Pediatric appendicitis: pARC tool works in community EDs

  • Ann Emerg Med

  • Jenny Blair, MD
  • Clinical Essentials
L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano

Takeaway

  • 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.

Key results

  • 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
    • 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

Study design

  • 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.

Limitations

  • Children age
  • Ability to reduce CTs not assessed.