A Traditional Yet Powerful Tool: The Superiority of the Pediatric Appendicitis Score (PAS) Despite the Introduction of Novel Hematologic Markers

Öz

Abstract Objective: Acute appendicitis is one of the most common causes of emergency abdominal surgery in children, and early accurate diagnosis is essential. This study aimed to compare the diagnostic and severity-assessment performance of the Pediatric Appendicitis Score (PAS) with novel hematologic inflammatory markers in pediatric patients with suspected acute appendicitis. Materials and Methods: This retrospective single-center study included 209 pediatric patients evaluated for suspected acute appendicitis between January 2023 and January 2025. Patients were classified into three groups: non-appendicitis (n=70), uncomplicated appendicitis (n=69), and complicated appendicitis (n=70). PAS, C-reactive protein (CRP), procalcitonin, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI) were analyzed. Diagnostic performance was evaluated using ROC analysis. Results: PAS demonstrated the highest discriminative performance for the diagnosis of acute appendicitis (AUC=0.92, p<0.001). The AUC values were 0.84 for CRP and 0.81 for NLR. SII, AISI, and procalcitonin were also significant but showed lower performance. For distinguishing complicated from uncomplicated appendicitis, the AUC was 0.82 for PAS, 0.79 for CRP and procalcitonin, 0.75 for NLR, 0.74 for SII, and 0.70 for AISI. Multivariate analysis identified PAS as the strongest independent predictor of appendicitis (OR=8.9, 95% CI: 4.2-18.4; p<0.001). Conclusion: PAS remains the most reliable tool for diagnosing pediatric acute appendicitis and assessing disease severity. Novel hematologic markers may provide supportive value, but they do not outperform PAS when used alone. Keywords: acute appendicitis, Pediatric Appendicitis Score, hematologic inflammatory markers, child, pediatric surgery

Anahtar Kelimeler

• Pediatric Appendicitis Score
• hematologic inflammatory markers
• pediatric surgery

Etik Beyan

Ethical Approval and Informed Consent This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval for the study was obtained from the Institutional Review Board of our institution (Protocol No: 34). Due to the retrospective design of the study and the use of anonymized patient data, the requirement for informed consent was waived by the ethics committee. All data were handled confidentially and used solely for scientific research purposes.

Teşekkür

The author would like to thank all healthcare professionals who contributed to the management and care of the patients included in this study.

Geleneksel Ancak Güçlü Bir Araç: Yeni Hematolojik Belirteçlere Rağmen Pediatrik Apandisit Skorunun (PAS) Üstünlüğ

Öz

Özet Amaç: Akut apandisit, çocukluk çağında acil abdominal cerrahinin en sık nedenlerinden biridir. Erken ve doğru tanı büyük önem taşımaktadır. Bu çalışmada, pediatrik akut apandisit şüphesi olan hastalarda Pediatric Appendicitis Score (PAS) ile yeni hematolojik inflamatuvar belirteçlerin tanısal ve hastalık şiddetini belirlemedeki performanslarının karşılaştırılması amaçlandı. Materyal ve Metot: Bu retrospektif, tek merkezli çalışmaya Ocak 2023-Ocak 2025 tarihleri arasında akut apandisit ön tanısıyla değerlendirilen 209 pediatrik hasta dahil edildi. Hastalar non-apandisit (n=70), komplike olmayan apandisit (n=69) ve komplike apandisit (n=70) olarak üç gruba ayrıldı. PAS, C-reaktif protein (CRP), prokalsitonin, nötrofil-lenfosit oranı (NLR), sistemik immün-inflamasyon indeksi (SII) ve agregat sistemik inflamasyon indeksi (AISI) değerlendirildi. Tanısal performans ROC analizi ile incelendi. Bulgular: PAS, akut apandisit tanısında en yüksek ayırt edici gücü gösterdi (AUC=0.92, p<0.001). CRP ve NLR için AUC değerleri sırasıyla 0.84 ve 0.81 olarak bulundu. SII, AISI ve prokalsitonin de anlamlı olmakla birlikte daha düşük performans gösterdi. Komplike ve komplike olmayan apandisit ayrımında PAS’ın AUC değeri 0.82 iken, CRP ve prokalsitonin için 0.79, NLR için 0.75, SII için 0.74 ve AISI için 0.70 olarak saptandı. Çok değişkenli analizde PAS, apandisitin en güçlü bağımsız belirleyicisi olarak bulundu (OR=8.9, %95 GA: 4.2-18.4; p<0.001). Sonuç: PAS, pediatrik akut apandisit tanısı ve hastalık şiddetinin değerlendirilmesinde en güvenilir yöntem olmaya devam etmektedir. Yeni hematolojik belirteçler PAS’a yardımcı olabilir; ancak tek başlarına üstünlük göstermemektedir. Anahtar Kelimeler: akut apandisit, Pediatric Appendicitis Score, hematolojik inflamatuvar belirteçler, çocuk, pediatrik cerrahi

Anahtar Kelimeler

• Pediatric Appendicitis Score
• hematolojik inflamatuvar belirteçler
• pediatrik cerrahi

Kaynakça

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