Evaluation of a new scoring system for early diagnosis and management of acute appendicitis in pediatric patients

Background
Acute appendicitis is a common surgical emergency among infants and children. The diagnosis of acute appendicitis in young children remains a big challenge, as most of such patients present late, with complications. However, unnecessary surgery should be avoided. Over years, many scoring systems have been introduced for helping the diagnosis of acute appendicitis such as Alvarado score, the Pediatric Appendicitis Score (PAS), and Appendicitis Inflammatory Response score.
Patients and methods
In the period between 3/2018 and 9/2019, 130 infants and children till the age of 16 years, with acute right iliac pain, were included in this study. These patients were evaluated using three diagnostic scores: Acute Pediatric Appendicitis Score (APAS), PAS, and Alvarado scores.
Results
Logistic regression analysis yielded a model comprising nine variables, all being statistically significant (<0.001). Moreover, we found a significant correlation between the management findings and four APAS items, including anorexia, right lower quadrant tenderness, cough/percussion tenderness, and positive ultrasound findings, as they showed the highest significant values statistically and were very predictive regarding the management of the cases, with the ultrasound examination showing the most accuracy value between all the items. The accuracy of APAS score to differentiate between both surgical appendicitis and conservative appendicitis groups was 99.2%, sensitivity was 100%, specificity was 98.04%, positive predictive value was 98.7%, and negative predictive value was 100%, whereas the accuracy of PAS score was 95.3%, and the accuracy of Alvarado score was 91.3%.
Conclusion
APAS score is a significant diagnostic tool for diagnosis of acute appendicitis in pediatrics. The study also provides a solid comparison among APAS, PAS, and Alvarado scores. APAS score is the first score in well-known literature to introduce ultrasound examination as a routine investigation among the suspected children with acute appendicitis with an accuracy of ∼95.38%.