A Simplified Appendicitis Score in the Diagnosis of Acute Appendicitis

Goh, PL

doi:10.1177/102490791001700305

Cited by 8 publications

(6 citation statements)

References 7 publications

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“…). Fifteen of these could be validated with the data collected in the cohort study ( Table ). These risk prediction models were based on 17 clinical parameters ( Table S1 , supporting information).…”

Section: Resultsmentioning

confidence: 99%

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Bhangu

2019

Br J Surg

113

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Background: Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis.Methods: A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16-45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis).Results: Some 5345 patients across 154 UK hospitals were identified, of which two-thirds (3613 of 5345, 67⋅6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28⋅2 per cent) than men (120 of 993, 12⋅1 per cent) (relative risk 2⋅33, 95 per cent c.i. 1⋅92 to 2⋅84; P < 0⋅001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut-off score 8 or less, specificity 63⋅1 per cent, failure rate 3⋅7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut-off score 2 or less, specificity 24⋅7 per cent, failure rate 2⋅4 per cent).Conclusion: Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision-making by identifying adults in the UK at low risk of appendicitis were identified. * Co-authors of this study are listed in Appendix S1 (supporting information).

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Section: Resultsmentioning

confidence: 99%

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Bhangu

2019

Br J Surg

113

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“…There is huge variation and inconsistency in results and vary widely amongst different institutions and practices. 15 In 1994, Ramirez et al 16 devised a scoring system from local database. They initially collected data from 360 patients retrospectively and analyzed it.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Negative Appendicectomy after Evaluation by JM Ramirez & J Deus Score

Haider¹,

Khan²,

Ghaffar³

et al. 2022

PJMHS

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Background: Acute Appendicitis (AA) is the commonest surgical emergency encountered by surgeon in public & private setup in Pakistan. When it comes to diagnosis, patient seldom presents with the typical bookish picture (symptoms / signs) of the condition. Diagnosis therefore remains an enigma many a times especially for house officers and residents during their emergency duty. Various scores had been developed to aid the diagnosis, Alvarado score although gained popularity and is practiced in our setup. This study was designed to evaluate one such score designed by JM Ramirez & J Deus, for its negative appendicectomy rate calculation with the view to adopt it to our routine practice if it turns out with lesser negative appendicectomy rate compared to other scores in practice. Methods: This descriptive study was designed & carried out at the Surgical “B” Unit of Ayub Teaching Hospital Abbottabad from November 01, 2020 to June 30, 2021. A total of 190 patients with suspected AA were included, assessed by the score and accordingly placed in three groups based upon their initial score. Group-I patients were discharged with the advice to come back to same unit / hospital if pain persists or recurs. Group-II patients were kept in observation for 24 hours and finally re-categorized either as Group-I or Group-III based upon a drop or rise in their score. Group-III patients were operated after preparation. Data collected over a special proforma was finalized at the time of discharge of patient, earlier in case of group I patients or after getting histopathology report in case of Group-III patients that was later analyzed with the help of SPSS-version 26. Results: Out of 190 patients included in study 129 were male while 61 were female patients. 49 patients presented with a score less than –15 (Group–I) & were discharged after evaluation. 53 patients had a score between –15 to 09 (Group–II), were therefore kept under observation till next 24-48 hour. Score of 30 dropped to Group-I range & were similarly discharged like Group-I patients. Score of 23 patients rose up to 10 or above (i.e. Group-III range) & were therefore operated like other 88 patients belonging to Group-III. 91 patients were having acutely inflammed, phlegmonous, gangrenous, perforated appendix or appendix with impacted faecolith / pus in the lumen, their appendicectomy specimen along with the specimen of 20 other difficult to diagnose cases on gross vision were sent for histopathology. H/P report confirmed 100 as positive & 11 as negative for appendicitis. 111 patients totally got operated, out of which 11 turned out negative appendicectomies. Frequency of negative appendicectomies overall was therefore 09.9%. It was 05.56% in male (i.e. 04/72) and 17.94 % (i.e. 07/39) in female patients. Conclusion: Score developed by JM Ramirez and J Deus proved quite helpful in the diagnosis of acute appendicitis & reduction of the frequency of Negative appendicectomies. Being simple, non-invasive & cost-effective, requiring no special equipment or investigations for its application, it ensures an instant, structured & thorough assessment of patient. The score is therefore recommended for its routine adoption / application in our setup in the diagnosis of acute appendicitis to reduce the frequency of negative appendicectomies. Keywords: Acute appendicitis, frequency of negative appendicectomy, scoring system, Ayub Teaching Hospital

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“…Christian [17] Eskelinen [49] Fenyo [11] Goh [18] Jahn [12] Lindberg [13] Sammalkorpi [14] Tzanakis [15] Van-den Boek [16] Total this requires clinical experience which may be limited in junior doctors). A score of Cfive appears to be better than the originally recommended cut-off of nine as there is lower number of missed diagnoses without a significant reduction in specificity.…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly incorporated variable was the white cell count, which appeared in all 12 studies (Table 4) [8][9][10][11][12][13][14][15][16][17][18]. Temperature, rebound tenderness and migratory pain were the next most common across all studies (Table 4) [8][9][10][11][16][17][18]. Studies that used multivariate analysis identified gender, elevated C-reactive protein, RIF pain, neutrophilia, vomiting and signs of peritonism (guarding, rigidity) as likely variables [9,10,[13][14][15][16].…”

Section: Derivation Studiesmentioning

confidence: 99%

“…Studies that used multivariate analysis identified gender, elevated C-reactive protein, RIF pain, neutrophilia, vomiting and signs of peritonism (guarding, rigidity) as likely variables [9,10,[13][14][15][16]. Rectal tenderness, diarrhoea and Rovsing's sign were the least commonly used variables and appeared only in CPRs that used univariate analysis [11,12,18].…”

Section: Derivation Studiesmentioning

confidence: 99%

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