Modified Alvarado and Samuel scores: Contribution to the diagnosis of acute appendicitis in the pediatric acute and emergency department

Abstract

Introduction Acute abdominal pain is a common complaint among pediatric patients. Surgical emergencies, particularly acute appendicitis (AA), evoke significant concern due to the challenges associated with its diagnosis. Objectives This study aimed to evaluate the contribution of modified Alvarado and Samuel scores (pediatric appendicitis scoring systems) to the diagnosis of AA in children who attended our acute and emergency department. Study Population and Methods Children aged 3 to 16 years who presented to the acute and emergency department with acute abdominal pain were included after obtaining parental consent and Ethics Committee approval. Data on the patient’s age, sex, body temperature, history of bowel habits, trauma, weight loss, chronic gastrointestinal disease, etc., were collected. The modified Alvarado and Samuel scores were calculated, and children were classified into three groups: G1 (score <4), G2 (≥4 score <7), and G3 (score ≥7). The diagnostic value of both scores was assessed by calculating their positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). Children with known chronic inflammatory bowel disease, obvious sepsis, and incomplete case records were excluded. Results Of the 90 children recruited for this study, only 87 were included (49 boys, 38 girls, sex ratio: 1.3:1). The overall mean age of the study population was 9.3 years, and the mean ages per group were 9.25 years (G1), 10.3 years (G3), 9.5 years (G3-1), and 7.25 years (G3-2). Of the 87 children, 69 (79%) experienced abdominal pain attributed to a medical cause, and 18 (21%) required surgery [of whom 16 received early intervention, while 2 (G3-1 subgroup) received the intervention after 24 hours of observation]. Of the 16 patients who received early intervention, 6 (38%) who underwent immediate surgery had perforated appendicitis, 4 had suppurated appendicitis, and 6 had simple inflammatory appendicitis. For G3 patients, Alvarado score showed a PPV, an NPV, a sensitivity, a specificity, a PLR, and a NLR of 91.7%, 98%, 91.7%, 98%, 45.5, and 0.09, respectively. For Samuel score, the values were 93%, 98%, 93%, 98%, 46, and 0.08, respectively. The majority of patients with purulent and perforated appendicitis (except 1, score 3) belonged to G3, of whom 1 had a false-positive score (score ≥7) and another had a false-negative score (score 3). Four patients in G3 required abdominal tomodensitometry. Conclusion The modified Alvarado and Samuel scoring system is a valuable tool for diagnosing AA in children seeking care at the acute and emergency department.