Validation of Clinical Scoring System in the Primary Care of Children with Suspected Acute Appendicitis

Abstract

Objective: To establish a scoring system for the diagnosis of acute appendicitis in children in order to decrease the rate of negative and delayed appendectomies and delayed.
Methods: Record charts of pediatric patients admitted with suspected appendicitis at the Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital during July 2000 - September 2001 were retrospectively reviewed. Clinical predictors were listed out and weighed as coefficients, which were later formed into a score equation. The score was then prospectively studied in the following year from October 2001-September 2002. The score was used to aid decision making in the management of cases suspected of appendicitis. The out come was compared to the conventional management based on histologically confirmed diagnosis.
Results: The retrospectively collected data listed out 14 significant variables. Using logistic regression, the parameters were weighed as coefficients, which became scores to each parameter. The score was applied to a consecutive series in the following year. By using the score, the patients were categorized into three groups: discharged, observed and operated. The accuracy of the score is 85.83% with a positive predictive value of 96.55% and negative predictive value of 75.81%. From this study group, the negative appendectomy rate is 4.17% and the perforation rate is 6.67%. Compared to the previous year during which 133 children were treated under the conventional management, the negative appendectomy rate was 4.51% and the perforation rate was 21.8%
Conclusion: The scoring system is an accurate diagnostic tool, which proves the importance of history taking, physical examination in coordination with laboratory investigations and close observation. Altogether these parameters can reduce the rate of misdiagnosis and delayed diagnosis of pediatric appendicitis.