Clinical Scoring System for Diagnosis of Acute Appendicitis in Children
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Appendicitis is the most common abdominal emergency usually requiring surgery in the pediatric age group. Diagnosis of acute appendicitis can at times be difficult, especially in children. A failure to diagnose can lead to a progression of disease with its associated morbidity and mortality. The authors used a modification of Alvarado scoring system which consists of eight variables and would provide an accurate guide to the preoperative diagnosis of acute appendicitis leading to proper and timely management.
This was a prospective study conducted from Jan 2005 through Dec 2006 and included 90 consecutive patients with suspected acute appendicitis. They were given specific scores according to variables of scoring system and divided into 3 groups. Group III patients (score 7 or more) underwent surgery, group II (score 5–6) were admitted for close observation and group I (score 4 or less) were discharged home. Patients from group II with increased symptom intensity (score 7 or more) on re-evaluation underwent surgery. Diagnosis was confirmed by operative findings and histopathological examination. Reliability of scoring system was assessed by calculating negative appendicectomy rate and positive predictive value.
Out of total 90 patients, 73 patients underwent surgery and appendicitis was confirmed in 68 cases. The negative appendicectomy rate was 6.84%, perforation rate was 36.9%. Positive predictive value was 93.1%.
Our scoring system is useful as a first line, rapid, reliable and economic way of early preoperative diagnosis of acute appendicitis in children and in reducing the incidence of negative appendicectomy rate.
KeywordsAcute appendicitis in children Scoring system Early diagnosis Appendicectomy Alvarado score
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- 2.Stevenson RJ. Appendicitis. In: Ziegler M, editor. Operative pediatric surgery. 1st ed. New York: McGraw Hill; 2003. p. 671–89.Google Scholar
- 3.Fitz RH. Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment. Am J M Sci. 1886;92:321–46.Google Scholar
- 6.Choudhary IA, Ajmal RM, Mumtaz A, Maqsood R. Cough sign: reliability in diagnosis of acute appendicitis. J Coll Physicians Surg Pak. 2002;12:546–8.Google Scholar
- 7.Ohman C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Abdominal pain study group. Eur J Surg. 1995;161:273–381.Google Scholar
- 12.Moore SW, Schneider J. Acute appendicitis in childhood: experience in a developing country. Paediatric Surg Int. 1995;10:71–5.Google Scholar
- 14.Arian GM, Sohu KM, Ahmad E, Haider W, Nagi SA. Role of Alvarado score in the diagnosis of acute appendicitis. Pak J Surg. 2001;17:41–6.Google Scholar
- 19.Ellis H, Nathanson LK. Appendix and appendicectomy. In: Zinner MJ, editor. Maingot’s abdominal operations, vol 2. 10th ed. Singapore: Appleton and Lange; 1997. p. 1191–227.Google Scholar