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A Clinical Score to Predict Appendicitis in Older Male Children
Anupam B Kharbanda1, Michael C Monuteaux2, Richard G Bachur2
1Department of Pediatrics Emergency Medicine, Children's Minnesota, Minneapolis.
Insights
A new clinical score accurately predicts appendicitis in older boys presenting to the emergency department. This tool may reduce the need for diagnostic imaging in some male patients with suspected appendicitis.
Area of Science:
- Pediatric Emergency Medicine
- Surgical Outcomes
- Clinical Diagnostics
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate diagnosis in older male children can be challenging, potentially leading to over- or under-utilization of diagnostic imaging.
- Developing reliable clinical prediction tools is crucial for optimizing patient management.
Purpose of the Study:
- To develop and validate a clinical scoring system for predicting appendicitis in male children aged 8-18 presenting with suspected appendicitis.
- To identify key clinical and laboratory predictors of appendicitis in this demographic.
Main Methods:
- A prospective cohort of 961 male patients aged 8-18 with suspected appendicitis was analyzed.
- Data on clinical presentation and laboratory results were collected.
- A multivariable model was used to identify significant predictors, and a clinical score was derived using beta-coefficients.
Main Results:
- The final model included maximum right lower quadrant tenderness, pain with ambulation/coughing/hopping, and absolute neutrophil count.
- A score of ≥8.1 demonstrated a sensitivity of 25% and a specificity of 98% for appendicitis.
- The positive predictive value for appendicitis was 93%, with a low negative appendectomy rate of 3%.
Conclusions:
- An accurate clinical scoring system for predicting appendicitis in older boys was developed.
- If validated, this score could potentially reduce the need for diagnostic imaging in a subset of male patients.
- This may lead to more efficient and targeted management of suspected appendicitis.
Objective:
To develop a clinical score to predict appendicitis among older, male children who present to the emergency department with suspected appendicitis.
Methods:
Patients with suspected appendicitis were prospectively enrolled at 9 pediatric emergency departments. A total of 2625 patients enrolled; a subset of 961 male patients, age 8-18 were analyzed in this secondary analysis. Outcomes were determined using pathology, operative reports, and follow-up calls. Clinical and laboratory predictors with <10% missing data and kappa > 0.4 were entered into a multivariable model. Resultant β-coefficients were used to develop a clinical score. Test performance was assessed by calculating the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios.
Results:
The mean age was 12.2 years; 49.9% (480) had appendicitis, 22.3% (107) had perforation, and the negative appendectomy rate was 3%. In patients with and without appendicitis, overall imaging rates were 68.6% (329) and 84.4% (406), respectively. Variables retained in the model included maximum tenderness in the right lower quadrant, pain with walking/coughing or hopping, and the absolute neutrophil count. A score ≥8.1 had a sensitivity of 25% (95% confidence interval [CI], 20%-29%), specificity of 98% (95% CI, 96%-99%), and positive predictive value of 93% (95% CI, 86%-97%) for ruling in appendicitis.
Conclusions:
We developed an accurate scoring system for predicting appendicitis in older boys. If validated, the score might allow clinicians to manage a proportion of male patients without diagnostic imaging.
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