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Applying the Pediatric Appendicitis Score to predict complicated appendicitis in children
Takayuki Fujii1, Aya Tanaka1, Hiroto Katami1
1Department of Pediatric Surgery, Faculty of Medicine, Kagawa University, Kitagun, Kagawa, Japan.
Insights
Predicting complicated appendicitis (CA) in children is improved by combining symptom duration, C-reactive protein (CRP) levels, and the Pediatric Appendicitis Score (PAS). This combination offers high accuracy for diagnosing CA in pediatric patients.
Area of Science:
- Pediatric Surgery
- Emergency Medicine
- Diagnostic Accuracy
Background:
- Acute appendicitis is common in children.
- Accurate prediction of complicated appendicitis (CA) is crucial for timely intervention.
- Existing diagnostic tools require further validation.
Purpose of the Study:
- To evaluate the efficacy of the Pediatric Appendicitis Score (PAS).
- To identify key indicators for predicting complicated appendicitis in children.
- To assess the combined diagnostic performance of various predictors for CA.
Main Methods:
- Retrospective cohort study of 161 pediatric patients with acute appendicitis (2008-2020).
- Collection of demographic, symptomatic, physical, laboratory data, and PAS.
- Multivariate analysis and ROC curve analysis to identify CA predictors.
Main Results:
- Symptom duration >1 day, CRP > 4 mg/dL, and PAS ≥ 8 were significant predictors of CA.
- Combined predictors achieved an AUC of 0.91.
- The combination demonstrated high specificity (99%) and PPV (98%) for CA.
Conclusions:
- Symptom duration, CRP levels, and PAS are valuable predictors of CA in children.
- The PAS enhances CA prediction when used with symptom duration and CRP.
- This combined approach improves diagnostic accuracy for pediatric appendicitis.
Background:
This study aimed to investigate the efficacy of the Pediatric Appendicitis Score (PAS) and other indicators to enable the prediction of complicated appendicitis (CA) in children.
Methods:
This retrospective cohort study evaluated children (n = 161) aged ≤16 years with acute appendicitis between 2008 and 2020. Demographic data, symptoms, physical findings, laboratory data, and PASs were collected. Multivariate analysis was performed to identify predictors for CA. Receiver operating characteristic (ROC) curves were constructed. The diagnostic performance of each predictor was evaluated.
Results:
Multivariate analysis identified three predictors for CA: duration of symptoms >1 day, C-reactive protein (CRP) level > 4 mg/dL, and PAS ≥ 8. The ROC curve of the combined three predictors showed an area under the curve of 0.91. The multivariate ROC curve revealed that the presence of a PAS contributed to a significant improvement in the diagnosis of CA compared to the absence of PAS. When combined, the three predictors had a high specificity of 99% and positive predictive value of 98%.
Conclusions:
A symptom duration >1 day, CRP > 4 mg/dL, and PAS ≥ 8 were predictors for CA. The PAS can be useful for prediction of CA when combined with the duration of symptoms, CRP, or both.
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