Evaluation of the Reliability of Pediatric Appendicitis Score and Ultrasonography Findings in the Diagnosis of Acute Appendicitis in Children

OpenAlex İngilizce

Objective: Acute appendicitis is the most common surgical emergency in childhood. Early diagnosis is essential to prevent perforation-related morbidity. In this study, we aimed to evaluate the effectiveness of pediatric appendicitis score (PAS) and ultrasonography (USG) findings in the diagnosis of acute appendicitis. Materials and Methods: Patients who presented with acute abdominal pain and who were followed up or operated with a pre-diagnosis of appendicitis were analyzed retrospectively. The patients were divided into two groups as operated (n = 288) and non-operated (n = 161). PAS value of all patients was calculated and 1-4 negative (low risk), 5-6 suspect (moderate risk), 7 and above were considered positive (high risk). Patients who underwent USG were included in the study. The definitive diagnosis of the patients undergoing surgery was confirmed by histopathological evaluation. Results: With the pre-diagnosis of acute appendicitis, 449 patients (171 girls, 278 boys) were hospitalized. Appendectomy was performed in 288 (64 %) of the patients. The remaining 161 patients (36 %) who recovered after the observation were discharged without any surgery. Histopathological diagnosis of patients undergoing appendectomy was acute appendicitis in 217 patients (75.3 %), perforated appendicitis in 67 patients (23.2 %) and normal appendix in 4 patients (1.4 %). Patients undergoing appendectomy had a significantly higher PAS value (p < 0.001). PAS value was significantly higher in the patients diagnosed with perforated appendicitis (p < 0.05). The sensitivity of USG and PAS were 81.59 % and 82.98 %, and their specificity was 88.81 % and 95.03 %, respectively, in the diagnosis of appendicitis. The sensitivity decreased significantly (67.70 %), and the specificity increased (100 %) when the patients with appendicitis in USG and PAS 7 and above were evaluated together. The sensitivity was 32.29 % and the specificity was 83.85 % when USG positivity or high-risk PAS value was used alone. Conclusion: PAS is a useful clinical guide in determining the risk group for appendicitis and the use of additional imaging, and supports the diagnosis even in the high-risk group without additional imaging. However, in cases of incompatibility between USG and PAS values, we believe that close observation, repeated physical examination and, if necessary, further imaging are necessary to reduce the rate of negative appendectomy.