The Role of Alvarado and Pediatric Appendicitis Score in Acute Appendicitis in Children

INTRODUCTION: Acute appendicitis is the condition that most commonly requires a surgical procedure in children presented with acute abdominal pain to the emergency department. Alvarado and Pediatric Appendicitis Scores (PAS) are the most widely used scoring systems in the diagnosis of acute appendicitis in children. This study aims to evaluate the effectiveness of Alvarado and PAS scores in the diagnosis of acute appendicitis in children.
METHODS: One hundred and two patients aged 3-17 years, who admitted to the pediatric emergency department with acute abdominal pain and had a clinical suspicion of acute appendicitis were included in the retrospective study. The demographic characteristics, laboratory and radiological findings, and Alvarado and PAS scores were obtained from the records of the patients, retrospectively. According to the results of pathology, n = 48 patients for acute appendicitis group (AA) and n = 54 patients for non-acute appendicitis group (non-AA) have been found. AA and non-AA groups were compared in terms of PAS and Alvarado scores.
RESULTS: The mean age of 102 patients was 9.38±3.90, and 62 (60.85%) of them were male. The median PAS score was 7.79±1.2 (8) and 5.52±1.34 (6), and the median Alvarado score was 7.98±1.14 (8) and 5.89±1.53 (6) in AA and N-AA groups, respectively (p<0.001, p<0.001). For the PAS, the cut-off score was >7 with sensitivity 66.7%, specificity 94.4%, positive predictive value (PPV) 91.4%, and negative predictive value (NPV) 76.1% (p<0,001). For the Alvarado score, the cut-off was >7, with sensitivity 77.1%, specificity 85.2%, PPV 82.2%, and NPV 80.7% (p<0,001).

DISCUSSION AND CONCLUSION: Although both PAS and Alvarado scores provide useful diagnostic information in patients suspected of acute appendicitis, none of them is enough diagnose acute appendicitis alone.