Validation of Clinical Prediction Scores for Pediatric Appendicitis: Update with New Cutoff Values for the AIR Score.

Abstract

Gudjonsdottir et al validated four clinical prediction scores for appendicitis in children. The AIR score and pARC had the best performance. A recent validation of the AIR score (AIR2) recommended an adjustment of the low risk interval. With the new risk interval the PAS and AIR2 score assign about half of the no appendicitis patients to the low risk group with very high sensitivity for advanced appendicitis (0.97-0.99). Expectant management with planned reexamination, can thus safely be considered for this group. The AIR2 score and pARC both assign a smaller proportion of patients to the high risk groups (14 and 22%, respectively) but with high specificity (0.93 and 0.98). At such a high specificity a diagnostic laparoscopy should be considered before imaging, as a negative imaging study can probably not rule out appendicitis.