[Is there a connection between skin temperature and appendicitis? A prospective study on the predictive value of traditional tests and skin temperature for acute appendicitis.].
BACKGROUND
Appendicitis is a common disease, still its diagnosis can be difficult. Of resected appendices, every fifth to sixth is histologically normal. It has been suggested that local skin temperature could be helpful to diagnose appendicitis. The hypothesis was that skin temperature above an inflamed appendix was higher than elsewhere.


METHODS
Patients suspected of acute appendicitis admitted to Landspitalinn University Hospital, February through June 1993, were enrolled. Thirty six patients, 20 males and 16 females, aged 12 to 77, average 29, entered the study. Skin temperature was measured over McBurney's point and at a comparable spot on the left side of the abdomen. Beside the skin temperature there were also noted some symptoms from the history and examination and some lab results. For each of these variables sensitivity, specificity and prospective values for appendicitis, were calculated.


RESULTS
Of those 36 patients, 27 underwent surgery, 22 had appendicitis but 14 did not. Six of the patients had 5=0.5 degrees C higher temperature at McBurney's point but only two of them had appendicitis. The other 30 patients did not have that temperature difference but still 16 of them had appendicitis. The predictive value of a positive and a negative test was 33% each, for skin temperature measurements, sensitivity was 9% and specificity 71%. These results do not suggest any connections between skin temperature and appendicitis and therefore the test is useless for appendicitis in our opinion. White blood cells count showed the best results in this study, with prospective value of a positive test 91%, prospective value of a negative test 86%, sensitivity 91% and specificity 86%. Other traditional tests and symptoms turned out to be useless individually in evaluating patients suspected of appendicitis.


CONCLUSIONS
Skin temperature measurement is unfortunately an useless diagnostic tool. It is sobering to see that the traditional tests and symptoms for appendicitis are nearly useless too. On the other hand it is fascinating and challenging to know that the diagnosis of this common disease is still dependent on the clinical judgement of the patient's physician.
Runarsdottir
V A
VA
Gudbjartsson
T
T
Magnusson
J
J