Samuel developed a pediatric appendicitis score (PAS) for the diagnosis of acute appendicitis in pediatric patients. The author is from Great Ormond Street Hospital for Children in London, England.
Patient selection: 4 to 15 years of age
Parameters:
(1) coughing and/or percussion tenderness and/or hopping tenderness in right lower quadrant (RLQ)
(2) anorexia
(3) pyrexia (did not see defined)
(4) nausea and vomiting (emesis)
(5) tenderness to palpation in the right lower quadrant (RLQ), especially at McBurney's point
(6) leukocytosis with white blood cell count >= 10,000 per µL
(7) polymorphonuclear neutrophilia in the differential count (shift to the left)
(8) migration of pain from umbilicus to right lower quadrant
|
Parameter |
Finding |
Points |
|---|---|---|
|
tenderness on coughing or percussion or on hopping in RLQ |
present |
2 |
|
|
absent |
0 |
|
tenderness in RLQ |
present |
2 |
|
|
absent |
0 |
|
anorexia |
present |
1 |
|
|
absent |
0 |
|
pyrexia |
present |
1 |
|
|
absent |
0 |
|
nausea and vomiting |
present |
1 |
|
|
absent |
0 |
|
white blood cell count |
>= 10,000 per µL |
1 |
|
|
< 10,000 per µL |
0 |
|
neutrophilia |
present |
1 |
|
|
absent |
0 |
|
migration of pain |
present |
1 |
|
|
absent |
0 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• A score <= 5 excludes appendicitis.
• A score >= 6 indicates appendicitis is possible, especially if the score is 9 or 10.
Performance:
• The sensitivity was 100% and specificity 92%.
• The positive predictive value was 96% and the negative predictive value 99%.
• The PAS may not be reliable in very early appendicits. However, if the patient is kept in observation then the score should increase as the inflammation progresses.
Purpose: To evaluate a pediatric patient for acute appendicitis using the Pediatric Appendicitis Score (PAS) of Samuel.
Specialty: Gastroenterology, Pedatrics, Surgery, general
Objective: clinical diagnosis, including family history for genetics
ICD-10: K35,
