Clinical Criteria for Diagnosing Perforated Appendix in Pediatric Patients

Abstract

The use of our proposed scoring system to determine the indications to perform an abdominal ultrasound may prove to assist in deciding treatment (medical vs surgical) for children with perforated appendix. Initial antibiotic treatment followed by interval appendectomy would become a more likely treatment option if our study results can be validated in a prospective study.

A scoring system to predict the severity of appendicitis in children

“…Objective variables obtained from blood samples and imaging studies are usually better reproducible and therefore of higher value. As supported by many other studies, CRP was found to contribute significantly to the prediction of complex appendicitis [12,14,15,23,24,26,28,29]. A meta-analysis in 2004, focusing on the diagnosis of acute appendicitis in children as well as adults, reported that high WBC, high granulocyte count, and elevated CRP are strong predictors of complex appendicitis [12].…”

“…Recently, a retrospective study in 161 pediatric patients, evaluating the value of ultrasound in distinguishing simple from complex appendicitis, identified signs of an abscess, intraluminal appendicolith, and loss of submucosal echogenic layer of the appendix to be associated with appendicular perforation [37]. Another study reported a specificity of 98% and a PPV of 95%, but with a sensitivity of 35% and a NPV of 55%, with an overall diagnostic accuracy of 62%e64% for ultrasound to differentiate simple from complex appendicitis [15]. The interpretation of ultrasound is operator dependent.…”

“…Although it is not surprising that abscess-and appendicular-contained phlegmon are indicative of complex appendicitis, information on the value of ultrasound in differentiating simple from complex appendicitis in children is scarce [15]. For the diagnosis of acute appendicitis, ultrasound is the diagnostic modality of choice in children; it has higher sensitivity (99%), specificity (95%), and PPV (97%) than those in adults [34e36].…”

“…The goals of the scoring systems vary. Some determine the necessity of additional imaging studies [15,16], whereas others use it for therapeutical goals [13,14]. The reason for us to develop a scoring system was to assess the type of acute appendicitis so that in the future we can choose the optimal treatment strategy for each type.…”

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

“…Diagnosing AA in children remains challenging due to atypical presentations and difficulty of obtaining a reliable history and physical examination, especially in younger children . Prompt diagnosis of AA can prevent complications such as perforation and abscess formation …”