title: Acute appendicitis: the reliability of diagnosis by clinical assessment alone.
abstract: OBJECTIVE
  This prospective study aimed to review the trustworthiness of the initial clinical assessment in acute appendicitis without employment of imaging modalities, laparoscopy or any other adjunct diagnostic test.
  
  
  METHODS
  717 patients were operated on for appendicitis by six different surgeons. Initial clinical and laboratory examination were evaluated in relation to the intraoperative and the pathological appreciation of the appendiceal inflammation.
  
  
  RESULTS
  598 patients were found to have appendicitis, 34 a different condition, 41 had both appendicitis and an additional condition and 44 no pathology. 6% of the laparotomies and 11% of the appendectomies were unnecessary. The severity of the inflammation correlated significantly with periumbilical pain, pain migrating to right lower quadrant, loss of appetite, fever, rebound tenderness, local rigidity, polymorphonuclear predominance on deferential, polymorhonucleosis and leukocytosis. Leukocytosis was less frequent in aged patients. All the six surgeons were found to be equally reliable, although they all underestimated the setting compared to the pathologists. Patients with a long duration of symptoms had milder forms of inflammation and increased percentage of unanticipated abdominal conditions.
  
  
  CONCLUSIONS
  Appendicitis can be reliably diagnosed clinically without employment of adjunct tests. These can be reserved for equivocal cases.
authors.affiliation: Department of Surgery, Agrinion General Hospital, Agrinion, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Kalliakmanis
authors.forename: E
authors.initials: E
authors.lastname: Pikoulis
authors.forename: I G
authors.initials: IG
authors.lastname: Karavokyros
authors.forename: E
authors.initials: E
authors.lastname: Felekouras
authors.forename: P
authors.initials: P
authors.lastname: Morfaki
authors.forename: G
authors.initials: G
authors.lastname: Haralambopoulou
authors.forename: T
authors.initials: T
authors.lastname: Panogiorgou
authors.forename: E
authors.initials: E
authors.lastname: Gougoudi
authors.forename: T
authors.initials: T
authors.lastname: Diamantis
authors.forename: A
authors.initials: A
authors.lastname: Leppäniemi
authors.forename: C
authors.initials: C
authors.lastname: Tsigris
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D015203:Reproducibility of Results