Scoring System for Differentiation of Complicated Appendicitis in Pediatric Patients: Appendicitis Scoring System in Children

Abstract

Although several scoring systems have been used to differentiate simple acute appendicitis from perforated appendicitis, no particular system has been widely accepted. Therefore, this study aimed to investigate preoperative factors associated with complicated appendicitis and to develop a scoring system that distinguishes complicated appendicitis in children aged <10 years. Patients aged <10 years who underwent surgical treatment for acute appendicitis between 2011 and 2019 were included in this study, after excluding those with insufficient medical records, with other diseases that affect the length of hospitalization, or without formal reports of abdominal computed tomography (CT) or ultrasonography (US). Complicated appendicitis was defined as hospitalization for ≥5 days postoperatively or readmission within 30 days postoperatively. Patient characteristics, symptoms, physical examination, laboratory data, and radiographic results were collected to determine predictors of complicated appendicitis. The mean age of 279 patients was 7.3 years. Among them, 57 patients had complicated appendicitis. A scoring system was developed based on the following 5 independent risk factors derived from multiple logistic regression analysis: body temperature, anorexia, diarrhea, C-reactive protein (CRP) level, and presence of periappendiceal free fluid on CT or US. The scoring system resulted in an area under the curve of .898 ( P < .001). For patients aged <10 years, a new model that includes objective factors, such as body temperature, CRP levels, and radiography results, might help predict complicated appendicitis and determine treatment plans.

Applicability of predictive models for 30-day unplanned hospital readmission risk in paediatrics: a systematic review

“…Adding one additional recommended article 31 , we found that this results in 109 records being included in the full-text assessment. Among the 84 excluded records, 2 were predictive model studies for 30-day HRs (ie, UHRs and planned HRs) with discrimination metrics 32 33 ; 12 studies analysed 30-day UHRs or 30-day HRs combined with another outcome (ie, emergency department return visits (n=5), 34–38 mortality (n=3) 39–41 and other complications (n=4) 42–45 ); 3 were predictive model studies for 30-day UHRs or 30-day HRs with no discrimination metrics 46–48 ; 5 were non-regression-based predictive model studies for 30-day UHRs or 30-day HRs in paediatrics 21 49–52 ; and 59 were prognostic factor studies for 30-day UHRs or 30-day HRs. Based on the full-text assessments (n=25) and the hand search of reference lists (n=3 53–55 ), 28 studies were included in the systematic review, with 6 of them 55–60 already presented in a previous systematic review 3 with a different focus.…”

Related Markers for the Precision Diagnosis of Complex Appendicitis in Children

“…Lee et al developed a scoring system capable of differentiating CA in children under 10 years of age, which consisted of five risk factors: diarrhea, anorexia, temperature, CRP level, and presence of periappendiceal free fluid on radiological examination. Among them, fever ( Bonadio et al, 2018 ; Obinwa et al, 2015 ; Peng et al, 2006 ; van den Bogaard et al, 2016 ; Atema et al, 2015 ; Augustin et al, 2011 ) and CRP level ( van den Bogaard et al, 2016 ; Lee et al, 2021 ; Barreto et al, 2010 ; Bröker et al, 2012 ) were found to be predictors of CA in previous studies. The advantages of this score over other scores is that it includes CRP levels and excludes indistinguishable symptoms, such as pain metastasis and nausea.…”

“…To reduce the risk of delaying treatment due to misclassification of CA as uncomplicated appendicitis using this scoring system, this score uses a score of 4 as the threshold value to distinguish CA from SA. Appendectomy should be considered if the patient meets both an ASS score of four and CRP ≥ 50 mg/L or has two or more risk factors ( Lee et al, 2021 ).…”

Establishment of predictive models for acute complicated appendicitis during pregnancy—A retrospective case–control study

“…5 The early identification of CA is expected to improve pregnancy outcomes, but it is challenging to differentiate CA from UCA based solely on the clinical information or the radiologic findings. 8 Some scoring systems have been used to predict CA (some for children [9][10][11] and some for adults 8,[12][13][14] ); however, there is currently no scoring system for use in pregnant patients. The objective of this study was to develop a scoring system based on clinical and imaging features to distinguish CA from UCA during pregnancy in a convenient way.…”

“…Some scoring systems have been used to predict CA (some for children 9–11 and some for adults 8,12–14 ); however, there is currently no scoring system for use in pregnant patients. The objective of this study was to develop a scoring system based on clinical and imaging features to distinguish CA from UCA during pregnancy in a convenient way.…”