A Prospective Model for Detecting Missed Appendicitis in Low-Risk Pediatric Patients.

Area of Science:

• Pediatric Surgery
• Emergency Medicine
• Diagnostic Imaging

Background:

• Appendicitis is common in children, but diagnosis can be challenging in low-risk cases.
• The Pediatric Appendicitis Score (PAS) helps stratify risk, but some children with PAS < 4 still have appendicitis.

Purpose of the Study:

• To identify predictors of true appendicitis in children with PAS < 4.
• To develop a model for detecting missed appendicitis in this low-risk pediatric population.

Main Methods:

• A prospective study included children aged 2-14 years presenting with suspected appendicitis.
• Analysis focused on 404 children with a PAS < 4.

Main Results:

• Of 404 children with PAS < 4, 39 (9.6%) had confirmed appendicitis.
• Independent predictors for appendicitis included elevated white blood cell (WBC) count (>8.8 × 10⁹/L), elevated C-reactive protein (CRP) (≥10 mg/L), and positive ultrasound findings.
• Ultrasound demonstrated the highest diagnostic accuracy (85%) and negative predictive value (97%).

Conclusions:

• A significant proportion of children with a low PAS score have appendicitis.
• Integrating inflammatory markers (WBC, CRP) with targeted ultrasound can enhance the early detection of appendicitis in low-risk pediatric patients.