Clinical Scoring Systems and Radiologic Imaging in the Diagnosis of Pediatric Appendicitis.

Several clinical scoring systems have been developed to improve diagnostic accuracy in cases of suspected acute appendicitis. In 1986, Alvarado [1] described a scoring system, the Alvarado or MANTRELS score, to aid the diagnosis of acute appendicits. Samuel [2] was the first to describe a Pediatric Appendicitis Score (PAS) specifically for children incorporating eight statistically significant variables: cough/percussion tenderness/hopping tenderness right lower abdomen, anorexia, pyrexia, nausea/ emesis, tenderness in right iliac fossa, leukocytosis, polymorphonuclear leukocytosis, and migration of pain. Assigning a score of 1 to each parameter apart from the physical signs which were assigned a score of 2 each, Samuel [2], in his study of 1170 children, found a sensitivity of 100%, specificity of 92%, positive predictive value (PPV) of 96%, and a negative predictive value (NPV) of 99%. A PAS score of 6 or greater was indicative of a high probability of acute appendicits [2].