The diagnostic accuracy of clinical and laboratory parameters in the diagnosis of acute appendicitis in the adult emergency department population - a case control pilot study

Abstract

IntroductionThe evaluation of patients with suspected appendicitis strives to identify all patients with presenting symptoms while minimizing negative appendectomy rate. The aim of the study was to identify the optimal combination of clinical and laboratory parameters that should facilitate the emergency department surgeon’s definite decision.Materials and methodsThe study group comprised 120 patients with suspicion of acute appendicitis (AA). In 60 patients the AA diagnosis was confirmed intraoperatively and by histological analysis. Clinical parameters included: appetite, vomiting, diarrhea, dysuria, signs of localized peritonitis and pain migration. Measured laboratory parameters were: C-reactive protein (CRP), complete blood count (CBC) and the urine test strip.ResultsThe control group of patients were more likely to present following symptoms: no changes in appetite (P < 0.001), diarrhea (P = 0.009) and dysuria (P = 0.047). CRP and white blood cell count (WBC) were significantly higher in the group with confirmed AA compared to the control group (44.7 vs. 6.6, and 13.6 ± 3.9 vs. 9.0 ± 3.4, respectively; P < 0.001). The multivariate logistic regression analysis identified lack of appetite (P = 0.013), absence of diarrhea (P = 0.004), and positive finding of signs of localized peritonitis (P = 0.013), as well as WBCs (P < 0.001) and negative urine test strip results (P = 0.009) as statistically significant predictors of AA. The highest percentage of correctly classified cases (82%) was achieved by combination of common clinical exam and basic inexpensive laboratory parameters (WBCs and urine test strip).ConclusionsAcute appendicitis in the emergency setting may be successfully ruled in based on elevated WBCs and negative urine test strip in combination with signs of localized peritonitis, lack of appetite and absence of diarrhea. Since CRP did not contribute to the overall diagnostic accuracy, its use in AA diagnostic protocols is of no value.

A comparative study on the diagnostic validity of three scoring systems in the diagnosis of acute appendicitis in emergency centres

“…Various studies have reported the diagnostic value of this parameter in distinguishing acute appendicitis. In several studies on patients with acute appendicitis; however, CRP has not been recommended for the diagnosis of acute appendicitis [ [14] , [15] , [16] ]. In another three-year study performed by Al-Abed et al on 447 patients with acute appendicitis, CRP was noted as a beneficial parameter in the diagnosis of acute appendicitis and the decision to perform surgical operation [ 17 ].…”

Is Alvarado Score Helpful for Pediatrician in Diagnosis of Acute Appendicitis? Our Center Experience

“…The rate of negative appendectomy reported about 20%. So, to diagnose appendicitis, especially in the pediatric group, imaging can be a critical tool for decreasing misdiagnosis (9,10). Ultrasonography has been verified as an early diagnostic tool in young patients to avoid radiation exposure and risk of cancer secondary to CT (11,12).…”

The diagnostic and discriminatory value of neutrophil lymphocyte ratio (NLR) in acute appendicitis

“…These factors include the normal baseline haematology values, (16)(17)(18) co-morbid conditions (31,32) and stage of inflammatory process at the presentation of patients who have acute appendicitis. (33)(34)(35) It is worth noting that communicable diseases are highly prevalent in South Africa, which may affect baseline neutrophil and lymphocyte counts. These conditions include human acquired immunodeficiency virus (HIV) infection which may lead to the depletion of CD4+ T-lymphocytes (34) and therefore affect the diagnostic value of NLR.…”