Pediatric appendicitis score: A retrospective analysis

Goulder, Frances; Simpson, Thomas

doi:10.4103/0971-9261.44761

Cited by 15 publications

(12 citation statements)

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“…Management of children diagnosed of acute appendicitis involves a number of protocols which is mainly subject to the level of complications involved at the time certainty was established. Typically, children suspected of having acute appendicitis are immediately placed on admission for a close or active monitoring and clinical examinations in addition to scoring systems depending on the myriad of the symptoms presented so as to minimize misdiagnosis . Open appendectomy is the most common approach for children but advanced minimally invasive technique such as laparoscopy is now being introduced by skilled surgeons .…”

Section: Discussionmentioning

confidence: 99%

“…Typically, children suspected of having acute appendicitis are immediately placed on admission for a close or active monitoring and clinical examinations in addition to scoring systems depending on the myriad of the symptoms presented so as to minimize misdiagnosis. 25,26 Open appendectomy is the most common approach for children but advanced minimally invasive technique such as laparoscopy is now being introduced by skilled surgeons. 27 Subsequent recuperation devoid of events with appropriate fluid resuscitation and antibiotic administration, a smooth and full recovery is the eventual outcome.…”

Section: Discussionmentioning

confidence: 99%

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Sepsis after non‐perforated acute appendicitis

Faraji-Goodarzi

2019

Clinical Case Reports

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Key Clinical Message Appendicitis is a worm‐like appendage whose base is located on the posterior side of the inner cecum. Acute appendicitis is uncommon in children younger than 5 years old. The patient was a 1.5‐year‐old boy who was admitted to the hospital with a primary complaint of fever, diarrhea, and vomiting. A pathological report of acute puffiness appendicitis with peri appendicitis was confirmed. After two weeks of treatment, the patient was discharged with an good general condition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sepsis after non‐perforated acute appendicitis

Faraji-Goodarzi

2019

Clinical Case Reports

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“…When it was initially derived in 2002, the PAS showed a sensitivity of 100% and a specificity of 92% for acute appendicitis using a single cutoff of 6; however, several validation studies were unable to reproduce these test characteristics . Subsequently, improved sensitivity and specificity were found when two cutoffs were used, thereby dividing patients into high‐, moderate‐, and low‐risk clinical groups . For instance, for cutoffs of ≥7 the PAS specificity ranges from 82.4% to 98%, and for a cutoff of ≥8 of the PAS specificity ranges from 95.1% to 97.6% .…”

Section: Discussionmentioning

confidence: 99%

Utility of Pediatric Appendicitis Score in Female Adolescent Patients

Scheller

Depinet

et al. 2016

Academic Emergency Medicine

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Objectives: Acute appendicitis is common in the pediatric population and is difficult to diagnose in adolescent females. The validated Pediatric Appendicitis Score (PAS) has unclear utility in female adolescents. The purpose of this study is to determine the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the PAS for female adolescents compared to all other patients.Methods: This study examined a retrospective observational cohort of patients ages 3 to 21 years in a pediatric emergency department with prospectively assigned PAS from an existing database. We compared the sensitivity, specificity, PPV, and NPV of the PAS for acute appendicitis among female adolescent patients (13 to 21 years) and all other patients.Results: Of the 1,228 patients enrolled, 901 (73.4%) had a complete PAS. Among the 901 patients, 249 (27.6%) had pathology-proven appendicitis, 494 (54.8%) were female, and 272 (30.2%) were adolescent females. At a cutoff of ≥8, the PAS showed a specificity of 89% for adolescent females and 78% for all other patients (p < 0.001), although the specificities did not differ at a cutoff of ≥7. At both cutoffs, the PPVs were poor in both groups. At a cutoff of ≥3, the PAS showed similar sensitivities in both groups. At a cutoff of <3, the NPVs did not significantly differ between groups.Conclusion: At a cutoff of ≥8 (although not ≥7), the PAS demonstrated a higher specificity among female adolescents compared to all other patients. The PPV for both cutoffs in both groups were poor. At a cutoff of ≥3, sensitivities were equivalent. The NPV for a cutoff of <3 was acceptable but similar in both groups. While sensitivities were similar to previously reported, specificities in both groups were lower. This highlights the need for further investigation of the PAS's performance in specific subpopulations.ACADEMIC EMERGENCY MEDICINE 2016;23:610-615 © 2016 by the Society for Academic Emergency Medicine A cute appendicitis is a common surgical emergency seen in the pediatric population.1 Due to the presence of competing gynecologic diagnoses, it can be challenging to diagnose appendicitis in the female adolescent population.2 Negative appendectomies can both result in increased lengths of hospitalizations, infectious complications, and fatalities.3,4 The Pediatric Appendicitis Score (PAS) is a clinical prediction rule derived to aid in the diagnosis of pediatric appendicitis including components of physical examination such as right lower quadrant tenderness and laboratory findings such as white blood cell count

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“…Moreover, Goulder et al [17], in a study published in 2008, found that the PAS cannot be recommended as it would later lead to an unacceptable risk of high medical or surgical delays in up to 13% of patients with AA.…”

Section: Discussionmentioning

confidence: 99%

Clinical scores for prediction of acute appendicitis in children in a hospital of Lima, Perú

Guzmán¹,

García²

2014

Annals of Pediatric Surgery

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Objective To determine the usefulness of the Alvarado score and the Pediatric Appendicitis score (PAS) in the Pediatric Emergency of the National Hospital Daniel A. Carrion.Materials and methods A prospective observational study was carried out of patients younger than 15 years of age with abdominal pain and suspected acute appendicitis (AA) attending the Pediatric Emergency in a Hospital of Lima, Peru. These patients underwent a survey to assess the parameters of the Alvarado score and PAS.Results Three hundred and seventeen patients with abdominal pain and suspected of AA were recruited over a study period of 12 months. Of the patients, 232 were considered to have AA clinically and underwent surgery. 85.3% were confirmed by pathology and 14.7% were normal. The mean Alvarado score was 8.27 ± 1.31; the mean Surgical Procedure Assessment (SPA) score was 8.08 ± 1.47. Sensitivity and specificity for both scores are equivalent. The area under the curve for the Alvarado score and SPA were 0.887 and 0.901, respectively. Alvarado score higher than 6 had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 88.9, 75.6, 97.4, 68.1, and 86.4%, respectively. SPA higher than 6 points had sensitivity, specificity, PPV, NPV, and accuracy of 84.3, 80.7, 94.7, 73.1, and 86.7%, respectively. Conclusion Alvarado score and the PAS are scores with high sensitivity, specificity, PPV, and accuracy for the diagnosis of AA when the score is higher than 6 points. The results found in our study justify their use in emergency services, but they should not be used as the only means of clinically determining the need for surgery.

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Pediatric appendicitis score: A retrospective analysis

Cited by 15 publications

References 12 publications

Sepsis after non‐perforated acute appendicitis

Sepsis after non‐perforated acute appendicitis

Utility of Pediatric Appendicitis Score in Female Adolescent Patients

Clinical scores for prediction of acute appendicitis in children in a hospital of Lima, Perú

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