Original articleProspective Validation of the Pediatric Appendicitis Score
Section snippets
Methods
The study was approved by the Hospital for Sick Children Research Ethics Board. Between September 1, 2003, and March 31, 2005, we prospectively recruited children 1 to 17 years old who came to our tertiary urban pediatric emergency department in Toronto, Ontario, Canada, with a chief complaint of abdominal pain of less than 7 days duration. Our emergency department census is 50,000 children a year, with 24hour coverage by a pediatric emergency medicine staff and an in-hospital pediatric surgery
Results
A total of 1060 patients were approached to participate in the study, and 849 (80%) children 1 to 17 years old were recruited to the study and fulfilled the inclusion and exclusion criteria. We had no study attrition; all patients for whom consent was obtained were included in the study. A total of 123 patients (14.5%) had pathology-proven appendicitis. Comparison between the study group and the control group are presented in Table I. The mean (median, SD, range) score for children with
Discussion
We found PAS score24 to be valid for the diagnosis of appendicitis when the PAS was 7 or greater, and for the exclusion of appendicitis when the PAS was 2 or under. For children who have a PAS between 3 and 6, the score cannot accurately determine the diagnosis. This is the group in which further investigation using imaging studies is needed (Figure 1).
Several scoring systems have been suggested previously in the literature,12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 most in adults. In a
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2020, American Journal of Emergency MedicineCitation Excerpt :Notably, WBC was the most commonly reported laboratory test (10 studies) followed by ANC or percentage of neutrophils [28-30] (seven studies). The most commonly reported cutoff for WBC is 10,000 cells/mm3 (in nine studies), while the cutoff for ANC varied somewhat among studies: 7500 cells/mm3 in three studies [19,23,26] and 6750 cells/mm3 in one [31]. Our study confirms these cutoff points and the strong association between low ANC and the absence of appendicitis among patients with signs and symptoms suggestive of appendicitis found in previous studies [32].