A prospective study to evaluate the contribution of Pediatric Appendicitis Score in the decision process

Abstract

Abstract Background To predict acute appendicitis (AA) probability in children admitted to the emergency department (ED) with abdominal symptoms according to whether or not they had a previous consultation in primary care (PC). Methods From February to June 2021, all children admitted to the ED for acute abdominal pain suggestive of AA were prospectively enrolled and then allocated into three groups: assessed by a PC physician (PG); brought in by their family without a prior consultation (FG); admitted after a PC consultation without having been assessed as such. The main objectives were to compare the risk of AA development using the Pediatric Appendicitis Score (PAS). The secondary objectives were to analyze the PAS and CRP (C-reactive protein) levels according to the duration of pain and the definitive diagnoses. Results 124 children were enrolled (PG, n = 56; FG, n = 55; NG, n = 13). Twenty-nine patients (23.4%) had AA. Of these, 13 (23.2%) were from the PG and 14 (25.4%) were from the FG. The mean PAS scores for AA cases from the PG and the FG were 6.69 ± 1.75 and 7.57 ± 1.6, respectively, (p = 0.3340). The PAS scores and the CRP levels were significantly correlated to AA severity. There were no AA cases for PAS scores < 4. Conclusions There was no difference in the PAS scores between patients addressed by PG and FG even if this score was higher for patients with AA. We propose a new decisional algorithm for PC practice that integrates inflammatory markers and duration of pain. Trial registration: Institutional Ethics Committee number registration: 447-2021-103 (10/01/2021)