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Eur J Pediatr Surg 2022; 32(02): 198-205
DOI: 10.1055/s-0041-1722860
Original Article

Diagnostic Value of Clinical Prediction Scores for Acute Appendicitis in Children Younger than 4 Years

Ricardo Rassi
1   Department of Pediatric Surgery, Clínica del Sol, Córdoba, Argentina
2   Department of Pediatric Surgery, Hospital Infantil Municipal, Córdoba, Argentina
,
Florencia Muse
2   Department of Pediatric Surgery, Hospital Infantil Municipal, Córdoba, Argentina
,
José Sánchez-Martínez
2   Department of Pediatric Surgery, Hospital Infantil Municipal, Córdoba, Argentina
3   Department of Pediatric Surgery, Hospital Raúl A. Ferreyra, Córdoba, Argentina
,
Eduardo Cuestas 
4   Department of Pediatrics and Neonatology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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Abstract

Introduction Acute appendicitis can be difficult to diagnose, especially in children < 4 years old. The aim of the present study was to assess the diagnostic value of Alvarado score (AS), appendicitis inflammatory response (AIR) score, and pediatric appendicitis score (PAS) in children younger than 4 years.

Materials and Methods All children younger than 4 years who underwent appendicectomy between 2005 and 2019 were included retrospectively. The diagnostic performance of the scores was analyzed using the area under the receiver-operating characteristic (ROC) curve and by calculating the diagnostic performances at optimal criterion value cutoff points.

Results In this study, 100 children were included (58 boys and 42 girls) with a median age of 39.5 (12–47) months. Ninety children were diagnosed with pathologically proven acute appendicitis. The area under ROC curve of AS was 0.73, AIR score was 0.79, and PAS was 0.69 (p > 0.05, respectively). In children with low risk of acute appendicitis, negative predictive values were 75.0% for AS, 50.0% for AIR score, and 66.7% for PAS (p < 0.05, respectively). The positive predictive values in children with high risk of acute appendicitis were of 92.7% for AS, 92.6% for AIR score, and 93.6% for PAS (p > 0.05, respectively). AS, AIR score, and PAS plus positive ultrasonography have 0.58, 0.49, and 0.88 area under ROC curve.

Conclusion The three scores can be of assistance in the suspicion of acute appendicitis. PAS markedly improved combined with positive ultrasonography, but none can be used in setting the diagnosis of acute appendicitis in young children.

Keywords

appendicitis - diagnosis - clinical prediction scores - preschool children


Publication History

Received: 24 October 2020

Accepted: 09 December 2020

Article published online:
07 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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