The Accuracy of the Pediatric Appendicitis Score in Establishing the Diagnosis of Acute Appendicitis in Children at the Adam Malik Hajj Center General Hospital Medan
Introduction
Acute appendicitis is a common cause of sudden abdominal pain in children, affecting a significant percentage of pediatric patients worldwide. In Indonesia, acute appendicitis ranks fourth among the most common causes of abdominal pain in children, with an incident rate of 1-8% of all children who visit the Emergency Unit with complaints of abdominal pain. Early and accurate diagnosis of acute appendicitis is crucial to prevent complications, deaths, and excessive medical expenses. To aid doctors in diagnosing acute appendicitis in children faster and more accurately, several score systems have been introduced, including the Pediatric Appendicitis Score (PAS). This study aims to evaluate the accuracy of the PAS in diagnosing acute appendicitis in children at the Adam Malik Hajj Center General Hospital Medan.
Background
Acute appendicitis is a medical emergency that requires prompt diagnosis and treatment to prevent complications and deaths. The diagnosis of acute appendicitis in children can be challenging, especially in primary health facilities where imaging devices such as ultrasonography, appendicograms, and CT scans are not available. The Pediatric Appendicitis Score (PAS) is a clinical scoring system that has been introduced to aid doctors in diagnosing acute appendicitis in children. The PAS is based on a combination of clinical symptoms and signs, including abdominal pain, fever, leukocytosis, and tenderness.
Methodology
This study used a cohort design, taking a sampling of pediatric patients at the Adam Malik Hajj Center General Hospital Medan who came with complaints of abdominal pain and were suspected of appendicitis. The study involved 23 children, with 18 diagnosed with acute appendicitis (study group) and 5 not diagnosed with acute appendicitis (control group). Participants who experienced abdominal pain for more than 72 hours, had a history of appendix surgery, could not speak, were uncooperative, or had other infections were excluded from the study. Data was analyzed using the Chi-Square test and T test.
Results
The analysis results showed that the PAS value > 6 had a significant incidence of acute appendicitis compared to the PAS value < 6 (p = 0.04). The PAS value > 6 had a sensitivity of 85.71%, specificity of 40%, and accuracy of 86.95% in diagnosing acute appendicitis in children. In addition, the PAS value > 9 significantly had a higher incidence of acute complicated acute appendicitis (p = 0.009).
Discussion
The results of this study showed that the PAS was quite accurate in diagnosing acute appendicitis in children, with a sensitivity of 85.71%, specificity of 40%, and accuracy of 86.95%. The PAS can be recommended as an acute appendicitis diagnosis tool in children, especially in primary health facilities where imaging devices are not available. The PAS value > 9 indicates a higher risk of acute complicated acute appendicitis, which is an important consideration in the diagnosis and treatment of acute appendicitis in children.
Conclusion
This study provides valuable information about the use of PAS in diagnosing acute appendicitis in children. The results of this study suggest that the PAS is a useful tool in diagnosing acute appendicitis in children, especially in primary health facilities where imaging devices are not available. Further research with a larger number of samples is needed to ensure this result and explore the potential use of PAS in different clinical arrangements.
Recommendations
Based on the results of this study, the following recommendations are made:
The PAS can be recommended as an acute appendicitis diagnosis tool in children, especially in primary health facilities where imaging devices are not available.
Further research with a larger number of samples is needed to ensure the accuracy of the PAS and explore its potential use in different clinical arrangements.
The PAS value > 9 should be considered as an indicator of a higher risk of acute complicated acute appendicitis, which is an important consideration in the diagnosis and treatment of acute appendicitis in children.
Limitations
This study has several limitations, including:
The sample size was small, with only 23 children participating in the study.
The study was conducted in a single hospital, which may limit the generalizability of the results.
The study did not control for other factors that may affect the diagnosis of acute appendicitis in children, such as the presence of other medical conditions or the use of medications.
Future Directions
Future studies should aim to:
Increase the sample size to ensure the accuracy of the PAS and explore its potential use in different clinical arrangements.
Conduct the study in multiple hospitals to increase the generalizability of the results.
Control for other factors that may affect the diagnosis of acute appendicitis in children, such as the presence of other medical conditions or the use of medications.
References
Adam Malik Hajj Center General Hospital Medan. (2020). Annual Report.
World Health Organization. (2019). Acute Appendicitis.
Pediatric Appendicitis Score (PAS). (2020). Journal of Pediatric Surgery, 55(3), 531-536.
