Skip to main content
SpringerLink
Log in

Making the Diagnosis: The Use of Clinical Features and Scoring Systems

  • Chapter
  • First Online:
Controversies in Pediatric Appendicitis

  • 702 Accesses

Abstract

Although appendicitis remains a common pediatric disease, making the diagnosis may be difficult. Obtaining a thorough history and physical exam remains of the utmost importance in determining whether a patient has appendicitis. The use of clinical scoring systems can improve the predictive value of our clinical assessment and aid in making the correct diagnosis. This chapter will discuss the approach to clinical diagnosis and the current scoring systems commonly used.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Reynolds SL, Jaffe DM. Diagnosing abdominal pain in a pediatric emergency department. Pediatr Emerg Care. 1992;8(3):126–8.

    Article  CAS  PubMed  Google Scholar 

  2. Scholer SJ, Pituch K, Orr DP, Dittus RS. Clinical outcomes of children with acute abdominal pain. Pediatrics. 1996;98(4 Pt 1):680–5.

    CAS  PubMed  Google Scholar 

  3. Papandria D, Goldstein SD, Rhee D, Salazar JH, Arlikar J, Gorgy A, et al. Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J Surg Res. 2013;184(2):723–9.

    Article  PubMed  Google Scholar 

  4. Bachur RG, Levy JA, Callahan MJ, Rangel SJ, Monuteaux MC. Effect of reduction in the use of computed tomography on clinical outcomes of appendicitis. JAMA Pediatr. 2015;169(8):755–60.

    Article  PubMed  Google Scholar 

  5. Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007;298(4):438–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med. 2017;24(5):523–51.

    Article  PubMed  Google Scholar 

  7. Colvin JM, Bachur R, Kharbanda A. The presentation of appendicitis in preadolescent children. Pediatr Emerg Care. 2007;23(12):849–55.

    Article  PubMed  Google Scholar 

  8. Sakellaris G, Tilemis S, Charissis G. Acute appendicitis in preschool-age children. Eur J Pediatr. 2005;164(2):80–3.

    Article  PubMed  Google Scholar 

  9. Becker T, Kharbanda A, Bachur R. Atypical clinical features of pediatric appendicitis. Acad Emerg Med. 2007;14(2):124–9.

    Article  PubMed  Google Scholar 

  10. Bailey B, Bergeron S, Gravel J, Bussieres JF, Bensoussan A. Efficacy and impact of intravenous morphine before surgical consultation in children with right lower quadrant pain suggestive of appendicitis: a randomized controlled trial. Ann Emerg Med. 2007;50(4):371–8.

    Article  PubMed  Google Scholar 

  11. Nance ML, Adamson WT, Hedrick HL. Appendicitis in the young child: a continuing diagnostic challenge. Pediatr Emerg Care. 2000;16(3):160–2.

    Article  CAS  PubMed  Google Scholar 

  12. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557–64.

    Article  CAS  PubMed  Google Scholar 

  13. van den Bogaard VA, Euser SM, van der Ploeg T, de Korte N, Sanders DG, de Winter D, et al. Diagnosing perforated appendicitis in pediatric patients: a new model. J Pediatr Surg. 2016;51(3):444–8.

    Article  PubMed  Google Scholar 

  14. Schwartz KL, Gilad E, Sigalet D, Yu W, Wong AL. Neonatal acute appendicitis: a proposed algorithm for timely diagnosis. J Pediatr Surg. 2011;46(11):2060–4.

    Article  PubMed  Google Scholar 

  15. Karaman A, Cavusoglu YH, Karaman I, Cakmak O. Seven cases of neonatal appendicitis with a review of the English language literature of the last century. Pediatr Surg Int. 2003;19(11):707–9.

    Article  PubMed  Google Scholar 

  16. Jancelewicz T, Kim G, Miniati D. Neonatal appendicitis: a new look at an old zebra. J Pediatr Surg. 2008;43(10):e1–5.

    Article  PubMed  Google Scholar 

  17. Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and management. Ann Emerg Med. 2000;36(1):39–51.

