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ISSN 1561-3119 (Electronic)

2022, Number 1

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Rev Cubana Pediatr 2022; 94 (1)

Comparative performance of Alvarado scale and the pediatric appendicitis scale in schoolchildren and adolescents

Ramírez GA, Navarro SAB, Villamil MR

Language: Spanish
References: 37
Page: 1-17
PDF size: 836.34 Kb.


ABSTRACT

Introduction: Alvarado scale and the pediatric appendicitis scale are used for the stratification of pediatric patients with suspected appendicitis.
Objective: Compare the diagnostic performance of these scales in schoolchildren and adolescents, in general and according to age and sex.
Methods: Prospective observational study of 452 patients between 5 and 18 years of age, admitted to Centro Habana Pediatric Teaching Hospital due to abdominal pain or acute appendicitis in the period 2016-2017.
Results: Alvarado scale had at <4 points: sensitivity 99.14 %, negative likelihood ratio 0.02; at >7 points: specificity 96.15 %, positive likelihood ratio 10.3. The paediatric appendicitis scale presented at <5 points: sensitivity 96.55 %, negative likelihood ratio 0.07; at >8 points: specificity 96.15 %, positive likelihood ratio 5.60. The areas under the curve had a similar overall (0.851 - 0.858), being higher and similar to each other in male schoolchildren (0.918 - 0.923). In female adolescents, the area under the curve for the pediatric appendicitis scale (0.841) was greater than for Alvarado's (0.802).
Conclusions: Alvarado scale is more specific, while the pediatric appendicitis scale is more sensitive. Different cut-off points should be considered for each scale when stratifying according to probable appendicitis. Discriminative performance behaves similar in general for both scales, and very well in male schoolchildren. The biggest difference in performance occurs in female adolescents, in favor of the pediatric appendicitis scale.


REFERENCES

  1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emer Med. 1986;15(5):557-64.

  2. Samuel M. Pediatric appendicitis score. J Pediatr Sur. 2002;37(6):877-81.

  3. Kulik DM, Uleryk EM, Maguire JL. Does this child have appendicitis? A systematic review of clinical prediction rules for children with acute abdominal pain. J Clin Epidemiol. 2012;66:95-104.

  4. Mandeville K, Pottker T, Bulloch B, Liu J. Using appendicitis scores in the pediatric ED. Am J Emer Med. 2011;29:972-977.

  5. Dokumcu Z, Toker Kurtmen B, Divarci E, Tamay PB, Kose T, Sezak M, et al. Retrospective Multivariate Analysis of Data from Children with Suspected Appendicitis: A New Tool for Diagnosis. Emer Med Int. 2018;2018:4810730. DOI: 10.1155/2018/4810730

  6. Wu H-P, Yang W-C, Wu K-H, Chen C-Y, Fu Y-C. Diagnosing Appendicitis at Different Time Points in Children with Right Lower Quadrant Pain: Comparison Between Pediatric Appendicitis Score and the Alvarado Score. World J Surg. 2012;36(1):216-21.

  7. Ebell MH, Shinholser J. What are the most clinically useful cutoffs for the Alvarado and Pediatric Appendicitis Scores? A systematic review. Ann Emer Med. 2014;64(4):365-72.e2.

  8. Macco S, Vrouenraets BC, de Castro SMM. Evaluation of scoring systems in predicting acute appendicitis in children. Surgery. 2016;160(6):1599-604. DOI: 10.1016/j.surg.2016.06.023

  9. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emer Surg. 2020;15(1):27. DOI: https://doi.org/10.1186/s13017-020-00306-3

  10. Pogorelic Z, Rak S, Mrklic I, Juric I. Prospective validation of Alvarado score and Pediatric Appendicitis Score for the diagnosis of acute appendicitis in children. Pediatr Emer Care. 2015;31(3):164-8. DOI: 10.1097/PEC.0000000000000375

  11. Rentea RM, Peter SDS, Snyder CL. Pediatric appendicitis: state of the art review. Pediatr Surg Int. 2017;33(3):269-83. DOI: 10.1007/s00383-016-3990-2

  12. Sincavage J, Buonpane C, Benyamen B, Benya E, Lautz T, Helenowski I, et al. Alvarado Scores Predict Additive Value of Magnetic Resonance Imaging in Workup of Suspected Appendicitis in Children. J Surg Res. 2019;244:42-9. DOI: 10.1016/j.jss.2019.06

  13. Blitman NM, Anwar M, Brady KB, Taragin BH, Freeman K. Value of Focused Appendicitis Ultrasound and Alvarado Score in Predicting Appendicitis in Children: Can We Reduce the Use of CT? Am J Roentgenol. 2015;204(6):W707-12. DOI: 10.2214/AJR.14.13212

  14. Bhatt M, Joseph L, Ducharme FM, Dougherty G, McGillivray D. Prospective Validation of the Pediatric Appendicitis Score in a Canadian Pediatric Emergency Department. Acad Emer Med. 2009;16(7):591-6.

