Abstract 1: Validation Of The Pediatric Appendicitis Risk Calculator

Validation of the pediatric Appendicitis Risk Calculator (pARC) in a community emergency department setting Cotton DM, Vinson DR, Vazquez-Benitez G, et al. [published ahead of print June 19, 2019] Ann Emerg Med. doi:10.1016/j.annemergmed.2019.04.023.

SUMMARY:

• The pediatric Appendicitis Risk Calculator (pARC) is a risk score designed to aid in the management of possible appendicitis in children. It is not a bedside test, because it requires a calculator, in contrast to the Alvarado and Pediatric Appendicitis Score.
• pARC uses 7 variables: sex, age, duration of pain, guarding, pain migration, maximal tenderness in the right lower quadrant, and absolute neutrophil count (continuous scale).
• This was a multicenter, prospective observational cohort study in 11 Kaiser EDs in Northern California.
• Over 18 mo, 2,089 children with a median age of 12 were enrolled, of who 54% had very low (< 5%) or low (5% to 14%) predicted risk of appendicitis, 43% had intermediate risk (15% to 84%), and 4% had high risk (≥ 85%). These proportions were similar to those in the derivation sample.
• In the very-low and low-risk groups 1.4% and 3.0% of patients had appendicitis, respectively.
• Notable findings included the following. (1) The pARC did work better than the Pediatric Appendicitis Score in terms of its test characteristics. (2) One of the criticisms of previous appendicitis rules is that they place most patients into an intermediate-risk category, whereas pARC placed less than half the patients in this “do what you want” middle group. (3) Very few rules are so quickly subject to community validation.
• Although the test characteristics are decent, whether and by how much pARC actually would decrease CT utilization in practice remains unknown.

PMID: 31229394

EDITOR’S COMMENTARY: If you are looking for a risk score for pediatric appendicitis, pARC is the best one, and it has been validated in academic and community settings. However, it requires an online calculator, and the risk of appendicitis in low-risk and very low-risk groups may still be too high for your liking. Importantly, we still don’t know how it stacks up against clinical judgment.

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