Pediatric Modification For Alvarado Score: Appearance Of Patients With Apandisitis

Abstract

ABSTRACT Objective: This study, with the purpose of decreasing the morbidity rate in emergency pediatric surgery clinics, evaluates the reliability of an acute appendicitis diagnosis score we define as “appearance of the patient with appendicitis (APA)”, which is a new modification of Alvarado Score (AS). Methods: One hundred eighty patients, that admitted to Van Training and Research Hospital between February 2018 and June 2018 and were consulted to pediatric surgery with acute appendicitis suspicion; were analyzed as a randomized prospective study. In the new scoring system which we define as APA, instead of a left shift of neutrophils – a state of the patients lying still in the bed, reluctant to speak, with dry lips, with tired eyes, upset and with a troubled expression at the face is placed. For all the patients, AS (AS 1-4, AS 5-6 and AS 7-10) and APA (APA 1-4, APA 5-6 and APA 7-10) scores were independently calculated as three groups and were compared to each other. Results: 180 children (108 males – 72 female) with an average age of 11 (range, 6 – 15) were included in the study. Distribution of patients in the three groups of AS was determined as 1-4: 90 (50%), AS 5-7: 48 (26.7%) and AS 8-10: 42 (23.3%) respectively. Distribution of patients with respect to APA score were as APA 1-4: 72 (40%), APA 5-7: 69 (38.3%) and APA 8-10: 39 (21.7%). Appendectomy was performed on 3 patients from the AS 1-4 group, on 15 patients from AS 5-6 group and on 33 patients from AS 7-10 group. Whereas none of the patients from the APA 1-4 group had an appendectomy, 18 patients from APA 5-6 group and 33 patients from APA 7-10 group had an appendectomy. Conclusion: By means of the APA which we define as a combination of AS and clinical judgment (CJ), the number of pediatric cases with appendicitis suspicion to be kept under observation was increased and unnecessary –too early or too late- surgical intervention incidence was decreased. Our study shows CJ and scoring systems are not alternative methods for each other and collective use of both can decrease morbidity and mortality in acute appendicitis treatment.