Blumfield et al reported a score which can help to identify perforated appendicitis in a pediatric patient. The authors are from Albert Einstein College of Medicine in New York City.
Patient selection: pediatric appendicitis, age < 18 years
Parameters:
(1) abscess
(2) amount of echogenic fat
(3) complex free fluid
(4) loss of submucosal layer of the appendix
(5) appendix diameter in cm
(6) ESR in mm in first hour
(7) serum CRP in mg/L
(8) WBC count per µL
(9) days of fever
(10) diarrhea
(11) maximum temperature in °F
(12) pain days
(13) age in years
(14) vomiting
|
Parameter |
Finding |
Points |
|
abscess |
absent |
0 |
|
|
present |
5 |
|
amount of echogenic fat |
large |
4 |
|
|
small |
0 |
|
complex free fluid |
absent |
0 |
|
|
present |
4 |
|
loss of submucosal layer |
no |
0 |
|
|
yes |
3 |
|
appendix diameter |
< 1.6 cm |
0 |
|
|
>= 1.6 cm |
3 |
|
ESR |
< 22 mm in first hour |
0 |
|
|
>= 22 mm in first hour |
5 |
|
serum CRP |
<= 50 mg/L |
0 |
|
|
> 50 mg/L |
3 |
|
WBC count |
< 17,000 per µL |
0 |
|
|
>= 17,000 per µL |
1 |
|
fever days |
0 or 1 |
0 |
|
|
>= 2 |
5 |
|
diarrhea |
absent |
0 |
|
|
present |
3 |
|
maximum temperature |
< 100.9°F |
0 |
|
|
>= 100.9°F |
3 |
|
pain days |
0 or 1 |
0 |
|
|
>= 2 |
3 |
|
age |
< 8 years |
3 |
|
|
>= 8 years |
0 |
|
vomiting |
absent |
0 |
|
|
present |
3 |
total score =
= SUM(points for all 14 parameters)
Interpretation:
• minimum score: 0
• maximum score: 48
• The higher the score the greater the risk of perforation.
• Patients with nonperforated appendix had a mean score of 4.7 to 5.6 +/- 4.3.
• Patients with perforated appendix had a mean score of 12.4-13.8 +/- 6
|
Score |
Sensitivity |
Specificity |
|
>= 6 |
96% |
64% |
|
>= 11 |
61% |
91% |
|
>= 15 |
29% |
99% |
Using this information the following table is proposed:
|
Total Score |
Risk of Perforation |
|
<= 6 |
low |
|
7 to 10 |
intermediate |
|
11 to 14 |
high |
|
>= 15 |
very high |
Specialty: Gastroenterology, Pedatrics
