title: Manifestations of acute appendicitis: a prospective study on acute abdominal pain.
abstract: OBJECTIVE
  The aim of this prospective study was to identify the clinical symptoms and signs most important for the prediction of appendicitis among patients with acute abdominal pain.
  
  
  METHODS
  Clinical findings in 2,478 patients admitted to the emergency department of Mora Hospital from February 1997 to June 2000, with acute abdominal pain of up to 7 days' duration, were registered in a database. The medical records were reviewed after 1 year.
  
  
  RESULTS
  A total of 432 patients were suspected of having appendicitis and in 221 this diagnosis was confirmed. Some 53 patients, with another preliminary diagnosis, were eventually found to suffer from appendicitis, making a total of 274 patients with appendicitis. Appendectomy was performed in 316 patients and was negative in 14%. Clinical diagnosis of appendicitis had a sensitivity of 0.81, a specificity of 0.90, a positive predictive value of 0.51, a positive likelihood ratio of 8.1, and a diagnostic accuracy of 0.89. The highest odds ratios were found for isolated tenderness in the right iliac fossa (3.29), rebound tenderness (3.00), right-sided rectal tenderness (2.53), migration of pain to the right iliac fossa (2.18), and local guarding (2.11).
  
  
  CONCLUSIONS
  Clinical findings indicating localised inflammation in the right iliac fossa were reliable in predicting acute appendicitis. The patients' history of pain combined with a careful clinical examination still plays an important role in detecting appendicitis among patients with acute abdominal pain.
authors.affiliation: Departments of Surgery at Mora Hospital, Mora, Sweden. helena.laurell@ltdalarna.se
authors.forename: H
authors.initials: H
authors.lastname: Laurell
authors.forename: L-E
authors.initials: LE
authors.lastname: Hansson
authors.forename: U
authors.initials: U
authors.lastname: Gunnarsson
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology*; D000328:Adult; D000855:Anorexia / Q000209:etiology; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014839:Vomiting / Q000209:etiology