EMR Challenges: Discrepancies Between Clinical Scoring Tools in Pediatric Appendicitis

Electronic medical record (EMR) transitions can impact patient care. With our EMR transition, the pediatric appendicitis score (PAS) was replaced by the Pediatric Appendicitis Risk Calculator (pARC). This study examines the discordance between PAS and pARC to identify discrepancies.

A retrospective review was conducted of patients (ages 3-17 y) who underwent appendectomy at a children's hospital (5/2021-3/2024). PAS and pARC scores were retrospectively calculated and assigned risk categories. Descriptive statistics, percent discordance, and the McNemar-Bowker test were utilized.

Among 1182 children, the median age was 11 y (IQR 8-14), with 63% male. PAS categorized 3% as low risk, 23% moderate, and 75% high; pARC categorized 11% as low risk, 45% moderate, and 43% high (P < 0.001). PAS and pARC categorization were discordant in 40% of the patients. Discordance varied by age and sex: 40% for <12 y versus 48% ≥ 12 y (P = 0.003); 33% for males versus 59% for females (P < 0.001). Females aged ≥12 y had the highest discordance rate at 73%. Discordance was significantly higher in patients with a white blood cell (WBC) <10,000 cells/μL compared to WBC >10,000 cells/μL (P < 0.001).

Decision support tools do not exhibit the same clinical outputs. pARC categorized significantly fewer patients as high risk. Clinically challenging cohorts, such as adolescent females and those with a normal WBC count, had nearly two-thirds discordance, with pARC underestimating risk compared to PAS. Scrutiny is needed in all aspects of EMR transitions, especially those with direct patient impact.