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Objectives <p>To identify predictors of true appendicitis among children with a Pediatric Appendicitis Score (PAS) &lt;4 and to develop a model for detecting missed appendicitis in this low-risk population.</p> Methods <p>A prospective study including consecutive children aged 2–14 y presenting with suspected appendicitis was conducted between January 2022 and October 2025. Only children with PAS &lt;4 were included in the analysis.</p> Results <p>Among 1174 children evaluated, 404 (34.4%) had PAS &lt;4 and were included. Of these, 39 (9.6%) had confirmed appendicitis. The mean age of this cohort was 9.8 ± 2.6 y, and males accounted for 48.5% of the population. Compared with non-appendicitis cases, affected children had higher rates of vomiting (61.5% vs. 40.3%, <i>p</i> = 0.011), higher median WBC counts (8.8 vs. 7.7 × 10⁹/L, <i>p</i> = 0.001), and higher CRP levels (17 vs. 5&#xa0;mg/L, <i>p</i> = 0.001). On multivariable analysis, WBC &gt;8.8 × 10⁹/L (OR 2.77; <i>p</i> = 0.012), CRP ≥10&#xa0;mg/L (OR 3.17; <i>p</i> = 0.005), and positive ultrasound (OR 17.36; <i>p</i> &lt;0.001) were independent predictors. Ultrasound showed the highest diagnostic accuracy (85%) and negative predictive value (97%).</p> Conclusions <p>Nearly 10% of children with PAS &lt;4 had confirmed appendicitis. Combining inflammatory markers with targeted ultrasound may improve early detection of missed appendicitis in low-risk pediatric patients.</p>

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A Prospective Model for Detecting Missed Appendicitis in Low-Risk Pediatric Patients

  • 期刊论文

  • 发表日期：

    2026年5月18日

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  • Mohamed Zouari,
  • Manel Belhajmansour,
  • Mahmoud Laadhar,
  • Mohamed Karim Tounsi,
  • Manar Hbaieb,
  • Oumaima Jarboui,
  • Mahdi Ben Dhaou,
  • Riadh Mhiri

摘要

Objectives

To identify predictors of true appendicitis among children with a Pediatric Appendicitis Score (PAS) <4 and to develop a model for detecting missed appendicitis in this low-risk population.

Methods

A prospective study including consecutive children aged 2–14 y presenting with suspected appendicitis was conducted between January 2022 and October 2025. Only children with PAS <4 were included in the analysis.

Results

Among 1174 children evaluated, 404 (34.4%) had PAS <4 and were included. Of these, 39 (9.6%) had confirmed appendicitis. The mean age of this cohort was 9.8 ± 2.6 y, and males accounted for 48.5% of the population. Compared with non-appendicitis cases, affected children had higher rates of vomiting (61.5% vs. 40.3%, p = 0.011), higher median WBC counts (8.8 vs. 7.7 × 10⁹/L, p = 0.001), and higher CRP levels (17 vs. 5 mg/L, p = 0.001). On multivariable analysis, WBC >8.8 × 10⁹/L (OR 2.77; p = 0.012), CRP ≥10 mg/L (OR 3.17; p = 0.005), and positive ultrasound (OR 17.36; p <0.001) were independent predictors. Ultrasound showed the highest diagnostic accuracy (85%) and negative predictive value (97%).

Conclusions

Nearly 10% of children with PAS <4 had confirmed appendicitis. Combining inflammatory markers with targeted ultrasound may improve early detection of missed appendicitis in low-risk pediatric patients.