The APpendicitis PEdiatric (APPE) score: a new diagnostic tool in suspected pediatric acute appendicitis


Submitted: 23 January 2019
Accepted: 19 March 2019
Published: 2 April 2019
Abstract Views: 3097
PDF: 1361
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Authors

  • Mario Lima Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Dora Persichetti-Proietti Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Neil Di Salvo Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Claudio Antonellini Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Michele Libri Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Beatrice Randi Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Michela Maffi Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Tommaso Gargano Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Giovanni Ruggeri Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
  • Vincenzo Davide Catania Department of Pediatric Surgery, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

Our aim was to develop an APpendictis-PEdiatric score (APPE score) in quantifying risk of acute appendicitis based on combination of clinical and laboratory markers. 1025 patients were classified in: acute appendicitis (AA) and non-appendicitis. Demographic/clinical features, and laboratory were collected. They were compared for quantitative-variables and categorical-variables. Significant predictors (P=<0,05) were included in logistic regression model. Based on regression-coefficients, a diagnostic score was tested by calculating the area under the ROC curve. Two cut-offs were established to define classes of risk of AA. 9 variables were identified as potentially predictors for AA. Those underwent logistic regression and a score was assigned, for maximum 21-points. The score showed an area under the curve: 0.831 and a linear proportion with the state of appendicular inflammation (R20.85). Patients with a score ≤8 were at low risk of AA (sensitivity 94%); those with a score ≥15 were at high risk for AA (specificity 93%). Those between 8 and 15 were defined at intermediate risk class. APPE-score guides clinicians in classifying patients with suspected-AA according to clinical and laboratory findings in order to improve their management.


Lima, M., Persichetti-Proietti, D., Di Salvo, N., Antonellini, C., Libri, M., Randi, B., Maffi, M., Gargano, T., Ruggeri, G., & Catania, V. D. (2019). The APpendicitis PEdiatric (APPE) score: a new diagnostic tool in suspected pediatric acute appendicitis. La Pediatria Medica E Chirurgica, 41(1). https://doi.org/10.4081/pmc.2019.209

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