Article
Validación de la puntuación de apendicitis pediátrica (pas) frente a la escala de Alvarado, para el diagnóstico de apendicitis en niños de 4 a 15 años de edad
Fecha
2016-12Autor
Tipán Barros, Jonathan Maximiliano
Morocho Malla, Manuel Ismael
Córdova Neira, Fernando Marcelo
Tipán Barros, Tatiana Maribel
Institución
Resumen
Background: The appendicitis is the most common
surgical pathology in childhood. It is necessary an agile
and accurate method to avoid excessive paraclinical
examinations, diagnostic errors and unnecessary
appendectomies. The systematic scores are the best
processes for ordering clinical manifestations and reach
the diagnosis.
Objective: To validate simultaneously the pediatric
appendicitis score (PAS) and Alvarado scales for the
diagnosis of acute appendicitis in children aged from 4
to 15 years old with acute abdomen in pediatric emergencies
of a third level hospital in the national health
system.
Materials and methods: A total of 161 patients aged
from 4 to 15 years old were treated at the Vicente Corral
Moscoso Hospital in the pediatric emergency service
with clinical suspicion of acute appendicitis. They
were applied the two scores before the surgery. The
diagnosis was confirmed with histology. We compared
the diagnostic capacity of PAS and Alvarado, and the
proportion of agreement between tests with respect to
the gold standard.
Results: The sample had a predominance of males.
The median age was 12 years, weight 37.5 ± 12.2 kg,
height 138.5 ± 15.4 cm and 42% of malnutrition among
those that were: emaciation, overweight and obesity.
The sensitivity of PAS was higher (97.1 vs 79.8) although
with lower specificity (50 vs 59). The negative predictive
value of PAS was higher (73.1 vs 31.7). The agreements
between histology and tests were higher for PAS (90.7%
vs 74.5%). The 99% of phlegmonous appendicitis belonged
to PAS and the 84% to Alvarado. More false negatives
were produced with the Alvarado score (P <0.001).
Conclusion: The PAS score is a reliable and easy
diagnostic tool to use for deciding on acute appendicitis
surgery suspected in children. Until the conclusive
evidence is available, the use of both scores should be
considered as a good clinical practice