Yap et al reported a clinical score for children with suspected appendicitis. It uses two steps to determine the likelihood of appendicitis. The authors are from KK Women's and Children's Hospital and National University Health System in Singapore.
Patient selection: 4 to 16 years of age with possible appendicitis.
Step 1 involves normal value cutoffs for 3 inflammatory markers. When all 3 inflamamtory markers were normal there were no cases of appendicits.
Step 2 involves a raw score based on weightings for 6 parameters (2 of which are inflammatory markers).
|
Inflammatory Marker
|
Finding
|
Points
|
|
WBC count
|
< 10,000 per µL
|
0
|
|
|
>= 10,000 per µL
|
1
|
|
percent neutrophils in the differential count
|
< 75%
|
0
|
|
|
>= 75%
|
1
|
|
serum CRP in mg/L
|
< 5 mg/L
|
0
|
|
|
>= 5 mg/L
|
1
|
where:
• The paper reports CRP in g/L; mg/L would make more sense for the values shown.
|
Clinical Parameters
|
Finding
|
Points
|
|
pain quality
|
not constant
|
0
|
|
|
constant
|
1
|
|
localized right iliac fossa tenderness
|
absent
|
0
|
|
|
present
|
1.5
|
|
pain on percussion or coughing
|
absent
|
0
|
|
|
present
|
1
|
|
generalized guarding
|
absent
|
0
|
|
|
present
|
1.5
|
|
WBC count
|
< 14,000 per µL
|
0
|
|
|
>= 14,000 per µL
|
1.5
|
|
serum CRP
|
< 24 mg/L
|
0
|
|
|
>= 24 mg/L
|
1
|
score for inflammatory markers =
= SUM(points for all 3 markers)
score for clinical parameters =
= SUM(points for all 6 parameters)
If the score for inflammatory markers is 0, then "coefficient A" is 0.
If the score for inflammatory markers is >= 1, then "coefficient A" is 1.
Children Appendicitis Score = CAS =
= (coefficient A) * (score for clinical parameters)
Interpretation:
• minimum score for inflammatory markers: 0
• maximum score for inflammatory markers: 3
• minimum score for clinical parameters: 0
• maximum score for clinical parameters: 7.5
• minimum CAS: 0
• maximum CAS: 7.5
|
CAS
|
Risk of Appendicitis
|
Management
|
|
0 to 1
|
low
|
Discharge
|
|
1.5 to 4.5
|
intermediate
|
Ultrasound or CT scan
|
|
5 to 7.5
|
high
|
surgery
|
Performance:
• The area under the ROC curve is 0.88.
