Lima et al reported the APpendicitis PEdiatric (APPE) score for evaluating a pediatric patient for acute appendicitis. The authors are from the University of Bologna.
Patient selection: pediatric patient from 1 to 17 years
Parameters"
(1) age in years
(2) sex
(3) duration of symptoms in hours
(4) vomiting
(5) tenderness in the right iliac fossa
(6) Blumberg sign (rebound tenderness)
(7) white blood cell count in per µL
(8) percent neturophils in the differential count
(9) serum CRP in mg/dL
|
Parameter |
Findng |
Points |
|
age in years |
<= 6 years |
0 |
|
|
7 to 11 yeaers |
1 |
|
|
>= 12 years |
0.5 |
|
sex |
female |
0 |
|
|
male |
2 |
|
duration of symptoms |
<= 12 hours |
1 |
|
|
13 to 24 hours |
1.5 |
|
|
25 to 48 hours |
0.5 |
|
|
>= 49 hours |
0 |
|
vomiting |
no |
0 |
|
|
yes |
3.5 |
|
tenderness in right iliac fossa |
no |
0 |
|
|
yes |
1.5 |
|
Blumberg sign |
no |
0 |
|
|
yes |
4 |
|
WBC count |
<= 10,000 per µL |
0 |
|
|
10,001 to 15,000 per µL |
1 |
|
|
> 15,000 per µL |
3 |
|
percent neutrophils |
<= 75% |
0 |
|
|
> 75% |
2 |
|
serum CRP |
<= 1 mg/dL |
0 |
|
|
1.1 to 6 mg/dL |
2 |
|
|
> 6 mg/dL |
1.5 |
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20.5 (21 given in paper)
• The higher the score the greater the risk for appendicitis.
|
Score |
Risk of Appendicitis |
Management |
|
0 to 8 |
low |
discharge |
|
8.5 to 14.5 |
intermediate |
imaging studies |
|
>= 15 |
high |
surgery |
Performance:
• The area under the ROC curve is 0.83.
Specialty: Gastroenterology
