[Significance of anamnesis and clinical findings for diagnosis of acute appendicitis. Acute Abdominal Pain Study Group].
Acute appendicitis raises considerable diagnostic difficulties. This is proven by rates of negative appendectomies that sometimes extent 30%. In order to find reasons for this we tested 211 patients findings for diagnostic relevance.


METHODS
Within the European Community--Acute Abdominal Pain Survey, a study to support diagnosis in acute abdominal pain, 1254 patients were seen in the six participating German hospitals. 16.8% had appendicitis. History data and physical findings were tested for positive and negative predictive value (PPV/NPV), sensitivity and specificity (SEN/SPE).


RESULTS
We had 15% negative appendectomies and 16% perforated appendicies. Only few of the parameters tested show a PPW significantly higher than the prior probability of appendicitis: (PPV/NPV/SEN/SPE in %) rebound tenderness 39/63/91/80, tenderness in the right lower quadrant 36/82/95/70, pain right lower quadrant at presentation 34/77/94/70, onset of pain right lower quadrant 29/49/88/75, rigidity 28/9/84/95, guarding 26/43/87/76. All other parameters had a lower PPV. The combination of three parameters leads to maximal PPV of 85%.


CONCLUSIONS
Very few symptoms are helpful in diagnosing appendicitis: the pain related symptoms (spontaneous pain, tenderness and rebound tenderness, guarding) and the history of the pain hint at an appendicitis. A structured and complete medical history and physical examination focussing on these few symptoms, a systematic combination of these and possibly ultrasonography will improve diagnostic accuracy.
Böhner
H
H
Klinik für Allgemein- und Unfallchirurgie, Heinrich-Heine-Universität Düsseldorf.
Yang
Q
Q
Franke
K
K
Ohmann
C
C
D000006:Abdomen, Acute / Q000209:etiology* / Q000601:surgery; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003936:Diagnosis, Computer-Assisted; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D005062:European Union; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008487:Medical History Taking; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies
Bedeutung anamnestischer Angaben und klinischer Befunde für die Diagnose der akuten Appendizitis. Studiengruppe Akute Bauchschmerzen.