Effectiveness of the Paediatric Appendicitis Score for Diagnosing the Severity of Acute Appendicitis in Children: A Cohort Study

BACKGROUND: The Pediatric Appendicitis Score (PAS) was designed and validated to distinguish acute appendicitis from non-surgical abdominal pain, but not to differentiate between simple and complicated appendicitis. It is important to clarify that our intention is not to challenge the original purpose of the Pediatric Appendicitis Score (PAS), which was developed to support the diagnosis of appendicitis in children. Instead, our study evaluated the potential utility of a PAS score ≥8 in distinguishing between simple appendicitis (congestive or suppurative) and complicated appendicitis (gangrenous or perforated) in pediatric patients. METHODS: The cohort type study, the population evaluated, 86 children aged 4 to 14 years with preoperative diagnosis of appendicitis, grouped into 2 groups: complicated appendicitis (43) and simple appendicitis (43) exposed to PAS≥8 or PAS˂8. RESULTS: The effectiveness of PAS≥8 in diagnosing the severity of appendicitis showed an AUC of 59.3% and increases the probability of severity by 2.246 times (CI:95% 0.917-5.50 p=0.077) in the predictive model. There were statistically significant differences in cough sensitivity/jump/percussion, pain migration, anorexia, leukocytosis and neutrophilia, between PAS≥8 or PAS˂8. CONCLUSION: PAS≥8 alone is not sufficient to diagnose the severity of acute appendicitis with 59.3% predictive diagnostic accuracy and increases 2.246 times the probability of presenting with the severity of appendicitis in the logistic predictive model.