Comparative Evaluation of Alvarado Score and Pediatric Appendicitis Score for the Diagnosis of Acute Appendicitis in Children Undergoing Appendicectomy in AGMC & GBP Hospital

Field: Medicine (Health Sciences)

Introduction: The abdomen is a crucial diagnostic tool for many stomach-related illnesses, and acute appendicitis, a common cause of acute abdomen in surgical practice, has been a subject of ongoing study since its initial report in 1886. The vermiform appendix, a tubular structure from the postero medial portion of the caecum, is located inferior to the ileco caecal junction and is suspended by a fold of peritoneum. It contains the appendicular artery, a branch of the ileocolic artery. Acute appendicitis initially presents with vague symptoms like nausea, anorexia, and indigestion, which may cause vomiting and body temperature rise. Pain migration occurs when pain is overrun by local peritoneal nociception, and histopathologic characteristics include mucosal ulceration, neutrophilic leukocyte invasion, and in some cases, perforation and serositis. Men have an 8.6% lifetime risk of developing acute appendicitis, compared to 6.7% for females. The appendicitis organ has five layers: mucosa, lamina propria, sub mucosa, muscularis, and adventitia. It plays a role in immunity, with lymphoid aggregations in the sub mucosal layer causing an inflammatory response in acute appendicitis. Appendicitis is caused by obstruction of the appendicular lumen, which can be caused by foreign body, crohn’s disease, parasite infection, gastroenteritis, upper respiratory tract infection, fecolith, and lymphoid hyperplasia. Appendicitis diagnosis is a complex process involving various investigations, including laboratory and radiological tests, to find the most sensitive test for detecting acute appendicitis. Advancements in modern radiographic imaging and diagnostic laboratory tests have improved diagnostic accuracy and reduced misdiagnosis. Methodology: This research aims to compare PAS and Alvarado scoring systems for diagnosing acute appendicitis in children. The study involved 70 patients aged 4-14, divided into two groups using either system. Intraoperative findings included inflammation-characterized appendixes and normal ones, with histopathological analysis conducted on all appendicectomy specimens. Discussion: Clinical scoring systems have been developed to identify the most sensitive, specific, and accurate clinical scores for diagnosing acute appendicitis. The Alvarado score, developed by Samuel, is a well-known and researched method for pediatric appendicitis. A study involving 305 patients found that a score of less than five indicates no appendicitis, while a score of five or six requires observation. The Alvarado method has a sensitivity of 72%, specificity of 81%, and a sensitivity of 92.8%. A PAS score of 6 or higher was highly associated with appendicitis, while a score of 5 or less did not. A study comparing the Alvarado score and PAS for diagnosing acute appendicitis found no significant differences between the two. The study also found no significant differences in PAS scores for diagnosing AA among the 35 participants. Conclusion: Diagnosing acute appendicitis in pediatric patients remains a challenge, with PAS having better predictive values, sensitivity, and specificity than Alvarado. Further research is needed to determine the best scoring system for pediatric patients.