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Background . This study aimed to evaluate Pediatric Appendicitis Score (PAS), diagnostic delay, and factors responsible for possible late diagnosis in children <4 years compared with older children who were operated on for suspected appendicitis.  Method . 122 children, between 1 and 14 years, operated on with appendectomy for suspected appendicitis, were retrospectively analyzed. The cohort was divided into two age groups: ≥4 years ( n  = 102) and <4 years ( n  = 20).  Results . The mean PAS was lower among the younger compared with the older patients (5.3 and 6.6, resp.;  P  = 0.005), despite the fact that younger children had more severe appendicitis (75.0% and 33.3%, resp.;  P  = 0.001). PAS had low sensitivity in both groups, with a significantly lower sensitivity among the younger patients. Parent and doctor delay were confirmed in children <4 years of age with appendicitis. PAS did not aid in patients with doctor delay. Parameters in patient history, symptoms, and abdominal examination were more diffuse in younger children.  Conclusion . PAS should be used with caution when examining children younger than 4 years of age. Diffuse symptoms in younger children with acute appendicitis lead to delay and to later diagnosis and more complicated appendicitis.

Appendicitis in Children: Evaluation of the Pediatric Appendicitis Score in Younger and Older Children