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A prospective study to evaluate the contribution of the pediatric appendicitis score in the decision process
Kevin Vevaud1, Aymeric Dallocchio1, Nathalie Dumoitier2
1Service de chirurgie pédiatrique, Hôpital des Enfants, Hôpital Universitaire de Limoges, 8 Avenue Dominique Larrey, Limoges Cedex, 87042, France.
Insights
This study found no significant difference in acute appendicitis (AA) diagnosis scores between children seen in primary care versus those directly admitted to the emergency department. A new algorithm incorporating pain duration and inflammatory markers is proposed for primary care settings.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Support
Background:
- Assessing acute appendicitis (AA) in children presenting to emergency departments (ED) is crucial.
- Prior primary care (PC) consultation history may influence ED diagnostic pathways.
Purpose of the Study:
- To evaluate the likelihood of AA in children based on their prior PC consultation.
- To compare diagnostic scores between children with and without prior PC consultation.
Main Methods:
- Prospective enrollment of children with suspected AA in the ED.
- Categorization into groups based on PC consultation status (physician-assessed, family-brought, admitted post-consultation).
- Utilized the Pediatric Appendicitis Score (PAS) and C-reactive protein (CRP) levels for analysis.
Main Results:
- 29 out of 124 children (23.4%) were diagnosed with AA.
- No significant difference in mean PAS scores for AA cases between children with prior PC consultation (6.69 ± 1.75) and those without (7.57 ± 1.6).
- PAS and CRP levels correlated with AA severity; no AA cases had PAS < 4.
Conclusions:
- Prior primary care consultation did not significantly alter the Pediatric Appendicitis Score in children with suspected acute appendicitis.
- A novel decision-making algorithm for primary care, integrating inflammatory markers and pain duration, is suggested.
Background:
The objective of this study was to assess the likelihood of acute appendicitis (AA) in children presenting with abdominal symptoms at the emergency department (ED), based on their prior primary care (PC) consultation history.
Methods:
Between February and June 2021, we prospectively enrolled all children presenting at the ED with acute abdominal pain indicative of possible acute appendicitis (AA). Subsequently, they were categorized into three groups: those assessed by a PC physician (PG), those brought in by their family without a prior consultation (FG), and those admitted after a PC consultation without being assessed as such. The primary objective was to assess the probability of AA diagnosis using the Pediatric Appendicitis Score (PAS). Secondary objectives included analyzing PAS and C-reactive protein (CRP) levels based on the duration of pain and final diagnoses.
Results:
124 children were enrolled in the study (PG, n = 56; FG, n = 55; NG, n = 13). Among them, 29 patients (23.4%) were diagnosed with AA, with 13 cases (23.2%) from the PG and 14 cases (25.4%) from the FG. The mean PAS scores for AA cases from the PG and FG were 6.69 ± 1.75 and 7.57 ± 1.6, respectively, (p = 0.3340). Both PAS scores and CRP levels showed a significant correlation with AA severity. No cases of AA were observed with PAS scores < 4.
Conclusions:
There was no significant difference in PAS scores between patients addressed by PG and FG, even though PAS scores tended to be higher for patients with AA. We propose a new decision-making algorithm for PC practice, which incorporates inflammatory markers and pain duration.
Trial Registration:
Institutional Ethics Committee registration number: 447-2021-103 (10/01/2021).
Clinical Trials Registration Number:
ClinicalTrials.gov Identifier: NCT04885335 (Registered on 13/05/2021).
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01:29Appendicitis-II: Diagnostic Studies and Management
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