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Published on: October 16, 2013

EMR Challenges: Discrepancies Between Clinical Scoring Tools in Pediatric Appendicitis

Krysta M Sutyak1, Victor M Ringheanu2, Jack J Strubel2

  • 1Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice (CSTEP), McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.

The Journal of Surgical Research
|August 17, 2026
PubMed

Insights

Electronic medical record transitions can affect patient care. The Pediatric Appendicitis Risk Calculator (pARC) showed significant discordance with the Pediatric Appendicitis Score (PAS), especially in adolescent females and those with normal white blood cell counts.

Area of Science:

  • Pediatric Surgery
  • Health Informatics
  • Clinical Decision Support

Background:

  • Electronic medical record (EMR) transitions can disrupt patient care pathways.
  • A recent EMR transition replaced the Pediatric Appendicitis Score (PAS) with the Pediatric Appendicitis Risk Calculator (pARC).
  • Understanding score discrepancies is crucial for maintaining care quality.

Purpose of the Study:

  • To examine the discordance between the Pediatric Appendicitis Score (PAS) and the Pediatric Appendicitis Risk Calculator (pARC) following an EMR transition.
  • To identify patient demographics and clinical factors associated with score discrepancies.
  • To evaluate the impact of EMR system changes on diagnostic tool utilization.

Main Methods:

  • Retrospective review of 1182 patients (ages 3-17) who underwent appendectomy.
  • Calculation and comparison of PAS and pARC scores and their assigned risk categories.
  • Statistical analysis including percent discordance and McNemar-Bowker test to assess significance.

Main Results:

  • PAS and pARC showed significant discordance in 40% of patients (P < 0.001).
  • Higher discordance rates were observed in older children (≥12 years) and females.
  • Adolescent females (≥12 years) exhibited the highest discordance (73%), with pARC underestimating risk compared to PAS, particularly in patients with low white blood cell counts.

Conclusions:

  • Clinical decision support tools like PAS and pARC do not always yield identical risk categorizations.
  • The Pediatric Appendicitis Risk Calculator (pARC) classified fewer patients as high risk compared to the Pediatric Appendicitis Score (PAS).
  • Significant discordance in challenging cohorts highlights the need for careful EMR transition management and validation of diagnostic tools.
Abstract

Keywords:
AppendectomyElectronic medical recordPatient carePediatric appendicitisPediatric appendicitis risk calculatorPediatric appendicitis score

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