Key result
The Alvarado and Pediatric Appendicitis Scores provided acceptable prediction of appendicitis, with sensitivities of 84% and 85% and specificities of 92% at a 7-point threshold.
Why the study?
To determine whether classification systems for acute appendicitis applied in the emergency department could indicate the need for surgical consultation and reduce unnecessary paediatric surgery admissions.
Do the Alvarado Score and Pediatric Appendicitis Score accurately predict acute appendicitis in children with abdominal pain?
Observational (n=307)
Do the Alvarado Score and Pediatric Appendicitis Score accurately predict acute appendicitis in children with abdominal pain?
The Alvarado Score and Pediatric Appendicitis Score provide acceptable diagnostic prediction for acute appendicitis in children and may help reduce unnecessary surgical consultations and admissions.
Supports diagnostic utility of ALS/PAS in pediatric abdominal pain; leaves open prospective validation before changing referral patterns.
AIM: This study examined if the classification systems for acute appendicitis could be applied in the emergency department as an indicator for surgical consultation, in order to reduce unnecessary paediatric surgery admission. METHODS: The Alvarado Score (ALS) and the Pediatric Appendicitis Score (PAS) were applied. The decisions for hospitalisation and treatment were made independent of the scores. RESULTS: In total, 307 children with abdominal pain suggestive of acute appendicitis were included. We used a cut-off point of 7 and divided the patients into groups; the group with score ≥ 7 points was considered the positive ALS and/or PAS group, and the group with score < 7 points was the negative ALS and/or PAS group. The same process for cut-values set at 6 points was followed. The joint probabilities for the 7-point-thresholds were: ALS-sensitivity 84%, PAS-sensitivity 85%, ALS-specificity 92%, PAS-specificity 92%, ALS-positive predictive value (PPV) 83%, PAS-PPV 84% and 93% negative predictive value (NPV) for both scores. Considering the 6-point-thresholds, we estimated: 94% sensitivity for both scores, 74% ALS-specificity, 84% PAS-specificity, 66% ALS-PPV, 73% PAS-PPV, 91% ALS-NPV and 97% PAS-NPV. CONCLUSION: The scoring systems provided acceptable prediction of patients with and without appendicitis. They may be of use in the emergency department, as assistive diagnostic-tools, in order to reduce paediatric surgery consultations, admissions and treatment costs.
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Kaselas et al. (2022) conducted an observational in Abdominal pain suggestive of acute appendicitis (n=307). Alvarado Score (ALS) and Pediatric Appendicitis Score (PAS) was evaluated on Diagnostic accuracy (sensitivity, specificity, PPV, NPV) for acute appendicitis. The Alvarado and Pediatric Appendicitis Scores provided acceptable prediction of appendicitis, with sensitivities of 84% and 85% and specificities of 92% at a 7-point threshold.
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