression models, the patients with appendiceal diameter ≥ 8.45 mm, no target sign appearance, appendicolith, abscess, peritonitis, neutrophils ≥ 78.95%, C-reactive protein ≥ 1.99 mg/dL, body temperature ≥ 38 °C, pain migration to right lower quadrant, and duration of symptoms < 24 h were more likely to suffer from complicated appendicitis. The new score was comprised of the 10 variables that were found statistically significant in the multivariate logistic model. Each of these variables was assigned a score of 1 due to the values that were associated with complicated appendicitis. Conclusions: A cutoff value of ≥4 has been a good indicator of the final score. The sensitivity with the usage of this score is 81.1%, the specificity 82.4%, the PPV 73.2%, the NPV approaches 88% and finally the accuracy is 81.9%. Also, the pros and cons of this score are discussed in this study.

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Comparison of Appendicitis Scoring Systems in Childhood Appendicitis

Cited by 10 publications

References 20 publications

Negative Appendectomy Rates -Current Prospective- A Review

Negative Appendectomy Rates -Current Prospective- A Review

The Significance of Combined Detection of Ultrasonography, Pediatric Appendicitis Score and C-reactive Protein in the Diagnosis and Pathological type of Acute Appendicitis in Children

Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score)

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