Alvarado vs. Pediatric Appendicitis Score (PAS) in Acute Appendicitis of Children
Iranian Journal of Pediatric Surgery,
Vol. 6 No. 1 (2020),
11 August 2020
,
Page 1-9
https://doi.org/10.22037/irjps.v6i1.31696
Abstract
Introduction: Acute appendicitis in children is associated with morbidity and mortality due to late diagnosis. Several scoring systems, such as Alvarado and PAS have been developed to help diagnose acute appendicitis in children to make the most accurate and prompt decision. The purpose of this study was to compare the efficacy and diagnostic value of these scoring systems.
Materials and Methods: In this cross-sectional study, 130 children aged 5-14 with suspected acute appendicitis were included. After the collection of demographic data, all patients were scored by Alvarado and PAS systems. The decision for surgery was made by a surgeon, independently of these scores. The diagnosis of acute appendicitis was affirmed by surgical and pathologic findings.
Results: Male: Female ratio was 1.32:1, and the average age of the patients were 9.2±2.7 years. The mean Alvarado and PAS scores were higher in patients with positive pathologic findings. Neutrophilia >75% and RLQ tenderness had the highest relationship with the diagnosis of the disease. The diagnostic value of Alvarado was higher than PAS concerning the area under the ROC curve. The cutoff point of 7 was associated with a sensitivity of 74.5% and specificity of 66.7% for the Alvarado score, and a sensitivity of 58.5% and specificity of 79.2% for the PAS score.
Conclusions: The results showed the high sensitivity of Alvarado and the high specificity of PAS. However, the sensitivity, specificity, PPV, and NPV of these criteria were not satisfactory for the confirmation of the diagnosis.
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References
Sivit CJ, Siegel MJ, Applegate KE, et al: When appendicitis is suspected in children. Radiographics 2001;21(1):247-62.
Glass CC, Rangel SJ, editors: Overview and diagnosis of acute appendicitis in children. Seminars in pediatric surgery; 2016: Elsevier.
Smink DS, Finkelstein JA, Kleinman K, et al: The effect of hospital volume of pediatric appendectomies on the misdiagnosis of appendicitis in children. Pediatrics 2004;113(1):18-23.
Mallick MS: Appendicitis in pre-school children: a continuing clinical challenge. A retrospective study. International Journal of Surgery 2008;6(5):371-3.
Lee SL, Stark R, Yaghoubian A, et al: Does age affect the outcomes and management of pediatric appendicitis? Journal of pediatric surgery 2011;46(12):2342-5.
Pogorelic Z, Rak S, Mrklic I, et al: Prospective validation of Alvarado score and Pediatric Appendicitis Score for the diagnosis of acute appendicitis in children. Pediatric emergency care 2015;31(3):164-8.
Macco S, Vrouenraets BC, de Castro SMM: Evaluation of scoring systems in predicting acute appendicitis in children. Surgery 2016;160(6):1599-604.
Alvarado A: Improved alvarado score (MANTRELS) for the early diagnosis of acute appendicitis. Int J Surg Res Pract 2019;6:98.
Mandeville K, Pottker T, Bulloch B, et al: Using appendicitis scores in the pediatric ED. The American journal of emergency medicine 2011;29(9):972-7.
Nishizawa T, Maeda S, Goldman RD, et al: Predicting need for additional CT scan in children with a non-diagnostic ultrasound for appendicitis in the emergency department. The American journal of emergency medicine 2018;36(1):49-55.
Shah SR, Sinclair KA, Theut SB, et al: Computed tomography utilization for the diagnosis of acute appendicitis in children decreases with a diagnostic algorithm. Annals of surgery 2016;264(3):474-81.
Kulik DM, Uleryk EM, Maguire JL: Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. Journal of clinical epidemiology 2013;66(1):95-104.
Alvarado A: A practical score for the early diagnosis of acute appendicitis. Annals of emergency medicine 1986;15(5):557-64.
Bhatt M, Joseph L, Ducharme FM, et al: Prospective validation of the pediatric appendicitis score in a Canadian pediatric emergency department. Academic Emergency Medicine 2009;16(7):591-6.
Goldman RD, Carter S, Stephens D, et al: Prospective validation of the pediatric appendicitis score. The Journal of pediatrics 2008;153(2):278-82.
van Amstel P, Gorter RR, van der Lee JH, et al: Ruling out Appendicitis in Children: Can We Use Clinical Prediction Rules? Journal of Gastrointestinal Surgery 2019;23(10):2027-48.
Samuel M: Pediatric appendicitis score. Journal of pediatric surgery 2002;37(6):877-81.
Hsiao KH, Lin LH, Chen DF: Application of the MANTRELS scoring system in the diagnosis of acute appendicitis in children. Acta paediatrica Taiwanica= Taiwan er ke yi xue hui za zhi 2005;46(3):128-31.
Schneider C, Kharbanda A, Bachur R: Evaluating appendicitis scoring systems using a prospective pediatric cohort. Annals of emergency medicine 2007;49(6):778-84. e1.
Tan E, Severijnen R, Rosman C, et al: Diagnosis and treatment of acute appendicitis in children: a survey among Dutch surgeons and comparison with evidence-based practice. World journal of surgery 2006;30(4):512-8.
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