Abstract

Objective: Pediatric appendicitis score (PAS) is a scoring system which is improved to simplify the diagnosis of appendicitis in children. In this article it is aimed to investigate the efficiency of PAS and additional laboratory data in diagnosing appendicitis.

Material and Methods: Between 1st January 2010 and 31st December 2010, patients admitted to our department that are followed up and treated with an initial diagnosis of acute abdomen were reviewed retrospectively. Patients which were operated and histopathological examination confirmed the diagnosis appendicitis is defined as 1st group, and the patients with negative exploration and the ones that are non-operated are defined as 2nd group. Groups are compared in terms of demographic data, hospitalization time, PAS and laboratory data.

Results: A total of 562 patients (321 male, 241 female) with an initial diagnosis of acute abdomen are admitted to our department in the one-year period. There were 350 patients (224 acute, 126 complicated appendicitis) in the 1st group, and 212 patients (31 negative exploration, 181 follow-up) in the 2nd group. While the preoperative hospitalization time between the acute and complicated cases did not have significant difference (p>0.05), complicated cases had a long postoperative hospitalization time (p<0.001). PAS had significant difference between the acute, complicated and negative explorations (p<0.001). PAS was increased proportional to the severity of the appendicitis (p<0.001). White blood cell count, neutrophile count, neutrophile percentage, neutrophile/lymphocyte (N/L) ratio, and C-reactive protein (CRP) rates were significantly higher in the appendicitis group (p<0.001). Fever (in the 1st group 29.1%) and the migration of pain to right-lower quadrant (in the 1st group 6.2%) that are the PAS components had at least contribution to the scoring. Instead, the usage of N/L (81% higher in the 1st group) and CRP (76% higher in the 1st group) values increases the sensitivity of the score from 88.6% to 91.1% in diagnosing appendicitis. conclusion: Addition of the N/L ratio and CRP values may increase the diagnostic ability of the PAS which is composed of clinical and laboratory indications

Keywords: Appendicitis, Blood cell count, Child, C-reactive protein, Physical examination

References

  1. Shera AH, Nizami FA, Malik AA, Naikoo ZA, Wani MA. Clinical scoring system for diagnosis of acute appendicitis in children. Indian J Pediatr 2011;78:287-90.
  2. Goldman RD, Carter S, Stephens D, Antoon R, Mounstephen W, Langer JC. Prospective validation of the pediatric appendicitis score. J Pediatr 2008;153:278-82.
  3. Kıyak G, Korukluoğlu B, Özgün Y, Devay AÖ, Kuşdemir A. Apandisit tanısında Ohmann ve Eskelinen skorları ile lökosit sayısı ve ultrasonografi bulgularının değerlendirilmesi. Ulus Travma Acil Cerrahi Derg 2009;15:77-81.
  4. Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Laboratory tests in patients with acute appendicitis. ANZ J Surg 2006;76:71-4.
  5. Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002;37:877-81.
  6. Ohmann C, Franke C, Yang Q. Clinical benefit of a diagnostic score for appendicitis: Results of a prospective interventional study. German study group of acute abdominal pain. Arch Surg 1999;134:993-6.
  7. Çavuşoğlu YH, Erdoğan D, Karaman A, Aslan MK, Karaman İ, Tütün ÖÇ. Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis. Pediatr Surg Int 2009;25:277-82.
  8. Yazıcı M, Özkısacık S, Öztan MO, Gürsoy H. Neutrophil/lymphocyte ratio in the diagnosis of childhood appendicitis. Turk J Pediatr 2010;52:400-3.
  9. van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA. Acute appendicitis: Meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 2008;249:97-106.
  10. Lintula H, Pesonen E, Kokki H, Vanamo K, Eskelinen M. A diagnostic score for children with suspected appendicitis. Langenbecks Arch Surg 2005;390:164-70.
  11. Kamran H, Naveed D, Nazir A, Hameed M, Ahmed M, Khan U. Role of total leukocyte count in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2008;20:70-1.
  12. Thomson C, Underwood M, Dookeran K, Lloyd D, Bell P. Role of sequential Leukocyte count and CRP in the diagnosis of acute appendicitis. Br J Surg 1992;79:822-4.

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How to cite

1.
Ertürk A, Tuncer İS, Balcı Ö, Karaman İ, Karaman İ, Afşarlar ÇE, et al. The Value of Pediatric Appendicitis Score and Laboratory Findings on the Diagnosis of Pediatric Appendicitis. Turk J Pediatr Dis [Internet]. 2015 Jun. 1 [cited 2025 May 25];9(2):79-84. Available from: https://turkjpediatrdis.org/article/view/330