title: Clinical scoring system: a valuable tool for decision making in cases of acute appendicitis.
abstract: OBJECTIVE
  Decision making in cases of acute appendicitis poses a clinical challenge specially in developing countries where advanced radiological investigations do not appear cost effective and so clinical parameters remain the mainstay of diagnosis. The aim of our study was to devise a scoring system from our local database and test its accuracy in the preoperative diagnosis of acute appendicitis.
  
  
  METHODS
  Clinical data from 401 patients having undergone appendectomy were collected to identify predictive factors that distinguished those with appendicitis from those who had a negative appendectomy. Ten such factors were identified and using Bayesian probability a weight was assigned to each and the results summated to get an overall score. A cut-off point was identified to separate patients for surgery and those for observation. The scoring system was then retrospectively applied to a second population of 99 patients in order to compare suggested actions (derived from the scoring system) to those actually taken by surgeons. The sensitivity, specificity and accuracy for the level of decision was then calculated.
  
  
  RESULTS
  Of the 99 patients, the method suggested immediate surgery for 65 patients, 63 of whom had acute appendicitis (3.1% diagnostic error rate). Of the 33 patients in whom the score suggested active observation, 18 had appendicitis. The accuracy of our scoring system was 82%. The method had a sensitivity of 78%, specificity 89% and a positive predictive value of 97%. The negative appendectomy rate determined by our study was 7% and the perforation rate 13%.
  
  
  CONCLUSIONS
  Scoring system developed from a local database can work effectively in routine practice as an adjunct to surgical decision making in questionable cases of appendicitis.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi.
authors.forename: A
authors.initials: A
authors.lastname: Jawaid
authors.forename: A
authors.initials: A
authors.lastname: Asad
authors.forename: A
authors.initials: A
authors.lastname: Motiei
authors.forename: A
authors.initials: A
authors.lastname: Munir
authors.forename: E
authors.initials: E
authors.lastname: Bhutto
authors.forename: H
authors.initials: H
authors.lastname: Choudry
authors.forename: K
authors.initials: K
authors.lastname: Idrees
authors.forename: K
authors.initials: K
authors.lastname: Durrani
authors.forename: M
authors.initials: M
authors.lastname: Rahman
authors.forename: M
authors.initials: M
authors.lastname: Ahuja
authors.forename: Q
authors.initials: Q
authors.lastname: Nawab
authors.forename: R
authors.initials: R
authors.lastname: Ahmed
authors.forename: S
authors.initials: S
authors.lastname: Ali
authors.forename: S
authors.initials: S
authors.lastname: Aslam
authors.forename: S
authors.initials: S
authors.lastname: Abbasi
authors.forename: S
authors.initials: S
authors.lastname: Feerasta
authors.forename: S
authors.initials: S
authors.lastname: Alam
authors.forename: U
authors.initials: U
authors.lastname: Ahmed
authors.forename: I
authors.initials: I
authors.lastname: Jehan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012189:Retrospective Studies; D012680:Sensitivity and Specificity