A diagnostic score for children with suspected appendicitis
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.
KeywordsDiagnostic score Acute appendicitis
- 1.Winsey HS, Jones PF (1967) Acute abdominal pain in childhood: analysis of a year’s admissions. BMJ 18:653–655Google Scholar
- 2.Stone HH, Sanders SL, Martin JD Jr (1971) Perforated appendicitis in children. Surgery 69:673–679Google Scholar
- 3.Graham JM, Pokorny WJ, Harberg FJ (1980) Acute appendicitis in preschool age children. Am J Surg 139:247–250Google Scholar
- 5.Curran TJ, Muenchow SK (1993) The treatment of complicated appendicitis in children using peritoneal drainage. Results from public hospital. J Pediatr Surg 28:204–208Google Scholar
- 6.Pearl RH, Hale DA, Molloy M, Schutt DC, Jaques DP (1995) Pediatric appendectomy. J Pediatr Surg 30:173–181Google Scholar
- 7.Surana R, O’Donnell B, Puri P (1995) Appendicitis diagnosed following active observation does not increase morbidity in children. Pediatr Surg Int 10:76–78Google Scholar
- 9.Lindberg G, Fenyö G (1988) Algorithmic diagnosis of appendicitis using Bayes’ theorem and logistic regression. In: Bernardo JM, DeGroot MH, Lindley DV, Smith AF (eds) Bayesian statistics 3. Oxford University Press, Oxford, pp 665–668Google Scholar
- 10.de Dombal FT (1991) Diagnosis of acute abdominal pain. Churchill Livingstone, Edinburgh, pp 33–106Google Scholar
- 11.Eskelinen M, Ikonen J, Lipponen P (1992) A computer-based diagnostic score to aid in diagnosis of acute appendicitis. A prospective study of 1333 patients with acute abdominal pain. Theor Surg 7:86–90Google Scholar
- 12.Bond GR, Tully SB, Chan LS, Bradley RL (1990) Use of the MANTRELS score in childhood appendicitis: a prospective study of 187 children with abdominal pain. Ann Emerg Med 19:1014–1018Google Scholar
- 13.Sitter H, Hoffmann S, Hassan I, Zielke A (2004) Diagnostic score in appendicitis. Langenbecks Arch Surg 389:213–218Google Scholar
- 14.Madan S (2002) Pediatric appendicitis score. J Pediatr Surg 37:877–881Google Scholar
- 15.de Dombal FT (1979) Acute abdominal pain—an OMGE survey. Scand J Gastroenterol 14:29–43Google Scholar
- 16.de Dombal FT (1988) The OMGE acute abdominal survey, progress report 1986. Scand J Gastroenterol 23:35–42Google Scholar
- 17.Kokki H, Lintula H, Vanamo K, Heiskanen M, Eskelinen M (2005) Oxycodone vs placebo in children with undifferentiated abdominal pain—a randomized, double blind clinical trial of effect of analgesia on diagnostic accuracy. Arch Pediatr Adolesc Med (in press)Google Scholar
- 19.Fenyö G (1987) Routine use of a scoring system for decision-making in suspected acute appendicitis in adults. Acta Chir Scand 153:545–551Google Scholar
- 20.Christian F, Christian GP (1990) A simple scoring system to reduce the negative appendectomy rate. Ann R Coll Surg Engl 74:281–285Google Scholar
- 21.Izbicki JR, Wilker DK, Mandelkow HK, Müller K, Siebeck M, Geissler K, Schweiberer L (1990) Retro- und prospective Untersuchung zur Wertigkeit klinischer und laborchemischer Daten bei der akuten Appendicitis. Chirurg 61:887–894Google Scholar
- 22.Ohmann C, Franke C, Yang Q, Margulies M, Chan M, van Elk PJ, deDombal FT, Roher HD (1999) Diagnosescore für akute Appendicitis. Chirurg 66:135–141Google Scholar
- 23.Arnbjörnsson E (1985) Scoring system for computer-aided diagnosis of acute appendicitis. Ann Chir Gynaecol 74:159–166Google Scholar
- 25.Ohmann C, Franke C, Yang Q (1999) Clinical benefit of a diagnostic score for appendicitis. Arch Surg 134:993–996Google Scholar
- 26.Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI (1992) Evaluation of the Alvarado score in acute appendicitis. J R Soc Med 85:87–88Google Scholar
- 27.Dado G, Anania U, Baccarani U, Marcotti E, Donini A, Risaliti A, Pasqualucci A, Bresadola F (2000) Application of a clinical score for the diagnosis of acute appendicitis in childhood: a retrospective analysis of 197 patients. J Pediatr Surg 35:1320–1322Google Scholar
- 28.Macklin CP, Radcliffe GS, Merel JM, Stringer MD (1997) A prospective evaluation of the modified Alvarado score for acute appendicitis in children. Ann R Coll Surg Engl 79:203–205Google Scholar