Dado et al used a clinical score to evaluate a pediatric patient for acute appendicitis. This help to triage the patient in the Emergency Department. The score is a modification of the Lindberg score. The authors are from the University of Udine in Italy.
Patient selection: 2 to 17.4 years of age
Parameters:
(1) gender
(2) white blood cell (WBC) count
(3) duration of abdominal pain in hours
(4) progression of pain
(5) temperature
(6) vomiting
(7) migration of pain from umbilicus to right lower quadrant (RLQ)
(8) rebound tenderness
(9) rigidity of the abdominal wall
(10) tenderness outside of right lower quadrant (RLQ)
|
Parameter |
Finding |
Points |
|
gender |
male |
8 |
|
|
female |
-8 |
|
WBC count |
< 12,000 per µL |
-15 |
|
|
12,000 - 20,000 per µL |
2 |
|
|
> 20,000 per µL |
10 |
|
duration of pain |
< 24 hours |
3 |
|
|
24 - 48 hours |
0 |
|
|
> 48 hours |
-12 |
|
progression of pain |
no |
-4 |
|
|
yes |
3 |
|
temperature |
< 37.5°C |
-9 |
|
|
>= 37.5°C |
7 |
|
vomiting |
no |
-5 |
|
|
yes |
7 |
|
migration of pain |
no |
-11 |
|
|
yes |
4 |
|
rebound tenderness |
no |
-10 |
|
|
yes |
5 |
|
rigidity of abdominal wall |
no |
-4 |
|
|
yes |
15 |
|
tenderness outside of RLQ |
no |
4 |
|
|
yes |
-6 |
where:
• Differences from the score of Lindberg et al include (1) using temperature instead of aggravation by coughing; (2) change in points for WBC count; (3) change in points for relocation/migration of pain.
total score =
= SUM(points for all 10 parameters) - 10
Interpretation:
• minimum score: - 94
• maximum score: 56
• The higher the score the more likely acute appendicitis is present.
|
Total Score |
Management |
|
>= -2 |
emergency surgery |
|
-3 to -18 |
observation for 24 hours |
|
<= -19 |
discharge home |
Performance:
• The sensitivity was 86% (greater for male than female).
• The specificity was 87%.
Specialty: Gastroenterology, Pedatrics, Surgery, general
