eP29 High Alvarado score is independently associated with appendicitis in children with inconclusive ultrasound

Abstract

Acute appendicitis (AA) is a challenging diagnosis in the paediatric population. It usually requires meticulous examination of clinical, laboratory and radiological data. In most studies, ultrasound (US) was found to be highly reliable and accurate for diagnosing paediatric appendicitis. However, an inconclusive US in children with right lower quadrant pain is likely to be challenging for the emergency physician.

We performed a retrospective investigation in a paediatric emergency unit from 1st January 2020 to 31st December 2023. All paediatric patients under 14 years of age with right lower quadrant pain and an inconclusive US were included. The Alvarado score, based on a combination of clinical and laboratory factors, was computed for all patients. The surgeon was free to decide whether or not to order a CT scan.

Our analysis showed that patients with proven appendicitis had higher WBC counts, CRP levels, and Alvarado scores. Thus, this analysis identified that children with Alvarado scores ≥ 7 were over 34 times more likely to have AA than those with Alvarado scores < 7, Leukocytosis > 15 x109/L, and CRP> 50 mg/l were also identified as independent predictors of AA in these children. Our study showed that the Alvarado score, potentially combined with laboratory data, is highly useful for diagnosing appendicitis in children with right lower quadrant abdominal pain and inconclusive US. These factors would make it possible not only to provide an accurate pre- operative diagnosis, but also to inform the patient and his/her family, and ultimately to spare the child from unnecessary radiation.