  15. Fujii T, Tanaka A, Katami H, Shimono R. Usefulness of the pediatric appendicitis score for assessing the severity of acute appendicitis in children. Pediatr Int. 2020;62(1):70-3. DOI:10.1111/ped.14032

  16. El-Gohary Y, Molina M, Chang J, Dodd A, Miller E, Harrell C, et al. The Use of Computed Tomography Versus Clinical Acumen in Diagnosing Appendicitis in Children: A Two-Institution International Study. J Pediatric Surg. 2021;56(8):1356-61. DOI: 10.1016/j.jpedsurg.2020.09.061

  17. Aydin D, Turan C, Yurtseven A, Bayindir P, Toker B, Dokumcu Z, et al. Integration of radiology and a clinical score in pediatric appendicitis. Pediatr Int. 2018;60(2):173-8. DOI: 10.1111/ped.13471

  18. Kobayashi E, Johnson B, Goetz K, Scanlan J, Weinsheimer R. Does the implementation of a pediatric appendicitis pathway promoting ultrasound work outside of a children's hospital? Am J Surg. 2018;215(5):917-20. DOI: 10.1016/j.amjsurg.2018.03.017

  19. Lipsett SC, Bachur RG. Current Approach to the Diagnosis and Emergency Department Management of Appendicitis in Children. Pediatr Emer Care. 2017;33(3):198-203. DOI: 10.1097/PEC.0000000000001049

  20. Planella Cornudella M, Pociello Almiñana N, Domingo Ruiz A, Bringue Espuny X, Rue Monne M, Sole Mir E. Utilidad del Pediatric Appendicitis Score y la ecografía abdominal en el proceso diagnóstico de la apendicitis aguda. Cir Pediatr. 2019 [19/03/2020];32(3):128-34. Disponible en: https://secipe.org/coldata/upload/revista/2019_32-3_128-134.pdf

  21. Bachur RG, Callahan MJ, Monuteaux MC, Rangel SJ. Integration of ultrasound findings and a clinical score in the diagnostic evaluation of pediatric appendicitis. J Pediatr. 2015;166(5):1134-9. DOI: 10.1016/j.jpeds.2015.01.034

  22. Kharbanda AB, Madhok M, Krause E, Vazquez-Benitez G, Kharbanda EO, Mize W, et al. Implementation of Electronic Clinical Decision Support for Pediatric Appendicitis. Pediatrics. 2016;137(5):e20151745. DOI:10.1542/peds.2015-1745

  23. Scheller RL, Depinet HE, Ho ML, Hornung RW, Reed JL. Utility of Pediatric Appendicitis Score in Female Adolescent Patients. Acad Emer Med. 2016;23(5):610-5. DOI: 10.1111/acem.12916

  24. González del Castillo J, Ayuso FJ, Trenchs V, Martinez Ortiz de Zarate M, Navarro C, Altali K, et al. Diagnostic accuracy of the APPY1 Test in patients aged 2-20 years with suspected acute appendicitis presenting to emergency departments. Emer Med J. 2016;33(12):853-9. DOI: 10.1136/emermed-2015-205259

  25. Doniger SJ, Kornblith A. Point-of-Care Ultrasound Integrated Into a Staged Diagnostic Algorithm for Pediatric Appendicitis. Pediatr Emer Care. 2018;34(2):109-15. DOI: 10.1097/PEC.0000000000000773

  26. Dhatt S, Sabhaney V, Bray H, Skarsgard ED. Improving the diagnostic accuracy of appendicitis using a multidisciplinary pathway. J Pediatr Surg. 2020;55(5):889-92. DOI: 10.1016/j.jpedsurg.2020.01.040

  27. Dahn CM, Milne WK. Hot Off the Press: Does This Adolescent Female Have Appendicitis? Can the Pediatric Appendicitis Score Help? Acad Emer Med. 2017;24(1):130-2. DOI: 10.1111/acem.13057

  28. Amini M, Zandbaf T, Alizadeh SA, Jand Y, Hosseini A, Eshrati B, et al. The significance of Alvarado score in the diagnosis of acute appendicitis based on age and sex. (English). Arak Med University J. 2011;14(1):12-8.

  29. Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139.

  30. Tan WJ, Acharyya S, Goh YC, Chan WH, Wong WK, Ooi LL, et al. Prospective Comparison of the Alvarado Score and CT Scan in the Evaluation of Suspected Appendicitis: A Proposed Algorithm to Guide CT Use. J Am Coll Surg. 2015;220(2):218-24. DOI: 10.1016/j.jamcollsurg.2014.10.010

  31. Paramitha D, Fikri E, Nasution I. The accuracy of the Paediatric Appendicitis Score based on age group in cases of acute appendicitis. Stem Cell Oncol. 2018 [20/03/2019];289-92. Disponible en: https://library.oapen.org/bitstream/handle/20.500.12657/30284/646791.pdf?sequence=1#page=305

  32. Salö M, Ohlsson B, Arnbjörnsson E, Stenström P. Appendicitis in children from a gender perspective. Pediatr Surg Int. 2015;31(9):845-53. DOI: 10.1007/s00383-015-3729-5

  33. Song CW, Kang JW, Kim JY. Different Clinical Features and Lower Scores in Clinical Scoring Systems for Appendicitis in Preschool Children: Comparison with School Age Onset. Pediatr Gastroenterolo, Hepatol Nutrit. 2018;21(1):51-8. DOI: 10.5223/pghn.2018.21.1.51

  34. Pogorelic Z, Domjanovic J, Jukic M, Pericic TP. Acute Appendicitis in Children Younger than Five Years of Age: Diagnostic Challenge for Pediatric Surgeons. Surg Infect. 2020;21(3):239-45. DOI: 10.1089/sur.2019.175

  35. Declaración de Helsinki de la Asociación Médica Mundial AMM - Principios éticos para las investigaciones médicas en seres humanos. New York: Representación AMM. 2017 [acceso 14/02/2020] Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/

  36. Bachur RG, Hennelly K, Callahan MJ, Chen C, Monuteaux MC. Diagnostic imaging and negative appendectomy rates in children: effects of age and gender. Pediatrics. 2012;129(5):877-84.

  37. Akgül F, Er A, Ulusoy E, Çaglar A, Çitlenbik H, Keskinoglu P, et al. Integration of Physical Examination, Old and New Biomarkers, and Ultrasonography by Using Neural Networks for Pediatric Appendicitis. Pediatr Emerg Care. 2019;10.1097/PEC.0000000000001904. DOI: 10.1097/PEC.0000000000001904




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