Dokumcu et al reported the New Scoring System (NSS) for the diagnosis of appendicitis in pediatric patients. The score is based on clinical, laboratory and radiological findings. The authors are from Ege University in Izmir, Turkey,
Patient selection: age 1 to 18 years with suspected appendicitis
Parameters:
(1) sex
(2) time pattern of abdominal pain
(3) migration of pain
(4) anorexia
(5) bilious vomiting
(6) pyrexia
(7) right lower quadrant tenderness
(8) guarding
(9) rebound tenderness
(10) heel drop test
(11) gurgling
(12) leukocytosis
(13) neutrophilia
(14) C-reactive protein (CRP)
(15) scoliosis to right side
(16) localized air-fluid level
(17) localized gas deposition
(18) appendicolith
(19) appendix diameter
(20) appendix wall
(21) periappendiceal free fluid
|
Parameter |
Finding |
Points |
|
sex |
female |
0 |
|
|
male |
0.5 |
|
time pattern of abdominal pain |
absent or intermittent |
0 |
|
|
continuous |
3 |
|
migration of pain |
absent |
0 |
|
|
present |
3 |
|
anorexia |
absent |
0 |
|
|
present |
0.5 |
|
bilious vomiting |
absent |
0 |
|
|
present |
1 |
|
pyrexia |
absent |
0 |
|
|
present |
1 |
|
RLQ tenderness |
absent |
0 |
|
|
present |
1 |
|
guarding |
absent |
0 |
|
|
present |
2 |
|
rebound tenderness |
absent |
0 |
|
|
present |
2 |
|
heel drop test |
negative |
0 |
|
|
positive |
3 |
|
gurgling |
absent |
0 |
|
|
present |
2 |
|
leukocytosis |
absent |
0 |
|
|
present |
2 |
|
neutrophilia |
absent |
0 |
|
|
present |
2 |
|
C-reactive protein |
normal |
0 |
|
|
increased |
1 |
|
scoliosis to right side |
absent |
0 |
|
|
present |
1 |
|
localized air-fluid level |
absent |
0 |
|
|
present |
1 |
|
localized gas deposition |
abseent |
0 |
|
|
present |
1 |
|
appendicolith |
absent |
0 |
|
|
present |
3 |
|
appendix diameter |
normal |
0 |
|
|
increased |
1 |
|
appendex wall |
normal |
0 |
|
|
thickened |
2 |
|
periappendiceal free fluid |
absent |
0 |
|
|
present |
1 |
total score =
= SUM(points for all 21 parameters)
Interpretation:
• minimum score: 0
• maximum score: 34
• A score >= 12 had a sensitivity of 95% and specificity of 88%.
Performance:
• The authors reported an area under the ROC curve of 0.97.
• The false positive rate was 10-11% if the duration of symptoms was less than 24 hours.
Specialty: Gastroenterology, Pedatrics, Surgery, general
