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
