title: Clinical Importance of the Heel Drop Test and a New Clinical Score for Adult Appendicitis.
abstract: OBJECTIVE
  We tried to evaluate the accuracy of the heel drop test in patients with suspected appendicitis and tried to develop a new clinical score, which incorporates the heel drop test and other parameters, for the diagnosis of this condition.
  
  
  METHODS
  We performed a prospective observational study on adult patients with suspected appendicitis at two academic urban emergency departments between January and August 2015. The predictive characteristics of each parameter, along with heel drop test results were calculated. A composite score was generated by logistic regression analysis. The performance of the generated score was compared to that of the Alvarado score.
  
  
  RESULTS
  Of the 292 enrolled patients, 165 (56.5%) had acute appendicitis. The heel drop test had a higher predictive value than rebound tenderness. Variables and their points included in the new (MESH) score were pain migration (2), elevated white blood cell (WBC) >10,000/μL (3), shift to left (2), and positive heel drop test (3). The MESH score had a higher AUC than the Alvarado score (0.805 vs. 0.701). Scores of 5 and 11 were chosen as cut-off values; a MESH score ≥5 compared to an Alvarado score ≥5, and a MESH score ≥8 compared to an Alvarado score ≥7 showed better performance in diagnosing appendicitis.
  
  
  CONCLUSIONS
  MESH (migration, elevated WBC, shift to left, and heel drop test) is a simple clinical scoring system for assessing patients with suspected appendicitis and is more accurate than the Alvarado score. Further validation studies are needed.
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Shin
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Hyeji
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Wookjin
authors.initials: W
authors.lastname: Choi
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Ryeok
authors.initials: R
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Jung-Suk
authors.initials: JS
authors.lastname: Hong
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Sohn
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Seo
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Yoon-Seon
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lim
authors.affiliation: Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
mesh_terms: D000328:Adult; D001064:Appendicitis / Q000175:diagnosis / Q000503:physiopathology; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000503:physiopathology; D010147:