Appendicitis score for children with suspected appendicitis. A randomized clinical trial

Abstract

Appendicectomy is often performed without certainty of diagnosis. We have previously constructed and validated a diagnostic score for acute appendicitis in children. The purpose of this prospective study was to determine whether diagnosis by using the appendicitis score may improve clinical outcomes for children with suspected appendicitis. A total of 126 children with suspected appendicitis were randomly assigned to either the appendicitis-score group or the no-score group. The attending general surgeon indicated a provisional diagnosis, a differential diagnosis and a provisional disposition on admission at 3 h and, if necessary, at 6, 9 and 12 h. The decision to operate was based on a clinical assessment in the no-score group and on the use of the diagnostic scoring system in the appendicitis-score group. The main outcome measures were the diagnostic accuracy (primary endpoint), the rate of unnecessary appendicectomies and adverse events between the two groups. The diagnostic accuracy was significantly greater in the appendicitis-score group compared with that in the no-score group (92% vs 80%; P = 0.04). A significantly higher rate of unnecessary appendicectomies was observed in the no-score group compared with that in the appendicitis-score group (29% vs 17%; P = 0.05). In the appendicitis-score group, the sensitivity was 100%, specificity was 88%, positive predictive value was 83% and negative predictive value was 100%, compared to sensitivity of 96%, specificity of 67%, positive predictive value of 70% and negative predictive value of 96% observed in the no-score group. There were no differences in terms of the length of hospital stay, rate of complications and appendiceal histology between the two groups. The only case with missed appendicitis was in the no-score group. The use of the appendicitis score can reduce the unnecessary appendicectomy rate in general surgeons treating children with suspected appendicitis.