Scoring and diagnostic laparoscopy for suspected appendicitis.
OBJECTIVE
To develop a reproducible scoring system to identify patients who present with a doubtful diagnosis of appendicitis and who would benefit from diagnostic laparoscopy.


METHODS
Prospective observational study.


METHODS
Regional teaching hospital, The Netherlands.


METHODS
577 consecutive patients during the period 1994-5, and 343 who presented during the period 1996-7.


METHODS
The variables that seemed to be predictive of acute appendicitis were abstracted from the earlier group. a logistic regression analysis applied, and score created. The score was validated on the 343 patients who presented during 1996-7, and then the groups were combined for further analysis.


METHODS
Reproducibility of the scoring system obtained by comparing odds ratios (OR) of the two groups; its effectiveness judged by comparing the delayed and normal appendicectomy rates.


RESULTS
The following variables were significantly correlated with the presence of acute appendicitis: white cell count 10 x 10(9)/L or more (score 3), rebound tenderness and male sex (score 2 each); and symptoms present for < 48 hrs and temperature 38 degrees C or more (score 1 each). The OR for the two groups were 1.80 and 1.76, respectively, indicating that score was reproducible. With a sensitivity of 93% and a specificity of 83% it would be at least as accurate as clinical judgment. The normal appendicectomy rate would be 7% instead of 9%. and the negative exploration rates (laparoscopy and primary appendicectomy) would both be 22%. The score would also result in a lower perforation rate (2% compared with 17%).


CONCLUSIONS
The score can indicate when there is an indication for laparoscopy in patients with suspected appendicitis.
van den Broek
Wim T
WT
Department of Surgery, Medical Centre Alkmaar, The Netherlands.
Bijnen
Bart B
BB
Rijbroek
Bram
B
Gouma
Dirk J
DJ
D000328:Adult; D001064:Appendicitis / Q000175:diagnosis*; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity