Bonadio et al developed a clinical score for identifying a pediatric patient at risk for appendiceal rupture during an episode of appendicitis. The authors are from Maimonides Medical Center in Brooklyn.
Patient selection: pediatric patient with appendicitis, < 18 years of age
Criteria for appendicitis:
(1) enlarged appendix (>= 7 mm in diameter)
(2) inflammatory signs (hyperemai in the wall, peri-appendiceal fat stranding, appendicolith)
Criteria for perforation - one or more of the following:
(1) intra-abdominal abscess or phlegmon
(2) extra-luminal air
(3) extra-luminal appendicolith
(4) focal defect in enhancing appendiceal wall
Parameters:
(1) duration of symptoms in days
(2) body temperature in °C measured in the Emergency Department (ED)
(3) absolute neutrophil count per µL
Parameter
|
Finding
|
Points
|
duration of symptoms
|
<= 1 day
|
0
|
|
> 1 day
|
1
|
body temperature in °C
|
< 38°C
|
0
|
|
>= 38°C (fever)
|
1
|
absolute neutrophil count
|
<= 13,000 per µL
|
0
|
|
> 13,000 per µL
|
1
|
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the greater the risk of perforation.
Score
|
Perforation Risk
|
0
|
7%
|
1
|
25%
|
2
|
58%
|
3
|
85%
|
Performance:
• The area under the ROC curve is 89%.