Availability of Pediatric Appendicitis Score (PAS) for the Prediction of Complicated Appendicitis in Children

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  • Kono Jun
    Department of Pediatric Surgery, Iizuka Hospital Present address: Department of Pediatric Surgery, Faculty of Medical Sciences, Kyushu University
  • Nakamura Masatoshi
    Department of Pediatric Surgery, Iizuka Hospital

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Other Title
  • Pediatric Appendicitis Score（PAS）を用いた小児複雑性虫垂炎の術前診断についての検討
  • Pediatric Appendicitis Score (PAS)オ モチイタ ショウニ フクザツセイ チュウスイエン ノ ジュツゼン シンダン ニ ツイテ ノ ケントウ

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<p>Purpose: Complicated appendicitis (CA) often needs to be managed surgically, and it is desirable that CA is diagnosed as soon as possible. The aim of this study is to identify a cutoff of the Pediatric Appendicitis Score (PAS) for CA in children. </p><p>Methods: Children who underwent appendectomy because of acute appendicitis in our hospital from May 2013 to September 2017 were enrolled in this study. We retrospectively identified a cutoff PAS for CA.</p><p>Results: One hundred twenty patients were included in the study, 75 of whom were male and 45 were female with a mean age of 10.3 years. Complicated appendicitis was found in 50 patients, and simple appendicitis (SA) was found in 70 patients. The histopathological diagnoses were gangrenous appendicitis (44 cases), phlegmonous appendicitis (71 cases), catarrhal appendicitis (3 cases), and normal appendix (2 cases). The PAS was significantly different between CA and SA (CA: median 8.0, IQR 7.3–9.0 vs SA: median 6.0, IQR 5.0–7.0, p<0.001). The area under the curve was 0.83 (95%CI: 0.80–0.93) based on the receiver operating characteristic curve. When the cutoff PAS was 8, the sensitivity was 0.74 and the specificity was 0.89.</p><p>Conclusion: The usefulness of PAS alone for the diagnosis of CA is limited. However, the PAS of CA is significantly higher than that of SA, and a child with a PAS of more than 8 is strongly suspected of having CA. Computed tomography can be performed when ultrasonography is inconclusive.</p>

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