EP.FRI.101 Paediatric Appendicitis Score (PAS): A local trial of a risk prediction pathway

Introduction Right iliac fossa (RIF) pain remains the commonest acute general surgical presentation in children. Our centre had been an outlier compared with the national average in terms of negative appendicectomy rates. Thus, we designed and implemented a local pathway for risk stratification and management of children with RIF pain. Methods The first phase was a retrospective analysis of all appendicectomies performed between April 2018 and March 2019, in children aged five to seventeen years old. Pre-operative inflammatory markers, clinical signs, and histology findings were analyzed. Second phase involved designing a pathway utilizing Paediatric Appendicitis Score (PAS), a ten-point scoring system when assessing children with RIF pain. The final phase was a prospective analysis of appendicectomy results performed between August and November 2019, after implementing PAS pathway. Results 92 cases were recruited in the first phase (mean age 12.3). 22 cases were analyzed in the final phase after implementing PAS pathway (mean age 10.9). Our negative appendicectomy rates had reduced from 25% to 15.4%. In addition, we found that 96% of positive appendicectomies had either raised inflammatory markers (WCC or CRP), raised PAS (Score of ≥ 4), or both. Conclusion There is noticeable difference in our negative appendicectomy rates since the introduction of PAS pathway. A diagnosis of appendicitis in a child with normal inflammatory markers and PAS score seemed unlikely. Our goal is to continue utilizing the PAS pathway in our department in order to reduce unnecessary surgeries in children.

774 Paediatric Appendicitis Score (PAS): A Local Trial of a Risk Prediction Pathway

Aim Right iliac fossa (RIF) pain remains the commonest acute general surgical presentation in children. Our centre had been an outlier compared with the national average in terms of negative appendicectomy rates. Thus, we designed and implemented a local pathway for risk stratification and management of children with RIF pain. Method The first phase was a retrospective analysis of all appendicectomies performed between April 2018 and March 2019, in children aged five to seventeen years old. Pre-operative inflammatory markers, clinical signs, and histology findings were analysed. Second phase involved designing a pathway utilizing Paediatric Appendicitis Score (PAS), a ten-point scoring system when assessing children with RIF pain. The final phase was a prospective analysis of appendicectomy results performed between August and November 2019, after implementing PAS pathway. Results 92 cases were recruited in the first phase (mean age 12.3). 22 cases were analysed in the final phase after implementing PAS pathway (mean age 10.9). Our negative appendicectomy rates had reduced from 25% to 15.4%. In addition, we found that 96% of positive appendicectomies had either raised inflammatory markers (WCC or CRP), raised PAS (Score of ≥ 4), or both. Conclusions There is noticeable difference in our negative appendicectomy rates since the introduction of PAS pathway. A diagnosis of appendicitis in a child with normal inflammatory markers and PAS score seemed unlikely. Our goal is to continue utilizing the PAS pathway in our department in order to reduce unnecessary surgeries in children.

Comparison of Alvarado Score and Paediatric Appendicitis Score for Diagnosing Appendicitis in Children

Objective: To compare diagnostic accuracy of Alvarado score (AS) and Paediatric Appendicitis Score (PAS) for diagnosis of acute appendicitis in children. Methods: This study was conducted at the department of Pediatric Surgery Children Hospital Lahore, over a period of 1 year. All the patients undergoing appendicectomy were included. Alvarado score and Pediatric Appendicitis score (PAS) was evaluated, compared and appendix specimen sent for histopa-thology. All findings were recorded in proforma. The collected data was analyzed by SPSS version 24. The mean Alvarado score and PAS was calculated, and stratified according to the histopathology reports. The sensitivity and specificity of both Alvarado score and PAS for three strata including score 3-5, 5-7 and 8-10 were also calculated. Results: A total of 177 patients were included in the study. The mean age of the patients was 9.16 ± 2.386 years. Among these 118 patients (67%) were male. The mean duration of pain was 21.42 ± 19.05 hours. Biopsy report showed that 18 patients (10.1%) had normal appendix with no signs of inflammations while 159 patients (89.9%) had inflammation on histopathology. We stratified the histopathology reports according to Alvarado score ≤7 and >7 and P-value was found significant. Similarly PAS ≤7 and >7 was stratified and P-value was not significant. The difference in mean Alvarado score between having acute appendicitis and those with normal histopathology was significant (P= 0.000) while this difference in mean PAS was not found significant (P= 0.325). Conclusions: None of the scoring system has adequate diagnostic accuracy and clinical judgment is preferred. Key Words: Alvarado Score; PAS; Appendicitis; Children How to cite: Liaqat N., Iqbal A., Rehman ur W., Ahmed Z., Bashir F., Dar H.S. Comparison of Alvarado score and Paediatric Appendicitis Score for diagnosing appendicitis in children” Esculapio 2021;17(02):175-178.

