Three recent articles examined methodologies involved in diagnosing acute pediatric appendicitis.
1. Two clinical scoring systems: Alvarado score vs. Pediatric Appendicitis Score (PAS).
The Alvarado score utilizes elements from the patients' history, physical examination and laboratory tests and assigns points to each; total score separates "compatible with diagnosis", "probable diagnosis" and "very probable" a diagnosis of acute appendicitis.
The PAS similarly assigns a point for a similar group of clinical/laboratory findings in the child presenting with acute abdominal pain.
Both the Alvarado scoring system and PAS are helpful, but not predictive in assessing acute appendicitis in children.
2. Bedside ultrasound (BUS).
While computed tomography (CT) appears to have become the "standard of care" for diagnosing appendicitis, it exposes the patient to radiation, is expensive and takes time to perform.
67.6% of 34 adults who underwent BUS for suspected appendicitis where positively diagnosed on pathology reports. BUS may be an appropriate initial test in the Emergency Department to evaluate patients with suspected acute appendicitis.
3. CT diagnosis.
A retrospective review of 154 CT examinations with multiplanar information indicates that the coronal plane is best to identify the appendix. No enteric contrast is required.
Pediatric Emergency Care
Pediatric Emergency Care
American Journal of Emergency Medicine
