Validity of paediatric appendicitis score in C hinese population: A prospective study

• Published in: Surgical practice Vol. 20; no. 3; pp. 114 - 118
• Main Authors: Chung, KLY, Wong, SYS, Liu, CSW, Tang, PMY, Chao, NSY, Liu, KKW, Leung, MMY
• Format: Journal Article
• Language: English
• Published: 01.08.2016
• ISSN: 1744-1625; 1744-1633
• DOI: 10.1111/1744-1633.12195

Aim Paediatric appendicitis score (PAS) was described to improve the clinical diagnostic accuracy of paediatric appendicitis. The present study aimed to prospectively evaluate the validity of PAS in a Chinese population. Patients and Methods From 2011 to 2012, consecutive patients aged 4–18 years admitted with acute, right‐sided abdominal pain lasting less than 7 days were enrolled. PAS was calculated on admission by surgical residents, from eight components, with a maximum score of 10. Clinical outcomes were assessed prospectively, with follow up for those discharged without operation. Results Sixty‐four children were recruited. Twenty‐two patients (34.4 per cent) underwent appendectomy. Eight patients with PAS ≤2 were managed conservatively and discharged without additional radiological investigations. Twelve patients had PAS ≥7, of which 11(92 per cent) had an appendectomy performed; 10 were confirmed appendicitis on histology. One patient with PAS =7 was managed conservatively and discharged uneventfully. Of the 44 patients with PAS =3–6, 18 (36.4 per cent) underwent sonogram or computed tomography. Eleven patients (25 per cent) with PAS =3–6 had an operation performed, and all histology confirmed appendicitis. For the accuracy of PAS in diagnosing appendicitis, the area under the receiver‐operating characteristic curve was 0.883 (95 per cent confidence interval: 0.798, 0.968, P < 0.05). To diagnose appendicitis at cut‐off PAS ≥7, the sensitivity was 0.48, specificity was 0.95 and the positive predictive value was 0.83. The negative predictive value at cut‐off PAS ≤2 was 1.00. The overall negative appendectomy rate was 4.5 per cent. Conclusion The PAS is a simple diagnostic tool that only requires basic physical examination skills with objective laboratory results. It does not replace clinical judgments and decision for operation, but can assist in the decision‐making process, especially in the general clinic or emergency department, or for relatively inexperienced surgical residents. PAS ≥7 cut‐off has high validity for predicting appendicitis, and PAS ≤2 rules out appendicitis. Children with PAS =3–6 might warrant further evaluation with repeat clinical and/or radiological assessments.