A Simple Preoperative Scoring System for Risk Stratification of Complicated Appendicitis in Children

Area of Science:

• Pediatric Surgery
• Clinical Decision Support
• Medical Diagnostics

Background:

• Preoperative diagnosis of complicated appendicitis in children is challenging.
• Accurate risk stratification is vital for timely surgical intervention and perioperative care.
• Existing methods lack sufficient clinical applicability for routine pediatric surgical practice.

Purpose of the Study:

• To develop a simple, clinically applicable scoring system for preoperative risk stratification of complicated appendicitis in children.
• To improve the accuracy of diagnosing complicated appendicitis before surgery.
• To support early and effective decision-making in pediatric surgical settings.

Main Methods:

• Retrospective single-center study of children aged 5 to <16 years undergoing emergency appendectomy (2015-2024).
• Complicated appendicitis defined by gangrene, perforation, or abscess.
• A multivariable logistic regression model using Firth's penalized likelihood was developed and validated.
• An additive scoring system was derived from the model's predictors: temperature, periappendicular fluid, sodium, WBC count, and CRP levels.

Main Results:

• The study included 301 patients; 33.9% had complicated appendicitis.
• The derived scoring system (0-7 points) showed good discrimination (AUC 0.880).
• Points assigned for: serum sodium < 135 mEq/L (2), CRP ≥ 3.0 mg/dL (2), temperature ≥ 38.0 °C (1), periappendicular fluid (1), WBC > 12,000/μL (1).
• Risk stratification into low, intermediate, and high categories demonstrated increasing prevalence of complicated appendicitis.

Conclusions:

• A simple, preoperative scoring system effectively stratifies risk for complicated appendicitis in children (5 to <16 years).
• The system is clinically interpretable and supports early decision-making in pediatric surgery.
• This tool enhances routine clinical practice for managing pediatric appendicitis.