Rassi et al reported a predictive score for appendicitis in a child less than 4 years of age. The clinical presentation of appendicitis in small children can be nonspecific and the diagnosis may be delayed. The authors are from the Privado Universitario de Cordoba and affiliated hospitals in Cordoba, Argentina.
Patient selection: child < 4 years with possible appendicitis
Parameters:
(1) Blumberg's sign (rebound tenderness)
(2) serum CRP in mg/L
(3) neutrophil to lymphocyte ratio (NLR)
(4) abdominal ultrasound
Parameter
Finding
Points
Blumberg's sign
absent
0
present
3
serum CRP
<= 7 mg/L
0
> 7 mg/L
2
NLR
<= 2.8
0
> 2.8
1
abdominal ultrasound
negative
0
positive for appendicitis
6
where:
• A positive ultrasound is any of the following: enlarged, noncompressible appendix; appendicolith; appendiceal abscess; appendicular mass; suppurative fluid in the abdominal cavity; dilated bowel loops; periappendicular fat infiltration; reactive peritoneal effusion.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
Total Score
Risk of Appendicitis
Suggested Management
0 to 4
low
outpatient observation
5 to 7
intermediate
observation in ED
8 to 12
high
surgery
Performance:
• The authors report an area under the ROC curve of 0.96 using a score > 7.
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