The Predictive Value of Ultrasound, Alvarado Score, and C-Reactive Protein in Pediatric Appendectomy Outcomes

Abstract

Aim: This retrospective study aimed to investigate the combined accuracy of appendix diameter, C reactive protein, and Alvarado score in classifying patients with negative appendectomy and acute appendicitis. Material and Methods: This descriptive observational cohort study research was conducted at the Emergency Department of a Training and Research Hospital between November 2017 and April 2019. We included the data of appendicitis cases aged under 18 years in this restrospective study and gathered data on patients’s demographics, preoperative laboratory values, signs, symptoms, and final pathological diagnosis, restrospectively. Then, cases were divided into acute appendicitis or negative appendectomy groups according to formal pathology reports. Results: The final study population consisted of 60 patients; the negative appendectomy rate was 25%. The diagnostic accuracy of the multivariate model`s involving CRP, Alvarado score, and appendix diameter was 93.3%, with a sensitivity and specificity of 93.3% for identifying acute appendicitis (+LR: 14 and -LR: 0.07). Applying the model could have prevented 93.3% of negative appendectomy cases (25% to 1.7%) from undergoing unnecessary surgery in our cohort. Conclusion: In conclusion, CRP, Alvarado score, or appendix diameter should not be used individually to diagnose AA in children. However, combining these variables can increase the accuracy of acute appendicitis diagnosis and may provide a significant reduction in negative appendectomy rates.