Prospective Validation of the Pediatric Appendicitis Score and Integration of Ultrasound Findings

Abstract

Background & Objective: Acute appendicitis is the most common surgical emergency during childhood. Accurate early diagnosis is important to avoid complications and unnecessary interventions. The aim of this study is to prospectively validate the Pediatric Appendicitis Score (PAS) and Integrate it with ultrasound findings in making the diagnosis.

Materials & Methods: a prospective observational study for children who presented to the emergency department in University Children's Hospital in Damascus experiencing abdominal pains with suspected appendicitis is in the primary differential diagnosis. They either had an appendectomy in the surgery department or had been discharged with telephone follow up, between 1/12/2018 and 30/11/2019.

Results: 357 children had been included in the study, 162 (45.38%) had pathology-proven appendicitis and 195 (54.62%) did not. Mean PAS for children with appendicitis was 8.12 with standard deviation of 1.563 and range between 3-10, Mean PAS for children without appendicitis was 4.74 with standard deviation of 2.097 and range between 0-10. The score’s performance improved when two cut-points were used as: PAS £ 4 to discharge patients without further investigation, with high sensitivity 98.8%, 2 missed cases 1.2% and NPV of 97.8%.  PAS ³ 8 to perform appendectomy without further investigation, with specificity of 92.3%, 15 negative appendectomy 12% and PPV of 88%. Depending on ultrasound alone in making the diagnosis had sensitivity of 81.48% and specificity of 58.46%, but after integrate it with PAS it had no actual benefit.

Conclusion: The PAS is a useful tool in making the diagnosis after using two cut-points £ 4 to rule out appendicitis, ³ 8 to diagnose it. It is possible to dispense using ultrasound in these two groups which mean reduction in its use by 60.2%.