7 Predictive factors of complicated appendicitis in children

Abstract Acute appendicitis represents one of the most common abdominal surgical emergency among pediatric population. Complicated appendicitis (gangrenous, perforated) is an extremely severe clinical situation because misdiagnosis led to delayed treatment and the development of complications, such as peritonitis, sepsis, bowel obstruction, and abscess formation. By that, clear pre-operative identification patients with complicated appendicitis are challenging. The aim of this study was to evaluate the different scoring systems and laboratory markers for the prediction of complicated appendicitis at admission. A retrospective medical records review of 1693 patients with acute appendicitis from 2017 to 2022 was performed. All patients divided on two groups: first with simple appendicitis (1167 patients) and second with complicated form (526 patients). Data analyzed included appendicitis inflammatory response score (AIRS) and pediatric appendicitis score (PAS), white blood cell (WBC) count, neutrophil count, neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP) level, and sodium plasma level. Receiver operating characteristic (ROC) curve with the area under the curve (AUC), specificity, sensitivity, positive prognostic value (PPV), negative prognostic value (NPV), and likelihood ratio (LR) were determined for all these markers. ROC analysis showed that for discriminating between complicated and simple appendicitis the high predictive value had NLR (AUC—0.848, sensitivity—90.3%, specificity—89.9%, PPV—98.9%, NPV—46.6%, LR(±)—8.94/0.11), low sodium level (AUC—0.801, sensitivity—90.3%, specificity—84.0%, PPV—98.5%, NPV—27.5%, LR(±)—5.21/0.21), and AIRS (AUC—0.774, sensitivity—82.0%, specificity—70.9%, PPV—98.2%, NPV—17.1%, LR(±)—2.82/0.25). WBC, neutrophil count, CRP level, and PAS had limited value for the pre-operative distinguishing complicated appendicitis. Thus, NLR, sodium plasma level, and AIRS permit with the high degree of reliability preoperatively select patients with suspected complicated appendicitis. Moreover, these markers is not expensive to measure, is easily available, and the short time required for analysis is valuable in the emergency department.