Utility of a scoring system in the diagnosis of acute appendicitis in pediatric age. A retrospective study.
BACKGROUND
Acute appendicitis is the most frequent cause of surgical emergency in pediatric age. The aim of this study has been to evaluate the diagnostic accuracy of a scoring system, retrospectively applied, to the clinical and laboratory parameters in patients with acute appendicitis.


METHODS
A group of 156 patients admitted for acute abdominal pain and operated for appendectomy, in the last 3 years, has been included in the study. The mean age was 8.4 years. The modified Alvarado score has been used as scoring system: white count, neutrophil count, fibrinogen level, body temperature, resistance in the right iliac fossa, length of symptoms, nausea/vomiting. The score has been calculated for each patient. They were subdivided into 3 groups. Group I (score 1-4), no admission; Group II (5-6), admission and observation; Group III (7-10), surgery. This subdivision was then compared with the intraoperative notes.


RESULTS
Patients were divided into 3 groups. Group I, 24 patients (15%); Group II, 34 patients (22%); Group III, 98 patients (63%). On the basis of the intraoperative notes 61 patients had acute appendicitis and 95 complicated acute appendicitis. In this last subgroup the score gave a percentage of patients to operate of 90.5%.


CONCLUSIONS
With the present work we confirm the utility of a scoring system in the preoperative diagnosis of acute appendicitis and in our opinion it is a useful system for a first, rapid and economic evaluation in the pediatric emergency department.
Impellizzeri
P
P
Pediatric Surgery Unit, Department of Medical and Surgical Pediatric Sciences, University of Messina, Messina, Italy.
Centonze
A
A
Antonuccio
P
P
Turiaco
N
N
Cifalà
S
S
Basile
M
M
Argento
S
S
Romeo
C
C
D000006:Abdomen, Acute / Q000209:etiology; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D001831:Body Temperature; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D009325:Nausea / Q000209:etiology; D009504:Neutrophils; D012189:Retrospective Studies; D014839:Vomiting / Q000209:etiology
D005340:Fibrinogen