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

BACKGROUND: The Pediatric Appendicitis Score (PAS) is a highly utilized diagnostic tool for acute appendicitis in pediatric patients. The severity of appendicitis subclassified as simple appendicitis (congested or suppurated) vs complicated appendicitis (gangrenous or perforated). A duration of symptoms >1 day, CRP > 4 mg/dl and SBP ≥ 8 were predictors of complicated appendicitis[1]. Therefore, we propose as a possibility in this study that PAS ≥ 8 could differentiate complicated appendicitis from simple appendicitis. We must emphasize to the reader that we do not intend to question that PAS was designed for the diagnosis of appendicitis in children, in this study we intended to evaluate to differentiate the severity of pediatric appendicitis. 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.