title: A Clinical Score to Predict Appendicitis in Older Male Children.
abstract: To develop a clinical score to predict appendicitis among older, male children who present to the emergency department with suspected appendicitis.
  
  
  
  Patients with suspected appendicitis were prospectively enrolled at 9 pediatric emergency departments. A total of 2625 patients enrolled; a subset of 961 male patients, age 8-18 were analyzed in this secondary analysis. Outcomes were determined using pathology, operative reports, and follow-up calls. Clinical and laboratory predictors with <10% missing data and kappa > 0.4 were entered into a multivariable model. Resultant β-coefficients were used to develop a clinical score. Test performance was assessed by calculating the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios.
  
  
  
  The mean age was 12.2 years; 49.9% (480) had appendicitis, 22.3% (107) had perforation, and the negative appendectomy rate was 3%. In patients with and without appendicitis, overall imaging rates were 68.6% (329) and 84.4% (406), respectively. Variables retained in the model included maximum tenderness in the right lower quadrant, pain with walking/coughing or hopping, and the absolute neutrophil count. A score ≥8.1 had a sensitivity of 25% (95% confidence interval [CI], 20%-29%), specificity of 98% (95% CI, 96%-99%), and positive predictive value of 93% (95% CI, 86%-97%) for ruling in appendicitis.
  
  
  
  We developed an accurate scoring system for predicting appendicitis in older boys. If validated, the score might allow clinicians to manage a proportion of male patients without diagnostic imaging.
authors.affiliation: Department of Pediatrics Emergency Medicine, Children's Minnesota, Minneapolis. Electronic address: Anupam.kharbanda@childrensmn.org.
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Kharbanda
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bachur
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.
authors.forename: Nanette C
authors.initials: NC
authors.lastname: Dudley
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Denver.
authors.forename: Lalit
authors.initials: L
authors.lastname: Bajaj
authors.affiliation: Department of Pediatrics, University of Louisville, Louisville, Ky.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Stevenson
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
authors.affiliation: Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Mittal
authors.affiliation: Department of Pediatrics, Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, Del.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Bennett
authors.affiliation: Department of Pediatrics, University of Missouri, Kansas City.
authors.forename: Kelly
authors.initials: K
authors.lastname: Sinclair
authors.affiliation: Department of Pediatrics, Columbia University, New York, NY.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D006801:Humans; D016015:Logistic Models; D018655:Lymphocyte Count; D008297:Male; D015999:Multivariate Analysis; D009504:Neutrophils / Q000166:cytology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: appendicitis; clinical scoring systems; pediatrics