Test characteristics of common appendicitis scores with and without laboratory investigations: a prospective observational study

Abstract

BackgroundDespite the poor independent test characteristics of the white blood cell count (WBC) and neutrophil count (NC) in identifying appendicitis, common clinical decision supports including the Pediatric Appendicitis Score (PAS) and Alvarado Score (AS), require the WBC and NC values. Moreover, blood tests cause discomfort/pain to children and require time for processing results. Scores based on clinical information alone may be of benefit in the pediatric population. The objective of our study was to determine the test characteristics of the PAS and the AS with and without laboratory investigations (mPAS, mAS respectively) as well as the Lintula Score.MethodsA prospective cohort study of children aged 5–17 years presenting to a pediatric ED with suspected appendicitis. Clinical care of the patient was left to the managing physician. At risk for appendicitis was defined by PAS ≥6; AS ≥5; LS ≥16, as originally described; modified cutoffs were defined as mPAS ≥4; mAS ≥4. Appendicitis was defined as acute inflammation, rupture or abscess of the appendix on pathologic evaluation. Test characteristics for each of the 5 scores were calculated.ResultsOf the 180 eligible children, 102 (56.7 %) were female. The average age was 11.2 years (SD 3.1). Appendectomy was performed in 58 (32.2 %) of children, 55 (94.8 %) were positive. For the PAS and mPAS, sensitivity and negative predictive values were similar (80.0 %, 86.4 % vs 87.3 %, 85.1 % respectively). For the AS and mAS, sensitivity and negative predictive values were also similar (85.5 %, 87.1 % vs 83.6 %, 83.3 % respectively). Specificities in the PAS, mPAS, AS and mAS were low (56.0 %, 32.0 %, 43.2 %, 63.0 % respectively). Test characteristics of the LS were poor (59.3 %, 79.2 %, 55.2 %, 81.8 %).ConclusionsA modified Alvarado and PAS can be used to screen for children at low risk of appendicitis who may be carefully observed at home without the need for laboratory investigation. Translation to primary care settings should evaluate generalizability and determine impact on referral patterns.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0687-6) contains supplementary material, which is available to authorized users.

Modified Alvarado Score in Children With Diagnosis of Appendicitis

“…PPV of MAS in our study was 87.7% which is significantly higher 36.0% in Khanafer et al study 6 . NPV was 51.2% in our report which was significantly lower than 83.6% in Khanafer et al study 6 .…”

“…In the study by Khanafer et al, sensitivity of MAS was 83.3% 6 . In the study by Macklin et al, sensitivity of modified Alvarado score ≥7 was 76.3 7 .…”

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

“…The weighted prevalence of AA was significantly (p < 0.001) higher in studies that used either “abdominal pain suspected of AA” or “right lower quadrant (RLQ) pain” as their inclusion criteria (19 studies, n = 7,510, AA prevalence = 42.8%, 95% CI = 41.7–43.9) compared to those that used “abdominal pain” or undifferentiated abdominal pain (two studies, n = 1,095, AA prevalence = 13.4%, 95% CI = 11.5–15.6).…”

“…Articles that only provided the final score with limited or no data on the variables were excluded . Twenty‐one studies were included in our review. The study selection process is shown in Figure .…”

Investigation of the Diagnostic Value of Neutrophil to Lymphocyte Ratio in Pediatric Appendicitis Cases

“…History and physical examination are still in the first line, but laboratory tests and imaging modalities are of great importance (5), because especially younger children have limitations in expressing themselves. Complete blood count (CBC) is in the first line of laboratory evaluation to diagnose appendicitis (6,7). White blood cell count (WBC) is studied well in the literature, but recently, there are several CBC parameters such as red blood cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) associated with the diagnosis of appendicitis (8)(9)(10)(11).…”