A New Approach to Accurate Diagnosis of Acute Appendicitis

Abstract

This study aimed (1) to develop a simple scoring system incorporating ultrasound (US) examination and clinical or laboratory predictors for increasing diagnostic accuracy in acute appendicitis (AA), and (2) to evaluate the performance of the scoring system as compared to that of previous models. Fifteen variables including US assessment for patients admitted with suspected AA were considered in multivariate analysis using the finding of AA at operation as the end point (internal study). The new score, together with 11 previous ones, was applied to a prospective independent population of subjects with suspected AA, and the respective performances were compared (external validation study). Among 303 patients (170 males, mean age 28.3 +/- 13.3 years) of the internal study, 161 went on to surgery, and 130 had AA at operation. Four independent correlates of AA were identified and used for the derivation of the following integer-based scoring system: number of points = 6 for US demonstrating AA + 4 for tenderness in the right lower quadrant + 3 for rebound tenderness + 2 for leukocyte count >12,000/microl. In the external study (201 subjects, 105 males, mean age 28.7 +/- 11.9 years, 109 operated, 87 with AA), when the cut-off of >/or = 8 points for AA was used, sensitivity, specificity, accuracy, and area under the curve of the proposed score were 95.4%, 97.4%, 96.5%, and 93%, respectively, exceeding noticeably the previous models. The proposed scoring system introduces a quantitative combination of the clinical evaluation with US imaging and a marker of inflammatory response, which may enhance the diagnostic accuracy for subjects with suspected AA especially in geographical areas where CT scanning is not readily available on a 24-hour basis.

The study of serum c-reactive protein and its diagnostic importance in reducing the rate of negative appendectomy

“…11 Cut off value for leukocyte was 12,000/L . 12 Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CRP and WBC count were estimated. CRP was positive in 168 patients out of which 160 had histologically inflamed appendix (true positive) while 8 had normal appendix (false positive).…”

Apendicectomia em pacientes com idade superior a 40 anos: análise dos resultados de 217 casos

“…Quatro variáveis entre 15 analisadas foram correlacionadas à apendicite aguda: Ultrassom que demonstre apendicite aguda; sensibilidade abdominal; contagem de leucócitos e sensibilidade abdominal à descompressão 8 . Yang e colaboradores 9 chamaram a atenção sobre a importância da dosagem sérica de proteina C reativa como de auxilio no diagnóstico da apendicite.…”

Alvarado score: can it reduce unnecessary interventions for acute appendicitis in children?

“…On the other side, the limits of imagistic methods in diagnosing acute appendicitis, referring to ultrasonography (operator dependent, weak performance in diagnosing complicated conditions of non-inflamed appendices) and computer tomography (high costs, radiation exposure, long time to investigate and have the results) led to an increased interest in the last years for scoring systems [1,2,3].…”