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The evaluation of the validity of Alvarado, Eskelinen, Lintula and Ohmann scoring systems in diagnosing acute appendicitis in children

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Abstract

Purpose

To show whether Alvarado, Eskelinen, Lintula and Ohmann scoring systems have predictive values in diagnosing acute appendicitis in children.

Methods

Sixty patients with suspected acute appendicitis were prospectively evaluated. Alvarado, Eskelinen, Lintula and Ohmann scores were calculated separately for each patient at the time of admission. The specificity, sensitivity, positive and negative predictive values of the scores were calculated. The predictive value of the scores was evaluated with the receiver operating characteristic (ROC) curve and the consistency among the scores by Kappa test.

Results

Twenty of the patients were female (33.3 %). The mean age of the patients was 9.9 years (3–16 years). Forty two patients were operated and appendectomies were performed with the diagnosis of acute appendicitis. The area under the ROC curve showed that the scores had no predictive value in diagnosing acute appendicitis. Kappa test showed that agreement between the scores was not good.

Conclusion

The sensitivity and specificity of the four scoring systems were not sufficient enough in diagnosing acute appendicitis in our patient group. We concluded that the most important factor affecting the decision for surgery in suspected acute appendicitis is the surgeon’s experience combined with physical findings of repeated clinical examinations.

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References

  1. Kosloske AM, Love CL, Rohrer JE et al (2004) The diagnosis of appendicitis in children: outcomes of a strategy based on pediatric surgical evaluation. Pediatrics 113:29–34

    Article  PubMed  Google Scholar 

  2. Paajonen H, Somppi E (1996) Early appendicitis is still a difficult diagnosis. Acta Paediatr 85:459–462

    Article  Google Scholar 

  3. Partrick DA, Janik JE, Janik JS et al (2003) Increased CT scan utilization does not improve the diagnostic accuracy of appendicitis in children. J Pediatr Surg 38:659–662

    Article  PubMed  Google Scholar 

  4. Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:577–580

    Article  Google Scholar 

  5. Christian F, Christian GP (1992) A simple scoring system to reduce the negative appendectomy rate. Ann R Coll Surg Engl 74:281–284

    CAS  PubMed Central  PubMed  Google Scholar 

  6. Ohmann C, Yang Q, Franke K et al (1995) Diagnostic scores for acute appendicitis. Eur J Surg 161:273–276

    CAS  PubMed  Google Scholar 

  7. Mandeville K, Pottker T, Bulloch B et al (2011) Using appendicitis scores in the pediatric ED. Am J Emerg Med 29:972–977

    Article  PubMed  Google Scholar 

  8. Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564

    Article  CAS  PubMed  Google Scholar 

  9. Eskelinen M, Ikonen J, Lipponen P (1992) A computer-based diagnostic score to aid in diagnosis of acute appendicitis. Theor Surg 7:86–90

    Google Scholar 

  10. Lintula H, Pesonen E, Kokki H et al (2005) A diagnostic score for children with suspected appendicitis. Langenbecks Arch Surg 390:164–170

    Article  PubMed  Google Scholar 

  11. Ohmann C, Franke C, Yang Q (1999) Clinical benefit of a diagnostic score for appendicitis: results of a prospective interventional study. German Study Group of Acute Abdominal Pain. Arch Surg 134:993–996

    Article  CAS  PubMed  Google Scholar 

  12. Stevenson RJ (2003) Appendicitis. In: Ziegler MM, Azizkhan RG, Weber TR (eds) Operative pediatric surgery. McGrawHill, New York, pp 671–689

    Google Scholar 

  13. Neuspiel DR, Kuller LH (1987) Fatalities from undetected appendicitis in early childhood. Clin Pediatr 26:573–575

    Article  CAS  Google Scholar 

  14. Limpawattanosiri C (2011) Alvarado score for the acute appendicitis in a provincial hospital. J Med Assoc Thai 94:441–449

    Google Scholar 

  15. Escribe A, Gamell AM, Fernandes Y et al (2011) Prospective validation of two systems of classification for the diagnosis of acute appendicitis. Pediatr Emerg Care 27:165–169

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  17. Shera AH, Nizami FA, Malik AA et al (2011) Clinical scoring system for diagnosis of acute appendicitis in children. Indian J Pediatr 78:287–290

    Article  CAS  PubMed  Google Scholar 

  18. Ohmann C, Yang Q, Franke C (1995) Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg 161:273–281

    CAS  PubMed  Google Scholar 

  19. Macklin CP, Radcliffe GS, Merei JM et al (1997) A prospective evaluation of the modified Alvarado score for acute appendicitis in children. Ann R Coll Surg Engl 79:203–205

    CAS  PubMed Central  PubMed  Google Scholar 

  20. Lintula H, Kokki H, Pulkkinen J et al (2010) Diagnostic score in acute appendicitis. Validation of a diagnostic score (Lintula score) for adults with suspected appendicitis. Langenbecks Arch Surg 395:495–500

    Article  PubMed  Google Scholar 

  21. Lintula H, Kokki H, Kettunen R et al (2009) Appendicitis score for children with suspected appendicitis. A randomized clinical trial. Langenbecks Arch Surg 394:999–1004

    Article  PubMed  Google Scholar 

  22. Yoldaş O, Karaca T, Tez M (2012) External validation of Lintula score in Turkish acute appendicitis patients. Int J Surg 10:25–27

    Article  PubMed  Google Scholar 

  23. Sitter H, Hoffmann S, Hassan I et al (2004) Diagnostic score in appendicitis. Validation of a diagnostic score (Eskelinen score) in patients in whom acute appendicitis is suspected. Langenbecks Arch Surg 389:213–218

    Article  CAS  PubMed  Google Scholar 

  24. Kiyak G, Korukluoğlu B, Ozgün Y et al (2009) Evaluation of Ohmann and Eskelinen scores, leukocyte count and ultrasonography findings for diagnosis of appendicitis. Ulus Travma Acil Cerrahi Derg 15:77–81

    PubMed  Google Scholar 

  25. Zielke A, Sitter H, Rampp TA et al (1999) Validation of a diagnostic scoring system (Ohmann score) in acute appendicitis. Chirurg 70:777–783

    Article  CAS  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Arzu Sencan.

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Sencan, A., Aksoy, N., Yıldız, M. et al. The evaluation of the validity of Alvarado, Eskelinen, Lintula and Ohmann scoring systems in diagnosing acute appendicitis in children. Pediatr Surg Int 30, 317–321 (2014). https://doi.org/10.1007/s00383-014-3467-0

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  • DOI: https://doi.org/10.1007/s00383-014-3467-0

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