Scoring system identifies appendicitis in pediatric acute abdomen pain

By Lauretta Ihonor

Using a pediatric appendicitis score (PAS) may help to identify true cases of appendicitis among children who present to emergency departments (EDs) with acute abdominal pain, researchers report.

"In our study, there were no patients diagnosed with appendicitis with a PAS of 3 or lower," explain Roberto Zúñiga (Teaching Hospital Río Hortega, Valladolid, Spain) and co-investigators.

They suggest that use of the PAS system in EDs may allow patients with a score of 3 or lower to be discharged without additional imaging or observation.

Zúñiga and colleagues emphasize, however, that "before discharge, it is very important to explain to the parents about the need for requesting for medical attendance in the next 6 and 23 hours if the symptoms do not disappear because, once 23 hours have passed, the risk of perforation rises significantly."

Assessment of the diagnostic use of the PAS system also revealed that a score of 8 or higher was associated with a positive appendicitis diagnosis and a need for appendectomy. A PAS between 4 and 7 was found to be diagnostically inconclusive.

In light of this, the researchers recommend that patients with such PAS scores should undergo abdominal imaging before a firm diagnosis is made.

These observations were made following the use of the PAS system among a group of 101 children (55 boys and 46 girls) with a mean age of 9.5 years. All presented to an ED with suspected appendicitis.

A diagnosis of acute appendicitis was made in 28 patients, adenitis in eight patients, nonspecific abdominal pain in 51 patients, gastritis in five patients, viral infection in four patients, and urinary tract infection, gastroenteritis, or ileitis among the remaining children.

The mean PAS was 7.43 among children diagnosed with appendicitis. This score was noticeably lower than the mean PAS of 4.97 observed among those without appendicitis.

Using a PAS of 8 or more as a cutoff for surgical intervention was associated with a false positive rate of 4.95%, highlight Zúñiga and team in Pediatric Emergency Care.

They conclude that, although PAS should not be used as a sole diagnostic method, "the application of this score at the ED might be helpful in making a decision and in better using resources, especially when identifying patients at low risk of appendicitis, hence avoiding the performance of unnecessary tests."

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