Evaluating Pediatric Appendicitis Score and Alvarado Scoring System for Detecting Acute Appendicitis in Pediatric Population
Authors: Eid Ali Ahmed Adel , Abdelhamid Sameh Abdelhay , Mohamed Abdelgawad Osama Fouad , El Zimaity Ahmed Osman , Elghandour Mostafa Mohamed 
Published: July 2024

Abstract

Background
Acute appendicitis is the most common surgical condition of children. About 1 to 10% of children presenting in surgical emergencies with acute abdomen fall within the domain of acute appendicitis. In few of these cases, clinical signs and symptoms at presentation are such that acute appendicitis is a clear diagnosis while more often it is challenging for a surgeon to make a clinical diagnosis of acute appendicitis. In these circumstances, explorations reveal negative appendectomies and an organ with potential functions can be lost.

Objective
To evaluate the Pediatric Appendicitis Score and Alvarado Scoring System in Detecting Acute Appendicitis in Pediatric Population in terms of applicability, safety, and specificity in the diagnosis of Acute Appendicitis among the study group and to suggest improvements and/or modifications to increase the predictive values of Pediatric Appendicitis Score and Alvarado Scoring System, decrease the rates of false diagnosis or reduce costs.

Methods
a prospective cohort study that was conducted on 50 patients aged under 14 years admitted to pediatric surgery department in Ain Shams University Hospital within a period of 6 months with an expected diagnosis of Acute appendicitis. Each patient was subjected to a detailed medical history taking (with emphasis on The age, gender, duration of pain, complaint complaints ofabdominal pain and duration, fever, nausea-vomiting, diarrhea or constipation), Clinical examination:(right lower quadrant sensitivity,defense, rebound tenderness, percussion/ cough/ right lower quadrant sensitivity with jumping). Laboratory investigations:(complete blood count, the total white blood cell (WBC) and total neutrophil counts c-reactive protein ) and Ultrasound examination. Alvarado score as well as PAS were calculated for each patient . the results were then compared to the intra operative findings confirming or excluding the diagnosis of acute appendicitis.

Results
in the study group that was 38% males and 62% females with ages ranging from 3 to 14 years .Pediatric appendicitis score (PAS) was found to significantly predict acute appendicitis in the studied patients at cutoff 5.0 with sensitivity, specificity, PPV and NPV was 60.5%, 100%, 100% and 71.9% respectively (p &lt; 0.001). Alvarado score can significantly predict acute appendicitis in the studied patients at cutoff 4.0 with sensitivity, specificity, PPV and NPV was 79.1%, 85.7%, 84.7% and 80.4% respectively (p &lt; 0.001).

Conclusion
The results of this study showed the higher sensitivity of Alvarado score and more specificity of the Pediatric Appendicitis score. However, the sensitivity, specificity, PPV, and NPV of these criteria were not considered enough to confirm the diagnosis of acute appendicitis alone. There is a need for new parameters in the scoring systems. Such as including ultrasonagraphic findings and additional laboratory investigations such as CRP.