“Kappa” conformance test between three acute appendicitis scoring systems (Pediatric Appendicitis Score/Pediatric Appendicitis Risk Calculator/Alvarado) in predicting appendicitis in children

Background: Appendicitis is the most common abdominal emergency in the pediatric population. The clinical features of appendicitis in children are usually atypical, leading to misdiagnosis in 19–57% of preschool age children, which can result in complications. Thus, scoring systems are used to estimate the risk of appendicitis based on symptomatology and laboratory results. Aim of the study: The aims of this study were to analyze the conformance of the Pediatric Appendicitis Score (PAS), the Pediatric Appendicitis Risk Calculator (pARC), and the Alvarado score as screening tools for appendicitis in children attending a public hospital emergency department. Material and methods: The inclusion criteria were all children aged < 14 years who presented with symptoms of appendicitis and were confirmed to have appendicitis either by imaging or surgery. The exclusion criteria were incomplete medical records. Data was collected retrospectively from medical records. Data analysis included examination of the proportion and distribution of data, and statistical analysis in the form of the Kappa conformance test. Results: The result of the conformance test between the PAS and the Alvarado score was 75%, but the Kappa conformance value between them was only 46.8κ although statistically significant (p value = 0.013). The conformance test between the PAS and the pARC was 50%, but the Kappa conformance value was only 19.4κ and not statistically significant (p value = 0.143). The conformance test between the Alvarado score and the pARC was 55%, but the Kappa conformance value was 13.5κ and not statistically significant (p value = 0.492). Conclusions: The PAS has advantages over other appendicitis screening questionnaires with greatest conformance between PAS and Alvarado.