VALIDITY OF SAMUEL'S PAEDIATRIC APPENDICITIS SCORE (PAS) IN THE DIAGNOSIS OF ACUTE APPENDICITIS IN CHILDREN

Paediatric Appendicitis Score (PAS)

Abstract

Objective: To validate the paediatric appendicitis score for the diagnosis of acute appendicitis in children using histopathology as a gold standard.
Design: Validation study.
Place and Duration of Study: Military Hospital (MH) and Combined Military Hospital (CMH) Rawalpindi, Pakistan from Dec 2009 to Jul 2010.
Patients and Methods: Eighty five children 1-17 year old who came to our tertiary surgical department with the chief complaint of abdominal pain of less than 7 days duration were included in the study. Paediatric appendicitis score (PAS) components including fever > 38°C, anorexia, nausea/vomiting, cough/ percussion/hopping tenderness, right-lower-quadrant tenderness, migration of pain, leukocytosis > 10,000 (109/l) and polymorphonuclear - neutrophilia > 7500 (109/l) were assessed and recorded on admission, but the sum was not calculated until later and the score did not play any role in the management of the patient. The diagnosis of appendicitis was made by the trainees and consultants clinically and with the aid of routine sonography of abdomen. After appendicectomies, resected specimens were sent for histopathological examination. Pre-operative PAS, and histopathology report of resected appendix were endorsed on patient’s performa. A two by two table was used to determine sensitivity, specificity, positive and negative predictive values and diagnostic efficacy of PAS.
Result: Sensitivity of PAS was 92.16%, specificity 88.23%, positive predictive value 92.16%, negative predictive value 88.23% and the diagnostic efficacy 90.59%.
Conclusion: PAS is a highly sensitive test with fair degree of specificity in diagnosing acute appendicitis in children and its routine usage may improve the diagnostic accuracy.