Routine use of a scoring system for decision-making in suspected acute appendicitis in adults.
Clinical data from 259 patients with suspected acute appendicitis were prospectively collected and used in construction of a Bayesian scoring system, comprising 19 attributes, for preoperative diagnosis. The scoring system was integrated into the routine clinical management of a prospective series of 830 patients. Laparotomy was performed in 310 cases, and of these 256 had acute appendicitis (perforation in 14%). Excluding 6 cases with normal appendix but laparotomy mandatory for other reasons, the negative laparotomy rate was 15.5%. This rate was significantly lower than in earlier series from the same hospital and in more than 8,000 appendectomies performed in Sweden since 1969. The scoring system had 90.2% sensitivity, 91.4% specificity, 82.5% positive predictive value and 95.4% negative predictive value. The system is regarded only as an aid in diagnosis, to be used in combination with clinicians' judgements. Construction of a local data base probably is essential for results equivalent to those here reported.
Fenyö
G
G
Department of Surgery, Nacka Hospital, Sweden.
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000175:diagnosis*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012422:Rupture, Spontaneous