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Usefulness of the Pediatric Appendicitis Score and Neutrophil to Lymphocyte Ratio for Assessing the Complicated Appendicitis in Children

Introduction: Acute appendicitis (AA) is a common surgical disease which occurs in 
almost all age groups, and especially in childhood. Acute appendicitis is one 
of the most common causes of acute abdomen. The lifetime occurrence of this 
disease is approximately 7%, with perforation rate of up to 20%. In spite of 
the well-known classical symptoms and clinical findings of acute appendicitis, 
early diagnosis can be sometimes challenging. For the treatment of simple 
appendicitis (SA) in children, the effectiveness of antibiotic treatment has 
been reported. We aimed to determine predictive value of combination NLR and 
PAS in pediatric patients with clinical suspicion of acute appendicitis and 
complicated appendicitis Methods: Our study was performed on 480 
children admitted for suspected acute appendicitis and underwent appendectomy 
at the MNCMCH, Ulaanbaatar Mongolia, between May 2019 and December 2019. White 
blood count (WBC), Neutrophil, NLR and PAS were compared between groups. Results: The sensitivity, specificity, PPV, NPV of PAS + NLR for differentiating 
complicated and noncomplicated appendicitis were 86.8%, 89.4%, 92.1% and 76% 
respectively. The sensitivity, specificity, PPV, NPV of PAS + NLR for diagnosis 
of acute appendicitis were 90.5%, 68.1%, 97.68% and 32.6% respectively. Conclusion: In the era of conservative antibiotic-based management of uncomplicated acute 
appendicitis, we advocate that combination of NLR and PAS is a useful aid in 
predicting complicated appendicitis.