SOC
Surgery on Children

Surgery on Children Journal aims to publish issues related to Pediatric Surgery, Pediatric Neurosurgery, Pediatric Plastic Surgery, Pediatric Cardiovascular Surgery, Pediatric Orthopedic Surgery, Pediatric Vascular Surgery, Pediatric Gynecology and Obstetrics, Pediatric Ear Nose Throat, Ophthalmology, Pediatric Anesthesiology and Reanimation, Pediatric Urology, Pediatric Surgical Intensive Care Clinic, and other clinical surgery fields on children of the highest scientific and clinical value at an international level and accepts articles on these topics.

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Original Article
Identification of low-risk pediatric patients with suspected acute appendicitis using the alvarado score: a diagnostic accuracy study
Abstract
Aims: Acute appendicitis (AA) remains a major diagnostic challenge in children because of its variable clinical presentation and overlap with other causes of abdominal pain. This study aimed to evaluate the diagnostic performance of the Alvarado score (AS) in children with suspected AA.
Methods: This retrospective study included 737 pediatric patients presenting with abdominal pain between January 2019 and December 2023. Patients were classified into the acute appendicitis (AA) and nonspecific abdominal pain (NAP) groups. The diagnostic performance of the AS was assessed using receiver operating characteristic (ROC) analysis. Clinically relevant rule-out and rule-in thresholds based on previously published literature were evaluated.
Results: A total of 104 patients were diagnosed with AA and 633 with NAP. The median AS was significantly higher in the AA group than in the NAP group (8 [IQR 7–8] vs 3 [IQR 2–4]; p < 0.001). ROC analysis demonstrated excellent diagnostic performance of the AS, with an area under the curve (AUC) of 0.979 (95% CI 0.961–0.996; p < 0.001). An AS threshold of ?4 demonstrated a sensitivity of 98.1% and a a negative predictive value (NPV) of 99.6%, whereas a threshold of ?6 demonstrated a specificity of 96.5% and a positive likelihood ratio of 27.2.
Conclusion: The AS demonstrated excellent diagnostic performance and may serve as a useful adjunctive tool for the initial risk stratification of children with suspected AA. In particular, an AS ?4 was associated with a very low probability of AA and may help identify selected patients who could potentially avoid immediate imaging. Prospective multicenter studies are needed to validate these findings.

Keywords : Risk stratification, diagnostic accuracy, emergency department, clinical scoring system, pediatric surgery

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Article available in :
Volume 3, Issue 3, 2026
Page : 82-87
https://doi.org/10.51271/SOC-0076
Article Information
Received : 08 Haz 2026
Accepted : 15 Tem 2026
Published : 29 Tem 2026
Corresponding Author :

Şenay Kurtuluş: Department of Pediatric Surgery, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkiye

[email protected]
Citation : Kurtuluş Ş. Diagnostic performance of the Alvarado score for identifying low-risk pediatric patients with suspected acute appendicitis. Surg Child. 2026;3(3):82-87. doi:10.51271/SOC-0076

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