Comparison of Clinical Scores for The Diagnosis of Acute Appendicitis in Children Comparison of Alvarado and PAS for the diagnosis of acute appendicitis
Iranian Journal of Pediatric Surgery,
Vol. 12 No. 1 (2026),
20 May 2026
,
Page 25-39
https://doi.org/10.22037/irjps.v12i1.50468
Abstract
Introduction: Acute appendicitis (AA) is the most common surgical abdominal condition and the leading cause of acute abdomen in the pediatric population. It requires rapid diagnosis, and many clinical scoring systems have been developed to aid in the diagnosis of AA. These scoring systems represent simple, non-invasive, and readily available diagnostic tools. The most commonly used scoring systems in children are the Alvarado score (MANTRELS) and the Pediatric Appendicitis Score – PAS (Samuel). The aim of this study is the determine and compare the diagnostic value of clinical scoring systems (Alvarado and PAS) in pediatric acute appendicitis.
Materials and Methods: A retrospective study was conducted for the period from January 1, 2023, to December 31, 2024. The study included 182 patients diagnosed with AA who underwent surgery and were hospitalized at the Pediatric Surgery Clinic of the Clinical Center of the University of Sarajevo (CCUS).
Results: The average age of patients with appendicitis was 11 years, corresponding mostly to school-age children, while 13.7% of the 182 patients were under 6 years of age. Based on histopathological findings, higher score values generally indicated more severe forms of appendicitis (gangrenous and perforated), while lower values were most often associated with phlegmonous appendicitis. The highest diagnostic value of the scores was observed in the time interval of 6–12 hours from the onset of symptoms. ROC analysis results showed that neither the Alvarado nor the PAS score had significant discriminative power in this sample. The average value of both Alvarado and PAS scores was 9. A statistically significant positive correlation was found (rho = 0.986; p = 0.000**) between Alvarado and PAS variables in patients with appendicitis. A statistically significant difference was also observed between the values of the Alvarado and PAS scores (p = 0.046, p < 0.05).
Conclusion: Although easy to apply, the Alvarado and PAS scores cannot be considered the sole and exclusive method for deciding on surgical treatment. The diagnosis of acute appendicitis can be improved by combining scoring systems with radiological diagnostics.
- Acute appendicitis
- Pediatric scoring systems
- Alvarado score
- PAS score
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References
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