Evidence map›Paper›PMID 42149353›Full record

ArticleIndian journal of pediatrics2026

A Prospective Model for Detecting Missed Appendicitis in Low-Risk Pediatric Patients.

Mohamed Zouari, Manel Belhajmansour, Mahmoud Laadhar, Mohamed Karim Tounsi, Manar Hbaieb, Oumaima Jarboui, Mahdi Ben Dhaou, Riadh Mhiri

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Article in Indian journal of pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

8 authors.

Mohamed ZouariResearch Laboratory "Developmental and Induced Diseases" (LR19ES12), University of Sfax, Sfax, Tunisia. mohamed.zouari@medecinesfax.org.ORCID 0000-0001-9491-816X
Manel BelhajmansourResearch Laboratory "Developmental and Induced Diseases" (LR19ES12), University of Sfax, Sfax, Tunisia.
Mahmoud LaadharDepartment of Pediatrics, Hedi Chaker Hospital, Sfax, 3029, Tunisia.
Mohamed Karim TounsiResearch Laboratory "Developmental and Induced Diseases" (LR19ES12), University of Sfax, Sfax, Tunisia.
Manar HbaiebResearch Laboratory "Developmental and Induced Diseases" (LR19ES12), University of Sfax, Sfax, Tunisia.
Oumaima JarbouiResearch Laboratory "Developmental and Induced Diseases" (LR19ES12), University of Sfax, Sfax, Tunisia.
Mahdi Ben DhaouResearch Laboratory "Developmental and Induced Diseases" (LR19ES12), University of Sfax, Sfax, Tunisia.
Riadh MhiriResearch Laboratory "Developmental and Induced Diseases" (LR19ES12), University of Sfax, Sfax, Tunisia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo identify predictors of true appendicitis among children with a Pediatric Appendicitis Score (PAS) <4 and to develop a model for detecting missed appendicitis in this low-risk population.

methodsA prospective study including consecutive children aged 2-14 y presenting with suspected appendicitis was conducted between January 2022 and October 2025. Only children with PAS <4 were included in the analysis.

resultsAmong 1174 children evaluated, 404 (34.4%) had PAS <4 and were included. Of these, 39 (9.6%) had confirmed appendicitis. The mean age of this cohort was 9.8 ± 2.6 y, and males accounted for 48.5% of the population. Compared with non-appendicitis cases, affected children had higher rates of vomiting (61.5% vs. 40.3%, p = 0.011), higher median WBC counts (8.8 vs. 7.7 × 10⁹/L, p = 0.001), and higher CRP levels (17 vs. 5 mg/L, p = 0.001). On multivariable analysis, WBC >8.8 × 10⁹/L (OR 2.77; p = 0.012), CRP ≥10 mg/L (OR 3.17; p = 0.005), and positive ultrasound (OR 17.36; p <0.001) were independent predictors. Ultrasound showed the highest diagnostic accuracy (85%) and negative predictive value (97%).

conclusionsNearly 10% of children with PAS <4 had confirmed appendicitis. Combining inflammatory markers with targeted ultrasound may improve early detection of missed appendicitis in low-risk pediatric patients.

Indexed as

AppendicitisMissed DiagnosisAdolescentChildChild, PreschoolC-Reactive ProteinFemaleHumansLeukocyte CountMalePredictive Value of TestsProspective StudiesUltrasonographyC-Reactive ProteinChildrenMissed appendicitisPediatric appendicitis scorePediatric emergency medicineUltrasound

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PMID42149353

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