Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
The diagnosis of acute appendicitis carries significant difficulties, particularly in very young ages on which the history and physical examination are difficult. The clinical challenge is to diagnose appendicitis early enough to prevent perforation, while minimizing the number of negative appendicitis that are performed. The diagnosis of acute appendicitis is primarily clinical and the clinical scoring systems have been investigated as alternatives or adjuncts to diagnostic imaging.
OBJECTIVE:
Is to establish the accuracy and applicability of using pediatric appendicitis scoring system (PAS) in evaluating acute appendicitis in pediatric age group.
METHODS:
A prospective cohort study was conducted in Al-Khansaa Teaching Hospital and Children Welfare Teaching Hospital, from January 2014 till November 2015. The study includes 143 patients aged from (3-13) years old referred from pediatric emergency unit or outpatient clinic with suspicion of acute appendicitis. All the obtained data were analyzed using pediatric appendicitis score (PAS) system which classifies the patients into 3 groups: Group (1): Patients with scoring (1-3) includes 38 patients, Group (2): Patients with scoring (4-6) includes 20 patients, while Group (3): Patients with scoring (7-10) includes 85 patients. Surgery was done to all patients of group 3 and thirteen patients of group 2. All removed appendices were sent for histopathological study.
RESULTS:
The median age of the 98 operated on patients was (8.9 years ± 2.6). The histopathological results of appendicitis were confirmed in 89 patients underwent surgery (five patients of group 2 and 84 patients of group 3), while negative histopathological result of appendicitis is seen in nine (9.2%) patients. There is significant association of positive histopathological findings with high PAS (≥7) scoring (p<0.0001). The 8 parameters of PAS system shows accuracy as following: the right lower quadrant tenderness, anorexia and hop tenderness shows accuracy of 90.8%, 87.8% and 86.7% respectively, while leukocytosis, fever and nausea/vomiting shows accuracy of 83.7%, 80.6% and 63.3% respectively. Migration of pain and PMN neutrophilia shows the lowest accuracy rate. The sensitivity of PAS system was 94.4%, the specificity was 88.9%, the PPV was 98.8%, the NPV was 61.5% with overall accuracy of PAS system was 93.9%.
CONCLUSION:
PAS system is easy, simple and useful tool in pre-operative diagnosis of acute appendicitis and can be used by pediatricians to reduce the number of admission to the hospital. Patients with scores of ≥ 7 show high probability of appendicitis and early operation is indicated, while patients with score of ≤3 rule out this disease. The CT scan and diagnostic laparoscopy is advocated for patients with score of (4-6).