Using appendicitis scores in the pediatric ED.
OBJECTIVE
The aims of the study were to prospectively evaluate the Alvarado and Samuel (pediatric appendicitis score [PAS]) appendicitis scoring systems in children and determine performance based on sex.


METHODS
Children with abdominal pain concerning for appendicitis were recruited. Nine parameters evaluated by the scores were documented before imaging/surgery consultation. Test characteristics were calculated on all patients and by sex.


RESULTS
Two hundred eighty-seven patients enrolled; median age was 9.8 years; and 155 (54%) were diagnosed with pathologic examination-confirmed appendicitis. Patients with appendicitis had mean PAS of 7.6, and those without had mean of 5.6 (P < .001). Patients with appendicitis had a mean Alvarado of 7.2, and those without had a mean of 5.2 (P < .001). In appendicitis patients, PAS cutoff of 6 or greater would give 137 correct diagnoses; sensitivity, 88%; specificity, 50%; and positive predictive value (PPV), 67%. An Alvarado cutoff of 7 or greater would give 118 correct diagnoses; sensitivity, 76%; specificity, 72%; and PPV, 76%. Both performed better in males than females.


CONCLUSIONS
Regardless of sex, neither PAS nor Alvarado has adequate predictive values for sole use to diagnose appendicitis.
Mandeville
Katherine
K
Department of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
Pottker
Tamara
T
Bulloch
Blake
B
Liu
Jiexin
J
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D001064:Appendicitis / Q000175:diagnosis*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012737:Sex Factors; D014057:Tomography, X-Ray Computed