To explore the clinical value of Alvarado score, ultrasound features, combined with serum CXC chemokine receptor 3 (CXCR3) and regulated on activation, normal T cell expressed and secreted (RANTES) levels in the diagnosis and pathological classification of pediatric appendicitis.

A prospective study was conducted. Totally 211 children with abdominal pain admitted to the Second Affiliated Hospital of Xi'an Medical University and Weinan Central Hospital were selected from January 2020 to December 2024. Complying with the pathological results, they were separated into the abdominal pain group (89 cases) and the appendicitis group (122 cases); the appendicitis group was further separated into the simple acute appendicitis group (68 cases) and the complex acute appendicitis group (54 cases) based on the pathological results. The general information of all the patients was collected. Alvarado scoring and abdominal ultrasound examination was performed, and serum CXCR3 and RANTES were detected by ELISA method. The diagnostic efficiency of each indicator and the combined model was analyzed using the receiver operating characteristic (ROC) curve. In addition, the relative risk was used to analyze their value in the classification identification process.

The duration of symptoms, the body temperature at admission, the white blood cell count and C-reactive protein levels of the children in the appendicitis group were longer or higher than those in the abdominal pain group (all P<0.001). The Alvarado score, serum CXCR3 and RANTES levels, and the positive rate of ultrasound in the appendicitis group were higher than those in the abdominal pain group (all P<0.001). ROC curve analysis showed that the area under the curve (AUC) values for diagnosing appendicitis using Alvarado score, ultrasound features, CXCR3, and RANTES were 0.853, 0.838, 0.784, and 0.749, respectively. The combined diagnostic performance of the four methods increased to 0.961 (95% CI: 0.925-0.983), with a sensitivity of 95.90% and a specificity of 84.27%. In the classification of appendicitis, the Alvarado score, CXCR3, RANTES levels, and ultrasound positive rate in the complex acute appendicitis group were obviously higher than those in the simple acute appendicitis group (all P<0.001). The relative risk results showed that patients with high Alvarado score, positive ultrasound results, high CXCR3, and high RANTES had a higher probability of developing complex acute appendicitis.

The combination of Alvarado score, ultrasound features, and serum CXCR3 and RANTES levels can obviously ameliorate the diagnostic accuracy for pediatric appendicitis and has important clinical value in differentiating simple and complex acute appendicitis.