October 13, 2025

Three different appendicitis diagnostic scores in pediatric emergency department

Key Points

The Alvarado score showed the highest diagnostic accuracy for appendicitis in children aged 1–17, with a significance level of p < 0.001.
Among 254 children assessed, 53 were diagnosed with appendicitis, with older age significantly correlating with diagnosis and blood tests.
Ultrasound imaging was performed in 95% of cases, indicating its importance in appendicitis evaluations, often alongside clinical scoring systems.
This study underscores the need for reliable scoring systems like the Alvarado score to enhance appendicitis diagnosis in pediatric emergency departments.

Abstract

Aim: Acute abdominal pain is a frequent pediatric emergency department (PED) complaint, with appendicitis as the top surgical cause. Diagnosis is challeng¬ing, especially in young children with vague symptoms. In this study we aimed to examine the alignment of Alvarado, PAS scores, and ultrasound with final appendicitis diagnoses. Materials and Methods: We conducted a retrospective single-center study of children aged 1–17 presenting with abdominal pain to our PED in September 2018. Alvarado, PAS, and HAS scores were calculated, and their diagnostic accuracy was assessed using AUC analysis. Results: Of 254 children (52.8% female, mean age 9.26 ± 4.64 years), 53 were diagnosed with appendicitis. Blood tests were performed in ~50%, and 95% had an abdominal US. Appendicitis was more common in older children and significantly associated with leukocytosis, neutrophilia, and CRP >60 mg/L. The Alvarado score showed a significant association (p < 0.001) and highest AUC (0.612), while PAS and HAS had slightly lower AUCs and were not statistically significant. Conclusions: Among clinical scoring systems, the Alvarado Score demonstrated the strongest, though moderate, predictive value for diagnosing appendicitis in this population.

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