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Clinical predictors of acute appendicitis: in a Portuguese Paediatric Department

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Background and aims: Acute appendicitis (AA) is a challenging diagnosis in children because the symptoms can mimic other common causes of abdominal pain.
Clinical scoring systems, as the Alvarado score (AS), are tools that can predict the risk of AA in children and evaluated signs, symptoms and blood exams.
Material and methods: A retrospective study of children between the ages of 4 and 18 years referred to the emergency department for abdominal pain and submitted to appendectomy. Two groups were defined: those with histology-confirmed appendicitis and those without appendicitis. Univariate analysis was performed with logistic regression to compute odds ratio [CIs]c for each possible predictor.
Results: The univariate analysis showed that six of the variables were significant predictors of appendicitis. These were leucocytes (OR=3.2 [2-5.1]), neutrophil (OR=3.6 [1.3-10.1]), AS (continuous variable) (OR=1.6 [1.3-2.1]), ASa‰¥5 (OR=7.6 [2.9-19.9]), ASa‰¥6 (OR=6.9 [2.5-18.7]) and ASa‰¥7 (OR=5.6 [1.6-19.7]). All other recorded findings were not statistically significant.
The negative appendectomy rate was estimated in 18%. It was an expected rate according to the information from other studies which reported a rate of 15-30%.
Clinical findings when associated in a score, as the AS, can predict the risk of this clinical situation. Using three different cut-points (5, 6 and 7 points) of AS we observed positive and significantly associations, that remains even after adjustment for age and gender.
Conclusion: Individually high leucocytes and neutrophil counts are associated with AA. Clinical story, signs and symptoms, as well, laboratory exams when grouped on a score can predict the risk of AA.


acute appendicitis; negative appendicitis rate; Alvarado score

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