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World Journal of Surgery

Published in:

01-01-2012

Diagnosing Appendicitis at Different Time Points in Children with Right Lower Quadrant Pain: Comparison Between Pediatric Appendicitis Score and the Alvarado Score

Authors: Han-Ping Wu, Wen-Chieh Yang, Kang-Hsi Wu, Chan-Yu Chen, Yun-Ching Fu

Published in: World Journal of Surgery | Issue 1/2012

Abstract

Background

Acute appendicitis is the most common abdominal emergency in clinical surgery. This study was designed to compare the diagnostic value of the Pediatric Appendicitis Score (PAS) with that of the Alvarado score based on different time points in children with right lower quadrant (RLQ) abdominal pain.

Methods

This prospective cohort study comprised 1,395 children (aged 3–18 years) with RLQ abdominal pain between 2005 and 2009. The patients were scored by the pediatric emergency physicians. Receiver operating characteristic (ROC) curves were used to determine the appropriate cutoff scores of the Alvarado and PAS systems. The sensitivity and specificity, and area under ROC curve were calculated for both systems.

Results

The AUCs of the Alvarado system were all higher than those of the PAS system (day 1: 0.09 vs. 0.87; day 2: 0.87 vs. 0.84; day 3: 0.88 vs. 0.82). The best appropriate cutoff scores were seven (days 1 and 2) and six (day 3) on the PAS and six (days 1 and 2) and seven (day 3) on the Alvarado system.

Conclusions

The preliminary data show that the best cutoff score of Alvarado and PAS systems vary with the different time points of RLQ pain presentation. It may provide helpful information for primary or emergency physicians to determine whether the patient should undergo surgical consultation.

Kharbanda AB, Taylor GA, Fishman SJ, Bachur RG (2005) A clinical decision rule to identify children at low risk for appendicitis. Pediatrics 116:709–716PubMedCrossRef

Tan EC, Severijnen RS, Rosman C et al (2006) Diagnosis and treatment of acute appendicitis in children: a survey among Dutch surgeons and comparison with evidence-based practice. World J Surg 30:512–518. doi:10.1007/s00268-005-0350-0 PubMedCrossRef

Bundy DG, Byerley JS, Liles EA et al (2007) Does this child have appendicitis? JAMA 298:438–451

Wu HP, Huang CY, Chang YJ et al (2006) Use of changes over time in serum inflammatory parameters in patients with equivocal appendicitis. Surgery 139:789–796PubMedCrossRef

Kwan KY, Nager AL (2010) Diagnosing pediatric appendicitis: usefulness of laboratory markers. Am J Emerg Med 28:1009–1015PubMedCrossRef

Bickell NA, Aufses AH Jr et al (2006) How time affects the risk of rupture in appendicitis. J Am Coll Surg 202:401–406PubMedCrossRef

Douglas CD, Macpherson NE, Davidso PM, Gani JS (2000) Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ 321:919–922PubMedCrossRef

Garcia Pena BM, Mandl KD, Kraus SJ et al (1999) Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA 282:1041–1046PubMedCrossRef

Tsao K, St Peter SD, Valusek PA et al (2008) Management of pediatric acute appendicitis in the computed tomographic era. J Surg Res 147:221–224PubMedCrossRef

10.

Taylor GA, Fishman SJ, Mandl KD (2000) Costs and effectiveness of ultrasonography and limited computed tomography for diagnosing appendicitis in children. Pediatrics 106:672–676PubMedCrossRef

11.

Daly CP, Cohan RH, Francis IR et al (2005) Incidence of acute appendicitis in patients with equivocal CT findings. Am J Roentgenol 184:1813–1820

12.

Stengel JW, Webb EM et al (2010) Acute appendicitis: clinical outcome in patients with an initial false-positive CT diagnosis. Radiology 256:119–126PubMedCrossRef

13.

Samuel M (2002) Pediatric appendicitis score. J Pediatr Surg 37:877–881PubMedCrossRef

14.

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

15.

Goldman RD, Carter S, Stephens D et al (2008) Prospective validation of the pediatric appendicitis score. J Pediatr 153:278–282PubMedCrossRef

16.

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

Title: Diagnosing Appendicitis at Different Time Points in Children with Right Lower Quadrant Pain: Comparison Between Pediatric Appendicitis Score and the Alvarado Score
Authors: Han-Ping Wu
Wen-Chieh Yang
Kang-Hsi Wu
Chan-Yu Chen
Yun-Ching Fu
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 1/2012
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-011-1310-5

At a glance: The STEP trials

Springer Medicine

Diagnosing Appendicitis at Different Time Points in Children with Right Lower Quadrant Pain: Comparison Between Pediatric Appendicitis Score and the Alvarado Score

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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