Pediatric Appendicitis Score a Better Diagnostic Tool in Indian Children with Lower Abdominal Pain

A recent study aimed to evaluate the efficacy of the Pediatric Appendicitis Score (PAS) in diagnosing acute appendicitis among children with lower abdominal pain, the correlation with ultrasound findings was assessed, and to determine the impact of PAS on clinical outcomes and its effectiveness in distinguishing between complicated and uncomplicated appendicitis.

This study involved a prospective examination of 260 cases presenting with lower abdominal pain, where appendectomy was performed for those with PAS ≥ 6, and histopathology confirmed the diagnosis. The performance of PAS was evaluated using a Receiver Operator Characteristic (ROC) curve. The sensitivity, specificity, and accuracy of ultrasound in diagnosing appendicitis were determined, and the agreement between ultrasound and PAS score was analyzed using kappa statistics.

The results revealed that 205 cases were suspected of appendicitis, with 159 having PAS ≥ 6. There were 2 cases (1.26%) of negative appendectomies and 2 cases (4.34%) of missed appendicitis. The mean PAS was significantly higher in patients with appendicitis compared to those without. The ROC curve showed an area under the curve of 0.9925 – indicating high diagnostic performance. PAS demonstrated a sensitivity of 98.74%, specificity of 95.65%, and positive and negative predictive values of 95.7% and 95.65%, respectively. Complicated appendicitis exhibited higher PAS, fever, and cough tenderness than uncomplicated cases. Ultrasound sensitivity and specificity were 86.79% and 17.39%, respectively, with weak agreement between ultrasound-proven appendicitis and PAS-dependent appendicitis.

Therefore, PAS proved to be highly effective in diagnosing acute appendicitis, contributing to more favorable clinical outcomes. The findings suggested judicious use of ultrasound in conjunction with clinical judgment.

Source: Nandan R, SamieAU, Acharya SK, et al. Indian J Pediatr. 2023;90:1204–1209.