Right iliac fossa pain: can children at low risk for acute appendicitis be identified?

  • Lancet Child Adolesc Health

  • curated by Emily Willingham, PhD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • For children who present with right iliac fossa pain, the Shera score performs pretty well at identifying those who are at low risk for acute appendicitis and complex appendicitis.

Why this matters

  • This condition is the most common reason children undergo emergency surgery, but some children with normal appendixes have the procedure.

Key results

  • Of 15 risk models, these authors homed in on the Shera model as being best at identifying children at low risk for acute appendicitis.
  • With a Shera score of ≤3:
    • Failure rate: 4.8% (29/608 patients).
    • Specificity: 49.2% (579/1176 patients).
  • With a Shera score cutoff of ≤6 points, the positive predictive value (PPV) (72.6%; 95% CI, 67.4%-77.4%) rivaled that of ultrasound (75.0%; 95% CI, 65.3%-83.1%).
  • With a cutoff of ≤8 points, the PPV was 79.1% (95% CI, 69.0%-87.1%).
  • The authors say that the optimal Shera scores were as follows:
    • ≤3 points for ages 5-10 years, girls ages 11-15 years.
    • ≤2 points for boys ages 11-15 years.
  • These cutoffs together identify 44.3% of children at low risk.

Study design

  • Prospective, multicenter cohort study involving 130 UK and 9 Irish hospitals and 1827 children.
  • Funding: None.

Limitations

  • Included only patients referred to surgical assessment.
  • Would not have captured children who presented later to a different, nonparticipating hospital.