Ultrasonographic findings of child acute appendicitis incorporated into a scoring system

• Published in: Singapore medical journal 2022-01, Vol.63 (1), p.35-41
• Main Authors: Pop, Gheorghe Nicusor, Costea, Flaviu Octavian, Lungeanu, Diana, Iacob, Emil Radu, Popoiu, Calin Marius
• Format: Article
• Language: English
• Subjects: Acute Disease; Appendectomy; Appendicitis - diagnostic imaging; Appendicitis - surgery; Appendix - diagnostic imaging; Appendix - pathology; Appendix - surgery; Child; Humans; Original; Sensitivity and Specificity; Ultrasonography - methods
• ISSN: 0037-5675; 2737-5935
• DOI: 10.11622/smedj.2020102

This study aimed to investigate the ultrasonographic features of paediatric acute appendicitis and incorporate them into a scoring algorithm that will quantify the risk of complications and the strength of recommendation for surgical intervention. 179 patients with suspected appendicitis who had undergone ultrasonographic examination were included in this study. Based on their medical evaluation and post-surgical histopathological results, patients were categorised into confirmed appendicitis (n = 101) and non-appendicitis (n = 78) groups. In the appendicitis group, the appendix was visualised in 66 (65.3%) patients. In cases where the appendix was not visualised, we looked out for secondary inflammatory signs, which were present in 32 (31.7%) patients. Using stepwise logistic regression, Blumberg's sign, free fluid or collection, hyperaemia, non-compressible appendix and an appendix diameter > 7 mm were found to be significant predictive factors for appendicitis. A new scoring system called POPs was developed, combining inflammatory predictors and ultrasonography findings, with an area under the receiver operating characteristic curve of 0.958 (95% confidence interval 0.929-0.986). The newly developed POPs-based diagnosis scheme proved a promising alternative to existing scoring systems such as the Alvarado score. Although further calibration would be beneficial, the proposed scoring scheme is simple and easy to understand, memorise and apply in the emergency room.