Discriminating acute appendicitis from other causes of acute abdominal pain in children

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Goldman et al have taken an important step in evaluating the usefulness of a clinical score for discriminating acute appendicitis from other causes of abdominal pain in children. They have applied the Samuel score (J Pediatr Surg 2002;37:877-881) prospectively to a different population (ie, broader age, different continent, Emergency Department of a provencial tertiary medical center) than that in which it was defined. The reader should note the caveats and limitations of the Toronto study. However, a low cutoff score supports the safe discharge from the Emergency Department of almost two-thirds of children evaluated without imaging studies, and a high cutoff score supports surgical intervention of almost 10% without imaging studies because they will almost certainly have acute appendicitis. Additional clinical observation, imaging studies, and clinical research can be focused on the more difficult quarter of children who have middling, non-discriminating scores.