Comparison of the Alvarado and Pediatric Appendicitis (PAS) Scoring Systems for Diagnosing Acute Appendicitis
Most. Mahfuja Parvin *
Department of Surgery, Shaheed Monsur Ali Medical College, Dhaka, Bangladesh.
Md. Saffait Jamil
Department of Vascular Surgery, National institute of Cardiovascular Diseases, Dhaka, Bangladesh.
Shahrzaad Chowdhury
Department of Surgery, Shaheed Monsur Ali Medical College, Dhaka, Bangladesh.
Sharmin Sultana
Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh.
Niaz Anam Nilave
Department of Pediatric Surgery, Dinajpur Medical College and Hospital, Dinajpur, Dhaka, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Background: In order to detect acute appendicitis in children as quickly and accurately as possible, a number of scoring systems, including Alvarado and PAS, have been established. Comparing different scoring systems' effectiveness and diagnostic usefulness was the aim of this research.
Materials and Methods: This prospective study was conducted in the pediatric surgery department of Bangladesh Medical University. Dhaka, Bangladesh from July 2022 to July 2024 over a period of 24 months. Data analysis was done by Statistical Package for Social Science (SPSS) software (version 26.0; SPSS Inc., Chicago, IL). Specificity, sensitivity, negative and positive likelihood ratios, diagnostic accuracy, negative and positive predictive values of the three scoring systems were analyzed after comparing the histopathology report. Receiver operating curve (ROC) was used to analyze the performance characteristics of the three scoring systems. P value of < 0.05 was considered statistically significant.
Results: A total number of 200 cases were studied to compare the predictive values of Alvarado and PAS scoring systems for the diagnosis of acute appendicitis. Maximum age group was between 8-10 years with a Mean ± SD of 8.0 ± 2.8 years. PAS scoring system had a better sensitivity (96.81%) than Alvarado (89.89%) scoring systems. Specificity was also more in PAS (85.82%) than Alvarado (63.64%). Diagnostic accuracy of PAS scoring system was 90.00% which is more than Alvarado (79.00%) scoring systems. Area under Curve (AUC) of Alvarado and PASA scoring systems are 0.809 and 0.864 respectively. Statistically significant difference (p<0.05) is found in the difference of Area Under Curves (AUC) of Receiver Operative Characteristic (ROC) between PAS and Alvarado scoring systems.
Conclusions: According to the current study, the PAS scoring system outperforms the Alvarado scoring systems in terms of sensitivity and specificity. Additionally, it has a low negative appendectomy rate due to its improved diagnostic accuracy, high positive predictive value, and high negative predictive value.
Keywords: Alvarado pediatric, appendicitis (PAS) score, acute appendicitis