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A new clinical score to identify children at low risk for appendicitis
J Benito1, S Fernandez1, M Gendive1
1Pediatric Emergency Department, BioCruces Bizkaia Health Research Institute, Bilbao, Basque Country, Spain.
Insights
A new Pediatric Appendicitis Laboratory Score (PALabS) accurately identifies children with low risk of acute appendicitis. This score combines clinical signs with biomarkers, enabling safe observation for low-risk pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Diagnostics
- Biomarker Research
Background:
- Biomarkers are increasingly vital for diagnosing acute appendicitis (AA) alongside clinical signs and imaging.
- Developing accurate diagnostic tools for pediatric AA remains a clinical challenge.
Purpose of the Study:
- To develop and validate a novel clinical score incorporating biomarkers for identifying children at low risk of AA.
- To improve the diagnostic accuracy for acute appendicitis in pediatric patients presenting with abdominal pain.
Main Methods:
- Prospective enrollment of children aged 2-14 with abdominal pain suggestive of AA.
- Development of the Pediatric Appendicitis Laboratory Score (PALabS) using clinical data, white blood cell (WBC) count, neutrophil (ANC) count, C-reactive protein (CRP), and calprotectin (CP) levels.
- Validation of the PALabS using two distinct pediatric emergency department cohorts.
Main Results:
- The PALabS, comprising 6 components (nausea, focal right lower quadrant pain, ANC, WBC, CRP, CP), demonstrated high discriminatory power (AUC: 0.88).
- The score outperformed existing appendicitis scores (PAS, Kharbanda).
- A PALabS ≤6 indicated low risk, with 99.2% sensitivity and 97.6% negative predictive value in the validation cohort.
Conclusions:
- The developed PALabS accurately identifies children at low risk for appendicitis.
- This score supports the safe management of low-risk pediatric patients with acute abdominal pain through close observation.
Background:
Besides clinical signs and imaging, in recent years, biomarkers have proven to be a viable diagnostic resource for acute appendicitis (AA).
Objective:
The objective of this study was to develop a clinical score including clinical signs and a combination of biomarkers to identify children with abdominal pain at low risk of AA.
Design/Methods:
We prospectively included children 2 to 14 years of age with abdominal pain suggestive of AA who presented to the emergency department between July 2016 and September 2017. A new score, the Pediatric Appendicitis Laboratory Score (PALabS) including clinical signs, leucocyte (WBC) and neutrophil (ANC) counts and plasma C-reactive protein (CRP) and calprotectin (CP) levels was developed and validated through secondary analyses of two distinct cohorts The validation sample included visits to a single pediatric emergency department from 2012 to 2013 and 2016 to 2017.
Results:
The derivation sample included 278 children, 35.9% of whom had AA and the validation sample included 255 children, 49% of whom had AA. Using logistic regression, we created a 6-part score that consisted of nausea (3 points), history of focal right lower quadrant pain (4 points), ANC of ≥7500/μL (7 points), WBC of ≥10,000/μL (4 points), CRP ≥ 10.0 mg/L (2 points) and CP ≥ 0.50 ≥ ng/mL (3 points). This score exhibited a high discriminatory power (area under the curve: 0.88; 95% confidence interval: 0.84 to 0.92) and outperformed the PAS and Kharbanda scores (area under the curve: 0.76; 95% confidence interval: 0.71 to 0.82 and 0.82; 95% confidence interval: 0.77 to 0.87, respectively). A PALabS ≤6 had a sensitivity of 99.2% (95% confidence interval [CI]: 95.6-99.9), negative predictive value of 97.6% (95% CI: 87.7-99.6), and negative likelihood ratio of 0.03 (95% CI: 0.00-0.18) in the validation set.
Conclusion:
In our validation cohort of patients with acute abdominal pain, the new score can accurately predict which children are at low risk of appendicitis and could be safely managed with close observation.
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