title: A scoring system to predict the severity of appendicitis in children.
abstract: BACKGROUND
  It appears that two forms of appendicitis exist. Preoperative distinction between the two is essential to optimize treatment outcome. This study aimed to develop a scoring system to accurately determine the severity of appendicitis in children.
  
  
  METHODS
  Historical cohort study of pediatric patients (aged 0-17 y old) with appendicitis treated between January 2010 and December 2012. Division into simple, complex appendicitis, or another condition based on preset criteria. Multiple logistic regression analysis was used to build the prediction model with subsequent validation.
  
  
  RESULTS
  There were 64 patients with simple and 66 with complex appendicitis. Five variables explained 64% of the variation. Independent validation of the derived prediction model in a second cohort (55 simple and 10 complex appendicitis patients) demonstrated 90% sensitivity (54-99), 91% specificity (79-97), a positive predictive value of 64% (36-86), and an negative predictive value of 98% (88-100). The likelihood ratio+ was 10 (4.19-23.42), and likelihood ratio- was 0.11 (0.02-0.71). Diagnostic accuracy was 91% (84-98).
  
  
  CONCLUSIONS
  Our scoring system consisting of five variables can be used to exclude complex appendicitis in clinical practice if the score is <4.
authors.affiliation: Department of Paediatric Surgery, Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands. Electronic address: rr.gorter@vumc.nl.
authors.forename: Ramon R
authors.initials: RR
authors.lastname: Gorter
authors.affiliation: Department of Surgery, IJsselland Hospital, Capelle aan Den IJssel, The Netherlands.
authors.forename: Anne Loes
authors.initials: AL
authors.lastname: van den Boom
authors.affiliation: Department of Paediatric Surgery, Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Heij
authors.affiliation: Department of Paediatric Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: C M Frank
authors.initials: CM
authors.lastname: Kneepkens
authors.affiliation: Department of Paediatric Surgery, Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Caroline C
authors.initials: CC
authors.lastname: Hulsker
authors.affiliation: Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Tenhagen
authors.affiliation: Department of Surgery, IJsselland Hospital, Capelle aan Den IJssel, The Netherlands.
authors.forename: Imro
authors.initials: I
authors.lastname: Dawson
authors.affiliation: Division Woman and Child, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Johanna H
authors.initials: JH
authors.lastname: van der Lee
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: Appendicitis; Clinical prediction rule; Complex appendicitis; Scoring system