The pediatric appendicitis risk calculator (pARC) was developed and validated through secondary analyzes of 3 distinct cohorts. Test performance of the park was compared with the Pediatric Appendicitis Score (PAS).

A pediatric appendicitis risk calculator (pARC) accurately quantified the risk among children and adolescents presenting to an emergency department with acute abdominal pain, said.

"Until now, the diagnosis of appendicitis in children has heavily relied on diagnostic imaging such as computed tomography," Dr. Anupam Kharbanda of Children's Minnesota in Minneapolis told.

Dr. Kharbanda and colleagues developed and validated the calculator through secondary analyses of three cohorts of children who went to a pediatric ED with acute abdominal pain. The derivation sample included 2,423 children ages 5 to 18, 40% of whom had appendicitis.

The validation sample, derived from two independent cohorts, included 1,426 children ages 5 to 18, 35% of whom had appendicitis. The final pARC model used the following variables to help assess risk: sex, age, duration of pain, guarding, pain migration, maximal tenderness in the right lower quadrant, and absolute neutrophil count.

Only 23% of patients would have been identified as having a comparable Pediatric Appendicitis Score of <3 or > 8. Dr. Kharbanda said, "Next steps include a validation of the calculator in community emergency departments in Minnesota, Wisconsin, and California. They are also developing a mobile application to allow the dissemination of our national pARC. "

Dr. Shari Platt, chief of pediatric emergency medicine at NewYork-Presbyterian and Weill Cornell Medicine in New York City, commented, "This calculator would be very needed, especially for less experienced providers , general pediatricians and emergency physicians who care for children in acute care settings. "

"At present, the guideline for evaluating a child with appendicitis is based on clinical judgment and experience," she said. "This calculator provides an objective measurement of risk, and this might be applied and integrated into clinical practice, with an understanding of its limitations."

Dr. Ethan Wiener, Associate Chief in the Division of Pediatric Emergency Medicine at Hassenfeld Children's Hospital, said, "Coming from authors who have done a great deal of the important appendicitis work in the last decade, this paper is an effort to develop a better clinical prediction rule for appendicitis. "

Dr. Wiener added that in his experience, wrong ultrasounds do not necessarily lead to more CT scans. "Having a patient in the ED undergoing a workup gives us an opportunity to re-examine him or her," he said. The longer observation might occur in some cases, leading to another ultrasound or surgery.

Dr. S. Daniel Ganjian of Providence St. John's Health Center in Santa Monica, California, added, "This study was performed only in patients presenting to children's hospital ." Validation studies need to be performed to this tool by those who used to present the pediatrician's office or general ED, as opposed to specifically to pediatrics ED. "