Comparison of the Diagnostic Value of the Neutrophil-to-Lymphocyte Ratio Versus the Pediatric Appendicitis Scoring System in Children with Suspected Acute Appendicitis.

OBJECTIVE: This study aimed to evaluate and compare the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) and the pediatric appendicitis score (PAS) in pediatric patients with suspected acute appendicitis (AA). METHODS: This cross-sectional study included 300 children presenting with suspected AA who underwent appendectomy at Akbar Children's Hospital in Mashhad, Iran, between March 2022 and February 2024. Preoperative white blood cell count, neutrophil count, NLR, and PAS were assessed. Following appendectomy and histopathological confirmation, patients were stratified into three groups: negative appendicitis (normal appendix), uncomplicated appendicitis, and complicated appendicitis. Diagnostic parameters were then compared among these groups. RESULTS: A total of 300 children aged 6 to 18 years suspected of having AA were studied, including 175 boys (58.3%), with a mean age of 9.7±3.18 years. For the diagnosis of AA, an NLR cutoff of >2.82 yielded a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 97.15%, 92.59%, 98.35%, and 87.72%, respectively. Conversely, a PAS cutoff of >6.5 yielded a sensitivity, specificity, PPV, and NPV of 89.43%, 94.44%, 98.65%, and 66.23%, respectively. CONCLUSION: Both NLR and the PAS were significantly elevated in children with AA. The NLR had higher sensitivity, whereas the PAS had greater specificity. Given its sensitivity, simplicity, and availability, the NLR could be effectively integrated into other clinical evaluations to enhance the diagnostic accuracy for AA in pediatric patients.