Table 2: Clinical risk scores for suspected acute appendicitis [47,48]. PAS = pediatric appendicitis score. Elevation in temperature for the Alvarado score is defined at temperature ≥ 37.5 °C, and for the PAS as ≥ 38 °C. The ruptured appendicitis score [50] has a sensitivity is 47 and specificity 98 for ruptured appendicitis at a score of 9.
|
Alvarado score |
Pediatric Appendicitis Score (PAS) |
Symptoms |
|
|
Migration of pain to the right lower quadrant |
1 |
1 |
Nausea/vomiting |
1 |
1 |
Anorexia |
1 |
1 |
Signs |
|
|
Right lower quadrant tenderness |
2 |
2 |
Rebound tenderness |
1 |
|
Elevation in temperature |
1 |
1 |
Cough/hopping/percussion tenderness in the right lower quadrant |
|
2 |
Laboratory tests |
|
|
Leukocytes ≥ 10,000/μl |
2 |
1 |
Polymorphonuclear neutrophilia ≥ 75% |
1 |
1 |
Total score |
10 |
10 |
Risk of appendicitis
Low risk: |
Alvarado score 0-4 |
PAS score 0-3 |
Intermediate risk: |
Alvarado score 5-6 |
PAS score 4-6 |
High risk: |
Alvarado score 7-10 |
PAS score 7-10 |
Ruptured appendicitis score |
Variable |
Points |
Generalized tenderness |
4 |
Abscess on imaging |
3 |
Duration > 48 hours |
3 |
WBC > 19,400 cells/μl |
2 |
Fecalith on imaging |
1 |
Total |
13 |