Evaluation of scoring systems in predicting acute appendicitis in children

Macco, Sven; Vrouenraets, B. C.; Castro, S. M. M. de

doi:10.1016/j.surg.2016.06.023

Cited by 51 publications

(47 citation statements)

References 26 publications

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“…Appendicitis scoring systems have been developed as a diagnostic tool to improve the decision-making process in patients with suspected acute appendicitis 20. In the current study, PAS score ≥5 was found to be the best cutoff point compatible with acute appendicitis, with a sensitivity of 95%, specificity of 84%, and an accuracy of 89%.…”

Section: Discussionmentioning

confidence: 61%

Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis

Sayed

Zeidan

Fahmy

et al. 2017

TCRM

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BackgroundDiagnosis of appendicitis in children is clinically challenging. Computed tomography (CT) is the gold standard for diagnosis; however, radiation exposure early in life is a concern with this technique. Therefore, in this study, we aimed to evaluate the diagnostic reliability of low-dose CT, pediatric appendicitis score (PAS), and abdominal ultrasound (US) in children with acute appendicitis, to reach a safe diagnosis.Patients and methodsThis retrospective study was conducted on 140 children who were admitted with clinically suspected acute appendicitis (45 with positive appendicitis and 95 children with negative appendicitis). Low-dose CT was performed, and PAS was retrospectively calculated for all subjects. US was initially performed for 38 subjects. All results were compared with the final diagnosis reached by an operative, histopathological analysis and follow-up.ResultsLow-dose CT showed a sensitivity, specificity, and accuracy of 97.8%, 100%, and 99.3%, respectively. At a cutoff value ≥5, PAS showed a sensitivity, specificity, and accuracy of 95%, 84%, and 89%, respectively. Abdominal US examination showed sensitivity, specificity, and accuracy of 55.6%, 85%, and 71%, respectively. Implementing Poortman’s model resulted in higher accuracy (92%) of US. There was a significant difference in accuracy between a low-dose CT and PAS on one side and between Poortman’s model and US examination on the other side. A diagnostic scheme was suggested using PAS as the excluding tool (PAS ≤2 send home and ≥7 send directly to operation) followed by US examination and reserving low-dose CT for inconclusive cases. This scheme would eliminate the use of CT for at least 33.7% and in 7 cases who had initial US examination.ConclusionAlthough CT remains the most accurate and less operator-dependent diagnostic tool for pediatric appendicitis, the radiation hazards could however be minimized using PAS as an excluding tool and US as the primary imaging modality followed by low-dose CT for inconclusive cases only.

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Section: Discussionmentioning

confidence: 61%

Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis

Sayed

Zeidan

Fahmy

et al. 2017

TCRM

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“…We decided to exclude retrospective studies from our review. All of these studies had issues related to reliability of their retrospectively abstracted data.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

Benabbas

Hanna

Shah

et al. 2017

Academic Emergency Medicine

167

101

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Presence of AA is more likely in patients with undifferentiated abdominal pain migrating to the RLQ or when cough/hop pain is present in the physical examination. Once AA is suspected, no single history, physical examination, laboratory finding, or score attained on PAS can eliminate the need for imaging studies. Operating characteristics of ED-POCUS are similar to those reported for RUS in literature for diagnosis of AA. In ED patients suspected of AA, a positive ED-POCUS is diagnostic and obviates the need for CT or MRI while negative ED-POCUS is not enough to rule out AA.

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“…Only a few scores have been validated in interventional or randomized studies. The Appendicitis Inflammatory Response (AIR) score ( Table S1, supporting information) has outperformed the more widespread Alvarado score in internal and external validation studies.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis

Andersson

Kołodziej

Andersson

2017

British Journal of Surgery

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Evaluation of scoring systems in predicting acute appendicitis in children

Cited by 51 publications

References 26 publications

Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis

Diagnostic reliability of pediatric appendicitis score, ultrasound and low-dose computed tomography scan in children with suspected acute appendicitis

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis

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