Langenbeck's Archives of Surgery

, Volume 390, Issue 2, pp 164–170 | Cite as

A diagnostic score for children with suspected appendicitis

  • Hannu LintulaEmail author
  • Erkki Pesonen
  • Hannu Kokki
  • Kari Vanamo
  • Matti Eskelinen
Original Article



Appendicectomy is an operation that is often performed without certainty of diagnosis. This study aimed to construct and to validate a prognostic score for the diagnosis of acute appendicitis in children.


Data for 35 symptoms and signs were prospectively recorded for 131 consecutive children with suspected appendicitis. Logistic regression analysis of the variables yielded a diagnostic score: gender (male 2 points, female 0) + intensity of abdominal pain (severe 2, mild or moderate 0) + relocation of pain (yes 4, no 0) + vomiting (yes 2, no 0) + pain in the right lower abdominal quadrant (yes 4, no 0) + fever (yes 3, no 0) + guarding (yes 4, no 0) + bowel sounds (abnormal 4, normal 0) + rebound tenderness (yes 7, no 0). The cut-off level for recommendation of appendicectomy was ≥21, and the cut-off level for non-appendicitis was ≤15. The score was prospectively validated on 109 children.


In the validation sample, based on clinical judgment, unnecessary appendicectomy was performed in ten (27%) children, and one (4%) child was misdiagnosed as not having appendicitis. By application of the score, unnecessary appendicectomies would have been reduced to four (13%), and three children (11%) with appendicitis would have been discharged.


The use of a predictive mathematical model may facilitate the diagnosis of appendicitis to avoid unnecessary operations.


Diagnostic score Acute appendicitis 


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Hannu Lintula
    • 1
    Email author
  • Erkki Pesonen
    • 2
  • Hannu Kokki
    • 3
    • 4
  • Kari Vanamo
    • 1
  • Matti Eskelinen
    • 5
  1. 1.Department of Pediatric SurgeryKuopio University HospitalKuopioFinland
  2. 2.Department of Computer ScienceUniversity of KuopioKuopioFinland
  3. 3.Department of Anesthesiology and Intensive CareKuopio University HospitalKuopioFinland
  4. 4.Department of Pharmacology and ToxicologyUniversity of KuopioKuopioFinland
  5. 5.Department of SurgeryKuopio University HospitalKuopioFinland

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