Lintula et al developed a score based on physical findings that can be used to evaluate a child with abdominal pain. This can be used to decide if an appendectomy is indicated or not. The authors are from Kuopio University in Finland.
Parameters:
(1) gender
(2) intensity of abdominal pain
(3) relocation (migration) of pain
(4) vomiting
(5) pain in the right lower quadrant
(6) fever
(7) guarding of the abdomen
(8) bowel sounds
(9) rebound tenderness
|
Parameter |
Finding |
Points |
|
gender |
female |
0 |
|
|
male |
2 |
|
intensity of abdominal pain |
mild or moderate |
0 |
|
|
severe |
2 |
|
relocation of pain |
no |
0 |
|
|
yes |
4 |
|
vomiting |
absent |
0 |
|
|
present |
2 |
|
pain in right lower quadrant |
no |
0 |
|
|
yes |
4 |
|
fever |
no |
0 |
|
|
yes |
3 |
|
guarding |
absent |
0 |
|
|
present |
4 |
|
bowel sounds |
normal |
0 |
|
|
abnormal |
4 |
|
rebound tenderness |
absent |
0 |
|
|
present |
7 |
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 32
|
Total Score |
Interpretation |
|
0 to 15 |
negative for appendicitis |
|
16 to 20 |
indeterminate |
|
21 to 32 |
appendicitis |
Performance:
• Clinicians tended to overdiagnose appendicitis (clinicians 27% unnecessary appendectomies vs score 13%) but missed fewer cases (clinicians 4% vs score 11%).
• Since missing appendicitis may be more serious than overdiagnosis, holding children for observation rather than discharging home may be warranted.
Specialty: Gastroenterology, Pedatrics, Surgery, general
