Evaluation of using Alvarado score and C-reactive protein in diagnosing acute appendicitis in children

Abstract

Background/Aims. Acute appendicitis (AA) remains a diagnostic challenge in children, despite ongoing researches. With an aim to facilitate making diagnosis of AA many scoring systems have been created; among them Alvarado score is the most popular. C-reactive protein (CRP) has proven significance for diagnosing AA in adults, but not in children. The aim of this study was to evaluate significance of Alvarado score, as well as CRP values, in making diagnosis of AA in children. Methods. This prospective six-month study was performed on 257 patients under the age of 15, admitted for acute abdominal pain in the Clinic of Pediatric Surgery and Orthopedics in the Clinical Centre of Nis. Alvarado score and CRP values were determined on admission and compared with final diagnosis on discharge. The patients were divided into two groups: group I - non operated patients with abdominal pain (n = 184) and group II - operated on patients for appendectomy (n = 73). Results. Values of Alvardo score were statistically significantly different between groups (group I: 4.9 ? 1.21, group II: 8.55 ? 1.32). Also, our results showed significantly high values of CRP measured in operated children (group I: 8.17 ? 4.7 mg/L, group II: 38 ? 26 mg/L). Values of validity parameters for Alvarado score were: sensitivity 90%, specifity 80%, positive predictive values 87%; for CRP 95%, 70% and 80%, respectively. Conclusion. Alvarado score and CRP are very useful adjuvant diagnostic tool for AA to a less experienced surgeon. High values of Alvarado score and CRP cannot be ignored neither at the same time, used as the sole diagnostic method for discriminating children with AA.Uvod/Cilj. Dijagnoza akutnog apendicitisa (AA) ostaje izazov upravo u decjoj populaciji. Sa namerom da olaksaju postavljanje dijagnoze AA i povecaju njenu tacnost kreirani su i brojni skoring sistemi, medju kojima najvecu popularnost ima Alvarado skor. C-reaktivni protein (CRP) ima dokazani znacaj za dijagnostiku AA u odrasloj, ali ne i u decjoj populaciji. Cilj naseg rada bio je da se odredi klinicka primenjivost Alvarado skora, kao i vrednosti CRP u dijagnostici AA kod dece. Metode. Prospektivna, sestomesecna studija obavljena u Klinici za decju hirurgiju i ortopediju KC Nis obuhvatila je 257 dece mladje od 15 godina, hospitalizovane zbog akutnog abdominalnog bola. Vrednosti Alvarado skora, kao i CRP, odredjivane su na prijemu i uporedjivane sa dijagnozom na otpustu. Bolesnici su bili podeljeni u dve grupe: grupu I cinili su neoperisani (n = 184) i grupu II bolesnici sa apendektomijom (n = 73). Rezultati. Vrednosti Alvarado skora bile su statisticki znacajno vece u grupi operisane (8,55 ? 1,32) nego u grupi neoperisane dece (4,9 ? 1,21). Takodje, vrednosti CRP bile su statisticki znacajno vece u grupi II (grupa I: 8,17 ? 4,70 mg/L, grupa II: 38 ? 26 mg/L). Senzitivnost Alvarado skora iznosila je 90%, specificnost 80%, pozitivna prediktivna vrednost (PPV) 87%, a za CRP: 95%, 70% i 80%. Zakljucak. Alvarado skor i CRP velika su pomoc u dijagnostici AA manje iskusnom hirurgu. Visoke vrednosti Alvarado skora i CRP ne smeju biti ignorisane, ali ni koriscene kao jedini dijagnosticki metod za AA u decjem uzrastu.