Associação entre escore de alvarado, aspecto cirúrgico e anatomopatológico do apêndice em crianças e adolescentes com apendicite aguda

Abstract

Objective: to evaluate the relationship between Alvarado score (AS) and surgical findings in children with acute appendicitis (AA) to identify possible concordances between the different scores and the complications of the disease. Methods: this is a cross-sectional study carried out in a tertiary hospital. Electronic medical records of children aged 0 to 12 years admitted to the emergency room, diagnosed with AA and referred for appendectomy, were reviewed between January 1, 2016 and December 31, 2018. AS and surgical finding were considered dependent variables. Pearson's chi-square test was applied for the difference in their frequency distribution in relation to the independent variables (5% statistical significance). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive value and accuracy for the cutoff points of five, six and seven of the AS in relation to complicated appendicitis were also calculated using the Wilson Points method. Results: among uncomplicated appendicitis (catarrhal/phlegmonous phase), 57.8% obtained scores of 6-10 in the AS, whereas in complicated appendicitis (gangrenous/perforation), 76.1% scored 6- 10 (p=0.01). The cut-off point of five showed the highest sensitivity (90.6%), NPV 36 (38,1%) and accuracy (72,7%) as a predictor of complicated appendicitis. Conclusions: AS is an important complementary tool to predict inflammatory levels of AA in children, since scores greater than or equal to six can suggest more advanced inflammatory processes and perforations. The cut-off point of five has a high sensitivity for complicated appendicitis, and surgical intervention may be indicated.