記住我
Gudjonsdottir et al validated four clinical prediction scores for appendicitis in children.[1] The Appendicitis Inflammatory Response (AIR) score and Pediatric Appendicitis Risk Calculator (pARC) had the best performance. A recent validation of the AIR score (AIR2) recommended an adjustment of the low-risk interval to 0 to 3 points compared with 0 to 4 in the design study.[2] This new interval does not change the final conclusion in the study by Gudjonsdottir et al but gives a different result ([Table 1]) worth a comment.
Table 1 Distribution of patients according to the risk level of respective score, with revised intervals for the AIR2 scorePAS
AIR2
Alvarado
pARC
p-Value
Total cohort
318
318
318
200
No appendicitis
167
167
167
92
Appendicitis
151
151
151
108
Complicated appendicitis
67
67
67
44
Low risk
93 (29)
102 (32)
61 (19)
41 (21)
< 0.001
No appendicitis
86 (51)
91 (54)
56 (33.5)
38 (41)
< 0.001
Appendicitis
7 (5)
11 (7)
5 (3)
3 (3)
0.33
Complicated appendicitis
1 (1)
2 (3)
2 (3)
1 (2)
1
Intermediate risk
171 (53)
80 (25)
115 (57)
< 0.001
No appendicitis
73 (44)
61 (36.5)
53 (58)
< 0.001
Appendicitis
98 (65)
19 (13)
62 (57)
< 0.001
Complicated appendicitis
32 (48)
4 (6)
22 (50)
< 0.001
High risk
225 (71)
45 (14)
177 (56)
44 (22)
< 0.001
No appendicitis
81 (49)
3 (2)
50 (30)
1 (1)
< 0.001
Appendicitis
144 (95)
42 (28)
127 (84)
43 (40)
< 0.001
Complicated appendicitis
66 (99)
33 (49)
61 (91)
21 (48)
< 0.001
Abbreviations: AIR2, revised Appendicitis Inflammatory Response score; PAS, Pediatric Appendicitis Score; pARC, Pediatric Appendicitis Risk Calculator.
Note: Values presented as n (%). p-Values are according to exact test. Scoring intervals: PAS: low = 0–5 and high = 6–10; AIR2 score: low = 0–3 and high = 9–12; Alvarado score low = 0–4 and high = 7–10; pARC: low = 0–14% and high = 85–100%.
With the new risk interval the Pediatric Appendicitis Score (PAS) and AIR2 score assign about half of the no appendicitis patients to the low risk group (51 and 54%, respectively) which is significantly better than the Alvarado and pARC (33.5 and 41%, respectively). All scores have high sensitivity for advanced appendicitis at their low cutoff point (0.97–0.99). Expectant management with planned reexamination, can thus safely be considered for this group.
The revision has no impact for the high-risk group. The AIR2 score and pARC both assign a smaller proportion of patients to this risk group (14 and 22%, respectively) compared with PAS and Alvarado (71 and 56%, respectively) but with much better specificity (0.93 and 0.98 vs. 0.64 and 0.72, respectively). At such a high specificity a diagnostic laparoscopy should be considered before imaging, as a negative imaging study can probably not rule out appendicitis.[3] [4]
© 2022. Thieme. All rights reserved.
留言 (0)