Kharbanda et al evaluated acute appendicitis in older male pediatric patients. They developed a score which can aid in diagnosis. The authors are from multiple children's hospitals in the United States.
Patient selection: older (8 to 18 years) male in the Emergency Department with suspected appendicitis
Parameters:
(1) maximum tenderness in right lower quadrant
(2) pain with walking or coughing or hopping
(3) absolute neutrophil count in 10^3/L
|
Parameter
|
Finding
|
Points
|
|
maximum tenderness RLQ
|
no
|
0
|
|
|
yes
|
2
|
|
pain on walking, coughing, hopping
|
no
|
0
|
|
|
yes
|
1.7
|
|
absolute neutrophil count in 10^3 per µL
|
|
* 0.3
|
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: less than 1 (depends on WBC count)
• maximum score: greater than 14 (depends on WBC count)
• The higher the score the greater the likelihood of acute appendicitis.
• A score >= 6.2 had the maximum Youden Index (sensitivity 69%, specificity 87%).
• A score >= 8.1 had the highest specificity (98%) but a low sensitivity (25%).
• According to Figure 2 the number of cases of appendicitis with a score less than 4 was low.
Performance:
• The authors claim an area under the ROC curve of 0.88.