Comparison of Alvarado score and pediatric appendicitis score for clinical diagnosis of acute appendicitis in children—a prospective study

Background Acute appendicitis is the most common surgical condition of children. Differential diagnosis of an acutely inflamed appendix in children includes a vast variety of diseases which can present with the same symptoms and signs as acute appendicitis. It is an important factor for delay in diagnosis. Many scoring systems are being used to reach a diagnosis within time and to reduce the rate of negative appendectomies. The purpose of this study was to compare both scoring systems (Alvarado and pediatric appendicitis scoring system) and to know which one is better to establish an early correct diagnosis of acute appendicitis in pediatrics, thus decreasing the morbidity and burden on hospital resources. Although many studies had been completed at the international level for comparing both of these scoring systems, the pediatric population in our region was still awaiting such an effort. So a prospective cohort study was designed. A total of 180 patients were recruited with 95% confidence level and 5% margin of error. Every enrolled patient was awarded clinical scores according to both the Alvarado scoring system and the pediatric appendicitis scoring system. Patients having a score of 7 or more by both scoring systems were considered “seven or more than seven group” and their appendectomies were performed and histopathology reports were reviewed. Patients having a score of 7 in one system and less than 7 in the other/both were considered “less than seven group” and were admitted in the ward for further clinical evaluation and observation. Results At cutoff 7, the Alvarado score showed a sensitivity of 85.5%, specificity of 70%, PPV of 96.5%, NPV of 33.3%, and diagnostic accuracy of 84.11% while the pediatric appendicitis score showed a sensitivity of 93.8%, specificity of 70%, PPV of 96.8%, NPV of 53.8, and diagnostic accuracy of 91.59%. Conclusion The pediatric appendicitis score (PAS) is superior in diagnosing acute appendicitis in the pediatric population than the Alvarado score as indicated by the values of diagnostic accuracy. So it can be a good diagnostic tool for pediatric patients presenting with clinical symptoms and signs of appendicitis.

Pediatric Appendicitis Score in differential diagnosis of acute nonspecific abdominal pain in children: age matters

Acute nonspecific abdominal pain in children is the most common problem requiring differential diagnosis with acute appendicitis. Scales for integrated assessment of individual symptoms and their combinations have been proposed and are constantly being developed that allow predicting the likelihood of acute appendicitis. Purpose to assess diagnostic value of Pediatric Appendicitis Score (PAS) in groups of children in different ages. Materials and methods. 374 children aged 4 to 15 years with acute abdominal pain were evaluated in prospective randomized blinded study. Statistical analysis: ROC – curves, specificity and sensitivity, positive and negative predictive values; Kullback criteria; logistic regression analysis; discriminant analysis. Results. Detection frequency and diagnostic significance of the PAS scale predictors as well as obtained results by using the Pediatric Appendicitis Score depend on children age significantly. In terms of diagnosis of acute appendicitis, the PAS scale shows the best results in older children. Conclusions. Results of Pediatric Appendicitis Score depend on children ages due to different diagnostic value of predictors used in the PAS scale. Pediatric surgeons should keep in your mind these data. Modification of the scale is required taking into account the patient’s age. Further analysis of the issue of PAS using is needed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: acute appendicitis, children, diagnosis, PAS scale.

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

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.