Diagnostic value of Pediatric Appendicitis Score for complicated appendicitis in preschool children

Background There are currently no definitive or reliable methods for diagnosing complicated appendicitis in preschool children. This study aimed to identify the independent risk factors for complicated appendicitis to assist physicians in assessing the severity of appendicitis in preschool children. Methods We conducted a retrospective analysis of 258 preschool-aged patients from January 2021 to December 2023, including 99 cases with complicated appendicitis and 159 cases with uncomplicated appendicitis. The characteristics of clinical symptoms and laboratory data were collected, and then the Pediatric Appendicitis Score (PAS) was calculated. Univariate and multivariate analyses were performed to identify the independent risk factors for complicated appendicitis. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to assess the diagnostic performance of these indicators. Results Univariate analysis revealed significant differences in PAS, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) levels between complicated and uncomplicated appendicitis ( p  < 0.05). And these three parameters were also confirmed to be independent risk factors for complicated appendicitis by further multivariate regression analysis. The PAS demonstrated moderate diagnostic performance in distinguishing complicated appendicitis, with an optimal cut-off value of 7.5, sensitivity of 77.8% and specificity of 49.1% (AUC: 0.678, 95% CI : 0.614 ~ 0.743). Additionally, the predictive accuracy elevated significantly when PAS was combined with CRP and NLR, with the AUC of 0.824 (95% CI : 0.773 ~ 0.875), sensitivity of 76.8%, and specificity of 79.2%, indicating enhanced discriminative capability for complicated appendicitis. Conclusion The PAS, NLR, and CRP are identified as independent predictors for identifying complicated appendicitis. Furthermore, the combination of PAS, NLR, and CRP increases the diagnostic accuracy in differentiating complicated appendicitis from uncomplicated appendicitis in preschool children.