Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation

Abstract Introduction Non-specific acute abdominal painis the most common process requiring differential diagnosis with appendicitisin clinical practice. The aim of this study was to assess the Paediatric AppendicitisScore in differentiating between these two entities. Material and methods All patients admitted due to suspicion of appendicitiswere prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal painand appendicitiswere enrolled in the study. Several variables were collected, including Score variables and C-reactive proteinlevels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. Results A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal painand 132 cases of appendicitis. Temperature and right iliac fossatenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussiontenderness in the right lower quadrantwas the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive proteinin the Score increased diagnostic accuracy, although with no statistically significant differences. Conclusions The Paediatric AppendicitisScore helps in differential diagnosis between appendicitisand non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive proteinat a cut-off value of 25.5 mg/L value could be used instead.