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Pediatric Appendicitis Score for Identifying Acute Appendicitis in Children Presenting With Acute Abdominal Pain to the Emergency Department

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Abstract

Objective

To determine the diagnostic accuracy of Pediatric Appendicitis Score (PAS) in predicting appendicitis in children presenting with acute abdominal pain to the Emergency Department (ED) of a private hospital in Pakistan.

Methods

This validation study was through retrospective chart review of children between 4–18 years of age with clinical suspicion of acute appendicitis, presenting to the pediatric ED. Diagnostic accuracy was determined using sensitivity, specificity, predictive values, and area under the curve (AUC).

Results

104 children (76% boys) with mean (SD) age of 10.9 (3.5) years met the eligibility criteria. 91% (n=95) patients had moderate to high PAS (score ≥4), and 95% (n=99) had biopsy-proven appendicitis. The likelihood ratio calculated for low, equivocal and high-risk PAS was 0.10, 2.17 and 2.53, respectively. An equivocal PAS (score 4–6) showed a sensitivity of 96.8%, specificity of 80%, positive predictive value of 98.9% and AUC of 0.84 for predicting acute appendicitis.

Conclusion

PAS showed good diagnostic accuracy in predicting acute appendicitis in children presenting to the ED.

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Funding

Funding: None

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Authors and Affiliations

  1. Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan

    Syed Maaz Salahuddin, Omair Ayaz, Mehtab Jaffer, Rubaba Naeem & Asad I. Mian

  2. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

    Shiyam Sundar Tikmani

Authors
  1. Syed Maaz Salahuddin
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  2. Omair Ayaz
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  3. Mehtab Jaffer
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  4. Rubaba Naeem
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  5. Shiyam Sundar Tikmani
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  6. Asad I. Mian
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Contributions

Contributors: MS, AIM: helped in conceptualization of the study, devised methodology, developed tool for the study, contributed in training the research assistant for data collection, gave supervision in data collection, input in data analysis, manuscript writing and critically reviewed the manuscript as submitted. OA: data collection and manuscript writing; MJ: data collection; RN: arranging data collection logistics, maintained data folders, manuscript reviewed by all co-authors, drafting the manuscript; SST: cleaned and performed statistical analysis of the data and provided technical input in the data interpretation. All authors have contributed, designed and approved the study.

Corresponding author

Correspondence to Syed Maaz Salahuddin.

Ethics declarations

Ethics clearance IEC, Aga Khan University; No.: 4433-EM ERC-16 dated Sept 9, 2016.

Competing interests: None stated.

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Note: Additional matter related to this article is available with the web version at "https://www.indianpediatrics.net

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Salahuddin, S.M., Ayaz, O., Jaffer, M. et al. Pediatric Appendicitis Score for Identifying Acute Appendicitis in Children Presenting With Acute Abdominal Pain to the Emergency Department. Indian Pediatr 59, 774–777 (2022). https://doi.org/10.1007/s13312-022-2620-4

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  • DOI: https://doi.org/10.1007/s13312-022-2620-4

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