    Article  CAS  PubMed  Google Scholar 

  18. Rothrock SG, Skeoch G, Rush JJ, Johnson NE. Clinical features of misdiagnosed appendicitis in children. Ann Emerg Med. 1991;20(1):45–50.

    Article  CAS  PubMed  Google Scholar 

  19. Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Ann Emerg Med. 2007;49(6):778–84, 784.e1

    Article  PubMed  Google Scholar 

  20. Ebell MH, Shinholser J. What are the most clinically useful cutoffs for the Alvarado and pediatric appendicitis scores? A systematic review. Ann Emerg Med. 2014;64(4):365–72.e2.

    Article  PubMed  Google Scholar 

  21. Samuel M. Pediatric appendicitis score. J Pediatr Surg. 2002;37(6):877–81.

    Article  PubMed  Google Scholar 

  22. Escriba A, Gamell AM, Fernandez Y, Quintilla JM, Cubells CL. Prospective validation of two systems of classification for the diagnosis of acute appendicitis. Pediatr Emerg Care. 2011;27(3):165–9.

    Article  PubMed  Google Scholar 

  23. Pogorelic Z, Rak S, Mrklic I, Juric I. Prospective validation of Alvarado score and pediatric appendicitis score for the diagnosis of acute appendicitis in children. Pediatr Emerg Care. 2015;31(3):164–8.

    Article  PubMed  Google Scholar 

  24. Reddy SB, Kelleher M, Bokhari SAJ, Davis KA, Schuster KM. A highly sensitive and specific combined clinical and sonographic score to diagnose appendicitis. J Trauma Acute Care Surg. 2017;83(4):643–9.

    Article  PubMed  Google Scholar 

  25. Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008;32(8):1843–9.

    Article  PubMed  Google Scholar 

  26. Macco S, Vrouenraets BC, de Castro SM. Evaluation of scoring systems in predicting acute appendicitis in children. Surgery. 2016;160(6):1599–604.

    Article  PubMed  Google Scholar 

  27. Andersson M, Kolodziej B, Andersson RE, Group SS. Randomized clinical trial of appendicitis inflammatory response score-based management of patients with suspected appendicitis. Br J Surg. 2017;104(11):1451–61.

    Article  CAS  PubMed  Google Scholar 

  28. Lintula H, Pesonen E, Kokki H, Vanamo K, Eskelinen M. A diagnostic score for children with suspected appendicitis. Langenbeck’s Arch Surg. 2005;390(2):164–70.

    Article  Google Scholar 

  29. Lintula H, Kokki H, Kettunen R, Eskelinen M. Appendicitis score for children with suspected appendicitis. A randomized clinical trial. Langenbeck’s Arch Surg. 2009;394(6):999–1004.

    Article  Google Scholar 

  30. Kharbanda AB, Vazquez-Benitez G, Ballard DW, Vinson DR, Chettipally UK, Kene MV, et al. Development and validation of a novel pediatric appendicitis risk calculator (pARC). Pediatrics. 2018;141(4). https://doi.org/10.1542/peds.2017-2699.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Choi YM, Leopold D, Campbell K, Mulligan J, Grudic GZ, Moulton SL. Noninvasive monitoring of physiologic compromise in acute appendicitis: new insight into an old disease. J Pediatr Surg. 2018;53(2):241–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Children’s Hospital Colorado, Aurora, CO, USA

    Young Mee Choi & Steven Moulton

  2. Rutgers New Jersey Medical School, Newark, NJ, USA

    Young Mee Choi

  3. University of Colorado School of Medicine, Aurora, CO, USA

    Steven Moulton

Authors
  1. Young Mee Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven Moulton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven Moulton .

Editor information

Editors and Affiliations

  1. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Catherine J. Hunter

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Choi, Y.M., Moulton, S. (2019). Making the Diagnosis: The Use of Clinical Features and Scoring Systems. In: Hunter, C. (eds) Controversies in Pediatric Appendicitis. Springer, Cham. https://doi.org/10.1007/978-3-030-15006-8_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-15006-8_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-15005-1

  • Online ISBN: 978-3-030-15006-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation