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Validation of pediatric appendicitis inflammatory response score in the diagnosis of acute appendicitis in children between ages of 3 to 18 years: An observational study

Jayakanthan S*, Krithika AP, Suresh Babu P, Sasi Kumar

Introduction: Acute appendicitis is one of the most common pediatric surgical emergencies resulting in 1%–2% of pediatric surgical admissions. The diagnosis of acute appendicitis is rather difficult in pediatric age group as the signs and symptoms mimic other illnesses especially in the early stage. So, it is the most challenging aspect for a surgeon is to decide, whether to operate or not without increasing the rate of unnecessary surgical exploration. There are many scores to clinically diagnose appendicitis like Alvarado, Lintula, Fenyo-Lindberg, and RIPASA scoring systems. The most frequently used ones are the Alvarado and appendicitis inflammatory response score. Though there are many studies to validate alvarado score, only very few are available for pediatric appendicitis inflammatory response score in children. Aim: The main aim of our study was to find out the usefulness of pediatric appendicitis inflammatory scoring system in the diagnosis of acute appendicitis. 88 children between the ages of 3 to 18 years, presenting with symptoms and signs of acute appendicitis to the Emergency room and in whom emergency appendicectomy was done were included in the study. They were evaluated using pediatric appendicitis inflammatory scoring system and the total score was given to each patient. Results: In age group of 3 to 6 years, there were 4% of children diagnosed with acute appendicitis. In the age group of 7 to 12 years about 13.6% and in the age group of 12 to 18 years, 81% of children were diagnosed with acute appendicitis based on pediatric appendicitis inflammatory response score. Boys outnumbered girls with the ratio of 1.58:1. Nausea, vomiting (90%) followed by right lower quadrant pain (88.6%) were the commonest of all the symptoms followed by anorexia (87%) and percussion tenderness (85%). 69 children who had score of 7 to 10 underwent appendicectomy. Out of the 13 children, 3 children worsened with scores going above 6. Of the 72 children who were opened up for appendicectomy, 69 children had appendicitis which was proved histopathological. Finally the validity of pediatric appendicitis inflammatory scoring system was done by calculating the positive predictive value (the proportion of patients with a positive test result who actually have the disease) and the negative predictive value. The proportion of patients with a negative test result who actually did not have the disease. The positive predictive value was found out to be as high as 92.7% Conclusion: In our study, 92.7% of the children had appendicitis and negative appendicectomy rates were 4.16% and the positive predictive value of the scoring system was 92.7%. So, the pediatric appendicitis inflammatory scoring system can be reliably used for clinically diagnosing acute appendicitis in children.