title: Institutional review of patients presenting with suspected appendicitis.
abstract: BACKGROUND
  Appendicitis is a common gastrointestinal surgical emergency. Treatment balances the risks of negative appendicectomy (NA) against potential complicated appendicitis in determining clinical priority. This study reviewed the population characteristics, results of the diagnostic modalities and Alvarado score (AlvS) of patients with suspected appendicitis.
  
  
  METHODS
  A clinical audit of emergency appendicectomies was performed. Generalized linear models with a binomial distribution were used to evaluate the association between the age groups, gender, white cell count (WCC), neutrophil count (NC) and C-reactive protein (CRP) levels versus NAs and the different types of appendicitis. The utilization and accuracy of preoperative ultrasound and computed tomography (CT) and a preliminary analysis of AlvS were also evaluated.
  
  
  RESULTS
  Patients 17 to 24 years old had significantly higher odds of NA but lower odds of complicated appendicitis compared with patients above 40 years. Adult women and men had significantly higher odds of NA and suppurative appendicitis (SA), respectively. Only adults with SA and acute appendicitis had significantly higher odds of raised WCC, NC and CRP. The sensitivity of CT for adult females was high (100%). Patients who had CT and an AlvS of more than 7 did not have NAs.
  
  
  CONCLUSIONS
  Elevated WCC, NC and CRP were all associated with acute appendicitis and SA in adults only. CT is useful for refining the diagnosis in adult females. A combination of inflammatory markers, ultrasound and AlvS may be used selectively to complement or maximize the advantages of CT.
authors.affiliation: Department of Surgery, Campbelltown Hospital, Sydney, New South Wales, Australia.
authors.forename: Andrew Teck Kwee
authors.identifier: http://orcid.org/0000-0002-5583-8682
authors.initials: AT
authors.lastname: Teo
authors.affiliation: Department of Surgery, Campbelltown Hospital, Sydney, New South Wales, Australia.
authors.forename: Liviu Paul
authors.initials: LP
authors.lastname: Lefter
authors.affiliation: Department of Surgery, Campbelltown Hospital, Sydney, New South Wales, Australia.
authors.forename: Ali Jafar Mohamad
authors.initials: AJ
authors.lastname: Zarrouk
authors.affiliation: Department of Surgery, Campbelltown Hospital, Sydney, New South Wales, Australia.|Department of Surgery, University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Neil Donald
authors.initials: ND
authors.lastname: Merrett
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001064:Appendicitis / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D002648:Child; D000066491:Clinical Decision-Making; D004630:Emergencies; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: appendicitis; laparoscopic appendicectomy; negative appendicectomy; preoperative computed tomography; preoperative ultrasound