AB212. SOH26AB_0320. The rate of negative appendectomies in a paediatric population and correlation with appendicitis scoring systems and use of pre-operative imaging
General Surgery Posters I

AB212. SOH26AB_0320. The rate of negative appendectomies in a paediatric population and correlation with appendicitis scoring systems and use of pre-operative imaging

Chiara Amisano, Maria O’Dea, Odhrán Ryan, Sharjeel Paul, Catherine Tracy Cronin

Department of General Surgery, St. Luke’s General Hospital, Kilkenny, Ireland

Background: The clinical diagnosis of acute appendicitis in paediatric patients remains challenging, with significant diagnostic uncertainty. This audit was performed to identify the negative appendicectomy rate in paediatric patients in our surgical unit, and aimed to evaluate factors affecting the negative rate.

Methods: A retrospective analysis of paediatric appendicectomy cases over a 1-year period was performed. Medical charts and hospital electronic systems were reviewed for clinical features and investigation results, including extraction of variables required for paediatric appendicitis score (PAS), appendicitis inflammatory response (AIR), and Alvarado scoring systems. Histopathology served as the diagnostic reference standard.

Results: There were 103 appendicectomies performed on paediatric patients. A total of 100% presented with right iliac fossa pain (48% migratory), 85% nausea, 30% vomiting, and 15% febrile. The negative appendicectomy rate was 4.85%, with 95.15% demonstrating pathology (69.9% acute inflammatory appendicitis, 20% lymphoid hyperplasia, and 10.1% other). A total of 45% underwent pre-operative imaging [90.9% ultrasound (20.2% positivity rate) and 9.1% computed tomography (100% positivity rate)]. Pre-operative use of the AIR score (positive >4) correlated with a positive appendectomy rate (P=0.007); however, the Alvarado and PAS did not (P=0.6 and P=0.8, respectively).

Conclusions: Negative appendicectomy rates in paediatric patients vary widely. Our institution falls within an acceptable range. Although most specimens demonstrate pathology, not all show acute inflammatory changes, with other findings including lymphoid hyperplasia and enterobiasis also identified. As ultrasonography is often non-confirmatory, clinical assessment remains essential, with scoring systems aiding the diagnostic process.

Keywords: Alvarado score; appendicitis inflammatory response score (AIR score); negative appendicectomy; paediatric appendicitis score (PAS); pre-operative imaging

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab212
Cite this abstract as: Amisano C, O’Dea M, Ryan O, Paul S, Cronin CT. AB212. SOH26AB_0320. The rate of negative appendectomies in a paediatric population and correlation with appendicitis scoring systems and use of pre-operative imaging. Mesentery Peritoneum 2026;10:AB212.

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