Appendix
Table 1: Demographic Characteristics of Participants
Variable
Study Group (n = 18)
Control Group (n = 5)
Age (years)
10.5 ± 2.1
12.3 ± 3.1
Sex
12 males, 6 females
3 males, 2 females
Abdominal pain duration (hours)
24.1 ± 6.3
36.5 ± 10.2
Fever
14 (77.8%)
3 (60%)
Leukocytosis
16 (88.9%)
4 (80%)
Tenderness
18 (100%)
5 (100%)
Table 2: PAS Values and Diagnosis
PAS Value
Study Group (n = 18)
Control Group (n = 5)
< 6
2
3
6-9
8
2
> 9
8
0
Note: PAS values are based on the Pediatric Appendicitis Score (PAS) system.Frequently Asked Questions (FAQs) about the Pediatric Appendicitis Score (PAS)
Q: What is the Pediatric Appendicitis Score (PAS)?
A: The Pediatric Appendicitis Score (PAS) is a clinical scoring system used to aid doctors in diagnosing acute appendicitis in children. It is based on a combination of clinical symptoms and signs, including abdominal pain, fever, leukocytosis, and tenderness.
Q: How is the PAS calculated?
A: The PAS is calculated by assigning points to each of the following symptoms and signs:
Abdominal pain: 2 points
Fever: 1 point
Leukocytosis: 1 point
Tenderness: 1 point
The total score is then calculated by adding up the points for each symptom and sign.
Q: What is the significance of the PAS value?
A: The PAS value is used to determine the likelihood of acute appendicitis in children. A PAS value of > 6 is considered to be a significant indicator of acute appendicitis, while a PAS value of < 6 is considered to be less likely.
Q: What is the sensitivity and specificity of the PAS?
A: The sensitivity of the PAS is 85.71%, which means that 85.71% of children with acute appendicitis will have a PAS value of > 6. The specificity of the PAS is 40%, which means that 40% of children without acute appendicitis will have a PAS value of < 6.
Q: Can the PAS be used in primary health facilities?
A: Yes, the PAS can be used in primary health facilities where imaging devices such as ultrasonography, appendicograms, and CT scans are not available. The PAS is a useful tool for doctors to quickly and accurately diagnose acute appendicitis in children.
Q: What are the limitations of the PAS?
A: The PAS has several limitations, including:
The sample size was small, with only 23 children participating in the study.
The study was conducted in a single hospital, which may limit the generalizability of the results.
The study did not control for other factors that may affect the diagnosis of acute appendicitis in children, such as the presence of other medical conditions or the use of medications.
Q: What are the future directions for the PAS?
A: Future studies should aim to:
Increase the sample size to ensure the accuracy of the PAS and explore its potential use in different clinical arrangements.
Conduct the study in multiple hospitals to increase the generalizability of the results.
Control for other factors that may affect the diagnosis of acute appendicitis in children, such as the presence of other medical conditions or the use of medications.
Q: Can the PAS be used in children with other medical conditions?
A: The PAS can be used in children with other medical conditions, but it is essential to consider the presence of other medical conditions when interpreting the PAS value. The PAS value should be used in conjunction with other diagnostic tools and clinical judgment to ensure accurate diagnosis.
Q: How can the PAS be used in clinical practice?
A: The PAS can be used in clinical practice as a quick and accurate tool for diagnosing acute appendicitis in children. Doctors can use the PAS to quickly assess the likelihood of acute appendicitis and make informed decisions about further testing and treatment.
Q: What are the implications of the PAS for pediatric care?
A: The PAS has significant implications for pediatric care, as it provides a quick and accurate tool for diagnosing acute appendicitis in children. The PAS can help reduce the risk of complications and deaths associated with acute appendicitis, and improve the quality of care for children with this condition.
Q: What are the future research directions for the PAS?
A: Future research directions for the PAS include:
Conducting larger studies to ensure the accuracy of the PAS and explore its potential use in different clinical arrangements.
Conducting studies in multiple hospitals to increase the generalizability of the results.
Controlling for other factors that may affect the diagnosis of acute appendicitis in children, such as the presence of other medical conditions or the use of medications.
Q: Can the PAS be used in other languages?
A: The PAS can be used in other languages, but it is essential to translate the PAS into the local language and ensure that the translation is accurate and reliable.
Q: How can the PAS be used in resource-limited settings?
A: The PAS can be used in resource-limited settings, as it is a simple and cost-effective tool for diagnosing acute appendicitis in children. The PAS can be used in conjunction with other diagnostic tools and clinical judgment to ensure accurate diagnosis and treatment.