| Objective: The objectives of this study were (1) to validate the Alvarado score andpediatric appendicitis score (PAS) in a retrospective analysis and (2) to assessabdominal ultrasonography (AUS) as a tool to increase the diagnostic reliability ofboth scores.Materials and Methods: The retrospective analysis from March2012to March2014in our hospital admitted220cases of pediatric surgery aged3to17years of agewith suspected acute appendicitis and underwent appendectomy surgery in pediatricpatients. Children were calculated for each admission Alvarado score and PAS score,divided into three groups according to the different score1-3points lower risk group;4-7risk group;8-10divided into high-risk groups. According to the appendix areaultrasound description, if ultrasound dropping and abnormal appendix or secondaryinflammatory response in accordance with right lower quadrant features to considerappendicitis, both of which are defined as a positive result. If the ultrasound droppingand normal appendix or appendix is not visible, or no secondary inflammatoryresponse to prompt appendicitis was defined as negative results. Using SPSS18.0statistical software for statistical analysis. Calculation alone Alvarado score and scorePAS diagnosis of appendicitis in children’s sensitivity, specificity, positive predictivevalue and negative predictive value. Alvarado scores were calculated risk group, PASscore associated risk group and positive results appendix area ultrasound diagnosis ofappendicitis sensitivity, specificity, positive predictive value and negative predictivevalue.Result:220pediatric patients, female patients73cases (73/220,34.1%),145cases of male children (145/220,65.9%). The mean age was9.9years (3-17years old).11cases of acute simple appendicitis (11/220,5%), our study considered negativeappendectomy cases;209cases of acute suppurative appendicitis (209/220,95.0%),including61cases of appendiceal perforation (61/220,27.7%). Alvarado score areaunder the ROC curve was0.96(95%CI，0.90-0.99), the area under the ROC curvePAS score was0.97(95%CI，0.92-0.99). The Alvarado score for the diagnosis sectoris divided into six points, Alvarado score a sensitivity of90.47%(95%CI,77.4%-97.3%), specificity was91.21%(95%CI,80.7%-97.1%), PPV was88.02%(95%CI,78.8%-98.0%), NPV was91.12%(95%CI,86.1%-99.6%). The PAS score for thediagnosis sector is divided into six points, the sensitivity was88.14%(95%CI,74.4%-96.0%), specificity was97.45%(95%CI,90.6%-99.7%), PPV was96.16%(95%CI,92.3%-100%), NPV was91.84%(95%CI,84.9%-98.7%). Alvarado score in the riskgroup (5-8points), the joint appendix area ultrasound positive diagnosis, thesensitivity was93.2%(95%CI,77.8%-98.9%), specificity was100%(95%CI,92.5%-100%), PPV was100%(95%CI,87.5%-100%), NPV was95.9%(95%CI,86.3%-99.4%). PAS score risk group (4-7points), the joint appendix area ultrasoundpositive diagnosis, the sensitivity was97.1%(95%CI,85.4%-99.5%), specificity was97.5%(95%CI,87.5%-99.5%), PPV was97.1%(95%CI,85.4%-99.5%), NPV was97.5%(95%CI,87.6%-99.6%).Conclusion: Both scores are a useful tool in the evaluation of children withpossible AA. For extreme values of scores, the results really ensure their use in theemergency department. The AUS can help on decision making for intermediatevalues. |
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