Diagnosing appendicitis at different time points in children with right lower quadrant pain

Background Acute appendicitis is the most common abdominal emergency in clinical surgery. This study was designed to compare the diagnostic value of the Pediatric Appendicitis Score (PAS) with that of the Alvarado score based on different time points in children with right lower quadrant (RLQ) abdominal pain. Methods This prospective cohort study comprised 1,395 children (aged 3-18 years) with RLQ abdominal pain between 2005 and 2009. The patients were scored by the pediatric emergency physicians. Receiver operating characteristic (ROC) curves were used to determine the appropriate cutoff scores of the Alvarado and PAS systems. The sensitivity and specificity, and area under ROC curve were calculated for both systems. Results The AUCs of the Alvarado system were all higher than those of the PAS system (day 1: 0.09 vs. 0.87; day 2: 0.87 vs. 0.84; day 3: 0.88 vs. 0.82). The best appropriate cutoff scores were seven (days 1 and 2) and six (day 3) on the PAS and six (days 1 and 2) and seven (day 3) on the Alvarado system. Conclusions The preliminary data show that the best cutoff score of Alvarado and PAS systems vary with the different time points of RLQ pain presentation. It may provide helpful information for primary or emergency physicians to determine whether the patient should undergo surgical consultation