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Neutrophil-to-lymphocyte ratio as an adjunct to clinical scoring systems for diagnosing perforated appendicitis in children: prospective cohort study

Year: 2025

Type: article

Abstract: Background: Prompt identification of children susceptible to appendicitis is essential to ensure optimal therapeutic intervention and minimize adverse sequelae. This study assesses the efficacy of laboratory tests and clinical examination findings in diagnosing pediatric patients with perforated appendicitis. Methods: This prospective cohort study included children susceptible to appendicitis who had surgery from 2021 to 2023. Laboratory markers, the Alvarado score (AS), the pediatric appendicitis score (PAS), and the appendicitis inflammatory response (AIR) score were assessed for sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to differentiate between perforated and non-perforated appendicitis. Results: = 0.044). Neutrophil-to-lymphocyte ratio (NLR) surpassed the white blood cell (AUC = 0.644) and the C-reactive protein (AUC = 0.632), exhibiting remarkable predictive capability (AUC = 0.987; sensitivity = 100%; specificity = 95.4%). AIR had strong performance (AUC = 0.833) in children under 4 years old, but AS (AUC = 0.648) and PAS (AUC = 0.688) displayed inadequate predictive accuracy. Conclusion: The AS and PAS demonstrated limited discriminative power, whereas the AIR score performed more favorably, particularly in children under 4 years of age. The NLR showed the strongest diagnostic performance and, when applied alongside established scoring systems, may enhance accuracy in differentiating perforated from nonperforated appendicitis in pediatric patients.

Source: Annals of Medicine and Surgery

DOI: 10.1097/ms9.0000000000003992