Validation of Pediatric Appendicitis Score in Suspected Acute Appendicitis

To evaluate the diagnostic performance of the Pediatric Appendicitis Score (PAS) and ultrasound (USG) for acute appendicitis in children and adolescents.

The study included children and adolescents, who presented with suspected acute appendicitis. PAS values were calculated for all patients, and USG findings were recorded. The diagnostic accuracy of PAS and USG, individually and in combination, was assessed.

A total of 146 (61.6% boys) patients with a mean (SD) age of 10.24 (2.85 years) were enrolled. Appendectomy was performed in 94 (64.4%) patients, confirming acute appendicitis in 91 cases and a normal appendix in 3. Among the 52 (35.6%) conservatively managed patients, none needed surgical intervention subsequently. The mean PAS values were significantly higher in surgically managed patients. PAS demonstrated an area under receiver operating characteristic curve (AUROC) of 0.850 (sensitivity 85.2%, specificity 78.4%), while USG had an AUROC of 0.880 (sensitivity 88.1%, specificity 85.2%). When PAS and USG were combined, the AUROC increased to 0.920 (sensitivity 92%, specificity 89.4%). A strong agreement (Kappa = 0.84, P < 0.001) was observed between PAS and USG findings.

PAS and USG are valuable tools for diagnosing pediatric acute appendicitis, with USG demonstrating slightly higher diagnostic accuracy. The combination of PAS and USG significantly improved diagnostic performance.