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 Niš. 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.

Keywords

• appendicitis
• diagnosis, differential
• child
• research design
• C-reactive protein
• sensitivity and specificity