Hospital emergency room diagnosis of acute appendicitis in patients aged 2 to 20 years: the INFURG-SEMES score from the emergency infections study of the Spanish Society of Emergency Medicine

Objectives.

To develop the INFURG-SEMES scale (based on the emergency infections study of the Spanish Society of Emergency Medicine) using clinical and laboratory data to diagnose acute appendicitis (AA) in patients aged 2 to 20 years who were evaluated in hospital emergency departments and to compare its diagnostic yield to that of the Alvarado

score.

Methods.

Prospective observational cohort study enrolling consecutive patients between the ages of 2 and 20 years who came to 4 hospital emergency departments with abdominal pain suggestive of AA and of less than 72 hours’ duration. We collected demographic, clinical, analytic (white blood cell count, differential counts, and C–reactive protein

[CRP] levels), and radiographic data (ultrasound and/or computed tomography scans). We also recorded surgical data if pertinent. The main outcome was a diagnosis of AA within 14 days of the index visit.

Results.

We included 331 patients with a mean (SD) age of 11.8 (3.8) years; 175 (52.9%) were male. The final diagnosis was AA in 116 cases (35.0%). The INFURG-SEMES scale included the following predictors: male sex, right quadrant pain (right iliac fossa) on examination, pain on percussion, pain on walking, and elevated neutrophil count and

CRP level. The areas under the receiver operating characteristic curves for the INFURG-SEMES scale and the Alvarado score, respectively, were 0.84 (95% CI, 0.79–0.88) and 0.77 (95% CI, 0.72–0.82). The difference was statistically significant (P=.002).

Conclusions.

The INFURG-SEMES scale may prove useful for diagnosing AA in patients aged between 2 and 20 years evaluated for abdominal pain in hospital emergency departments. The INFURG-SEMES score showed greater discrimination

than the Alvarado score.