- The pediatric Appendicitis Risk Calculator (pARC) performs well for assessing pediatric appendicitis risk in community emergency departments (EDs).
- It outperformed the Pediatric Appendicitis Score (PAS).
Why this matters
- Designed for use with electronic health records, pARC estimates risk on continuous scale, unlike PAS.
- pARC sorts most patients into higher- and lower-risk strata; PAS assigns most to intermediate risk.
- Previously, pARC was validated in an academic setting.
- 16.9% (353) had appendicitis.
- pARC vs PAS areas under the curve: 0.89 (95% CI, 0.87-0.92) vs 0.80 (95% CI, 0.77-0.82).
- pARC performance, by scores:
- 5%-15%: 97.5% sensitive.
- 65%-84%: 97.8% specific.
- ≥85%: 99.3% specific.
- At any specificity, sensitivity of pARC > PAS.
- Negative appendectomy rate: 6.5%.
- pARC 5%-15%: 22.2%.
- pARC ≥65%: 0.9%.
- Perforations: 15.6%; none in lower-risk strata.
- 9 cases in
- 9 missed cases, 2 were in
- Prospective observational cohort validation study of participants aged 5-20.9 years presenting to 11 general community EDs with ≤5 days of right-sided or diffuse abdominal pain (n=2089).
- Authors calculated pARC and PAS for each.
- Outcome: appendicitis within 7 days.
- Funding: NIH.
- Children age
- Ability to reduce CTs not assessed.