title: A diagnostic score for children with suspected appendicitis.
abstract: OBJECTIVE
  Appendicectomy is an operation that is often performed without certainty of diagnosis. This study aimed to construct and to validate a prognostic score for the diagnosis of acute appendicitis in children.
  
  
  METHODS
  Data for 35 symptoms and signs were prospectively recorded for 131 consecutive children with suspected appendicitis. Logistic regression analysis of the variables yielded a diagnostic score: gender (male 2 points, female 0) + intensity of abdominal pain (severe 2, mild or moderate 0) + relocation of pain (yes 4, no 0) + vomiting (yes 2, no 0) + pain in the right lower abdominal quadrant (yes 4, no 0) + fever (yes 3, no 0) + guarding (yes 4, no 0) + bowel sounds (abnormal 4, normal 0) + rebound tenderness (yes 7, no 0). The cut-off level for recommendation of appendicectomy was > or =21, and the cut-off level for non-appendicitis was < or =15. The score was prospectively validated on 109 children.
  
  
  RESULTS
  In the validation sample, based on clinical judgment, unnecessary appendicectomy was performed in ten (27%) children, and one (4%) child was misdiagnosed as not having appendicitis. By application of the score, unnecessary appendicectomies would have been reduced to four (13%), and three children (11%) with appendicitis would have been discharged.
  
  
  CONCLUSIONS
  The use of a predictive mathematical model may facilitate the diagnosis of appendicitis to avoid unnecessary operations.
authors.affiliation: Department of Pediatric Surgery, Kuopio University Hospital, PO Box 1777, 70211 Kuopio, Finland. hannu.lintula@kuh.fi
authors.forename: Hannu
authors.initials: H
authors.lastname: Lintula
authors.forename: Erkki
authors.initials: E
authors.lastname: Pesonen
authors.forename: Hannu
authors.initials: H
authors.lastname: Kokki
authors.forename: Kari
authors.initials: K
authors.lastname: Vanamo
authors.forename: Matti
authors.initials: M
authors.lastname: Eskelinen
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D019564:Unnecessary Procedures
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