Appendicitis in Children: Evaluation of the Pediatric Appendicitis Score in Younger and Older Children

Background. This study aimed to evaluate Pediatric Appendicitis Score (PAS), diagnostic delay, and factors responsible for possible late diagnosis in children <4 years compared with older children who were operated on for suspected appendicitis. Method. 122 children, between 1 and 14 years, operated on with appendectomy for suspected appendicitis, were retrospectively analyzed. The cohort was divided into two age groups: ≥4 years () and <4 years (). Results. The mean PAS was lower among the younger compared with the older patients (5.3 and 6.6, resp.; ), despite the fact that younger children had more severe appendicitis (75.0% and 33.3%, resp.; ). PAS had low sensitivity in both groups, with a significantly lower sensitivity among the younger patients. Parent and doctor delay were confirmed in children <4 years of age with appendicitis. PAS did not aid in patients with doctor delay. Parameters in patient history, symptoms, and abdominal examination were more diffuse in younger children. Conclusion. PAS should be used with caution when examining children younger than 4 years of age. Diffuse symptoms in younger children with acute appendicitis lead to delay and to later diagnosis and more complicated appendicitis. 1. Introduction Appendicitis is the most common abdominal disease requiring surgery in children [1]. The risk of developing appendicitis during a lifetime is reported to be 8.7% for boys and 6.7% for girls [2]. Despite its high incidence, there are still diagnostic difficulties. The overall negative appendectomy rate among all children is suggested to be 8.4%, but in children under 6 years of age, the rate has been reported to be as high as 56.7% [3]. The diagnosis of acute appendicitis is considered to be especially challenging in children due to difficulties in communication and examination [4]. There are several studies reporting difficulties in diagnosing appendicitis in younger children [3, 5–9]. The diagnostic difficulties result in increased risks of both negative appendectomies and a delayed diagnosis, both leading to increased morbidity, more complications, longer hospital stay, and higher costs [3, 5–9]. These risks are further increased in the younger children [3, 8, 9]. The doctor delay is a known cause contributing to late diagnosis in young children [5, 6]. Other studies, with patients under 3 years and 4 years of age, have found parent delay to contribute as well to the late diagnosis [7, 10]. Our clinical experience, confirmed by the literature, shows that the younger children with acute appendicitis deviate from the typical