Validity of paediatric appendicitis score in Chinese population: A prospective study

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Abstract

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.

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