Improving Appendicitis Prediction in Children Using the Paediatric Appendicitis Score (PAS): A Three-Year...

Area of Science:

• Pediatric Surgery
• Emergency Medicine
• Diagnostic Accuracy

Background:

• Acute appendicitis is a common pediatric surgical emergency with diagnostic challenges.
• The Paediatric Appendicitis Score (PAS) aids risk stratification but real-world application varies.
• Standardizing diagnosis is crucial to reduce negative appendicectomy rates.

Purpose of the Study:

• To evaluate the impact of implementing the Paediatric Appendicitis Score (PAS) into routine clinical practice.
• To assess the effect of an educational intervention on the negative appendicectomy rate and diagnostic accuracy.
• To analyze the diagnostic performance of PAS in a district-general hospital setting.

Main Methods:

• A two-cycle retrospective audit of 190 pediatric patients undergoing appendicectomy.
• Introduction of an educational intervention and quick-reference guide based on the GIRFT abdominal pain pathway between cycles.
• Evaluation of PAS diagnostic performance using sensitivity, specificity, predictive values, and AUC-ROC.

Main Results:

• The negative appendicectomy rate decreased from 29.5% to 17.6% post-intervention (not statistically significant).
• PAS ≥7 showed 87% specificity and 40% sensitivity; PAS ≥4 showed 96% sensitivity and 31% specificity.
• Mean PAS was significantly higher in confirmed appendicitis cases (6.18 vs 4.69; p < 0.001), with an AUC-ROC of 0.73.

Conclusions:

• Routine PAS implementation improved risk stratification and trended towards reduced negative appendicectomies.
• High PAS scores (≥7) are specific, low scores (≤3) effectively rule out disease, and intermediate scores benefit from adjuncts.
• Further multicenter studies incorporating imaging are recommended to enhance diagnostic accuracy and reduce negative appendicectomies.