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

What’s Known on This Subject

Appendicitis is an acute inflammatory process that affects the appendix, one of the common causes of abdominal pain in children in emergency. Being one of the most common conditions faced by surgeons.

The PAS scale, a clinical score for acute appendicitis, is among the most popular for use in children for diagnosis. The severity of appendicitis subclassified as simple appendicitis (congested or suppurated) vs complicated appendicitis (gangrenous or perforated) could be predicted with a PAS scale ≥8.

What This Study Adds

Tests logistic regression models as a basis for developing more complex models to improve prediction of complicated acute appendicitis in children.

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) could be predicted with a PAS scale ≥8.

Methods

The type of study of the present research, according to Altman Douglas, is: Observational, Retrospective y Longitudinal. The design is cohort-type. The population was evaluated, 86 children aged 4-14 years with a preoperative diagnosis of appendicitis, grouped into 2 groups: complicated appendicitis (43) and simple appendicitis (43) exposed to the PAS≥8 or PAS 8.

Results

The effectiveness of the PAS≥8 scale for diagnosing the severity of appendicitis showed a predictive diagnostic accuracy of 59.3% and increases the likelihood 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/hop/percussion Tenderness, migration of pain, anorexia, leukocytosis and neutrophilia, between scale PAS≥8 vs PAS<8.

Conclusion

The PAS≥8 scale alone is not sufficient to diagnose the severity of acute appendicitis, with 59.3% predictive diagnostic accuracy and increasing the likelihood of presenting the severity of appendicitis by 2.246 times.