Clinical scores for prediction of acute appendicitis in children in a hospital of Lima, Peru

Abstract

Objective To determine the usefulness of the Alvarado score and the Pediatric Appendicitis score (PAS) in the Pediatric Emergency of the National Hospital Daniel A. Carrion.
Materials and methods A prospective observational study was carried out of patients younger than 15 years of age with abdominal pain and suspected acute appendicitis (AA) attending the Pediatric Emergency in a Hospital of Lima, Peru. These patients underwent a survey to assess the parameters of the Alvarado score and PAS.
Results Three hundred and seventeen patients with abdominal pain and suspected of AA were recruited over a study period of 12 months. Of the patients, 232 were considered to have AA clinically and underwent surgery. 85.3% were confirmed by pathology and 14.7% were normal. The mean Alvarado score was 8.27± 1.31; the mean Surgical Procedure Assessment (SPA) score was 8.08± 1.47. Sensitivity and specificity for both scores are equivalent. The area under the curve for the Alvarado score and SPA were 0.887 and 0.901, respectively. Alvarado score higher than 6 had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 88.9, 75.6, 97.4, 68.1, and 86.4%, respectively. SPA higher than 6 points had sensitivity, specificity, PPV, NPV, and accuracy of 84.3, 80.7, 94.7, 73.1, and 86.7%, respectively.
Conclusion Alvarado score and the PAS are scores with high sensitivity, specificity, PPV, and accuracy for the diagnosis of AA when the score is higher than 6 points. The results found in our study justify their use in emergency services, but they should not be used as the only means of clinically determining the need for surgery.

Keywords: acute appendicitis, children, prediction, scores