Predictive Value of Alvarado Score and Pediatric Appendicitis Score in the Success of Nonoperative Management for Simple Acute Appendicitis in Children

Abstract

Introduction During the past decade, nonoperative management (NOM) for simple acute appendicitis (SAA) in children has been proven safe with noninferior complications rate. The aim of this study was to examine Alvarado score and pediatric appendicitis score (PAS) together with other factors in predicting failure of NOM in children presenting with SAA. Materials and Methods Patients aged 5 to 18 years admitted to our department between 2017 and 2019 diagnosed with SAA were given a choice between surgical management and NOM. We divided the NOM patients into two groups: successful treatment and failed NOM, comparing their files for Alvarado score and PAS and other clinical and demographic factors, with a mean follow-up of 7 months. Failure was determined as need for appendectomy following conservative treatment due to any reason. Results A total of 85 patients answered criteria and chose NOM. Overall failure rate was 32.9%. We found no difference in the mean Alvarado score and PAS as well as in each component of both scores between success and failed NOM groups. However, when using the risk classification of the scores, we found a significant correlation between high-risk Alvarado score and failed NOM. After adjusting for age, gender, duration of symptoms, diagnosis of tip appendicitis, and presence of appendicolith, the odds of failure were four times higher among high-risk Alvarado group. Conclusion Alvarado score of 7 or higher, older age, and diagnosis of an appendicolith on imaging are possible predictors for failure of NOM for SAA in children.

Predicting the Severity of Acute Appendicitis in Children Using Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR)

“…These markers (NLR and PLR) can both be easily calculated from the complete blood count (CBC) differential, thus are inexpensive markers. This has practical implications for ease of use and avoids reliance on more complex scoring systems which usually require reference to online calculators or text-based scoring systems [6,8,9]. However, the sensitivity and its specificity can differ significantly depending on the time the test was conducted.…”

“…Numerous scoring methods to help in the quick clinical diagnosis and categorization of acute appendicitis have been developed, such as the Alvarado score, pediatric appendicitis score (PAS), the appendicitis inflammatory response (AIR), and Shera score [6,[8][9][10]. Although each of these scores differs in their utilized clinical parameters, the overdiagnosis of appendicitis is 32% by PAS and 35% by the Alvarado score [11].…”

The importance of physician speciality on the diagnosis of acute appendicitis and its effect on morbidity in children

“…Therefore, the most important method in diagnosis is the physician's serial physical examinations. [3][4][5][6] The gold standard in the treatment of AA is appendectomy. However, the risk of unnecessary exploration (due to negative appendectomy) increases in patients whose diagnosis is not made correctly.…”

The Gut Microbiota and Inflammatory Factors in Pediatric Appendicitis

“…The AA attack is more common among children from 10 to 19 years old [ 4 ]. Antibiotics have still been the appropriate first-line therapy for patients, with uncomplicated appendicitis compared to surgery [ 5 , 6 ]. The occurrence of appendicitis was correlated to the metabolic disorder induced by abnormal bacterial colonization, suggesting that bacterial infection has been involved in the pathophysiology [ 1 , 6 ].…”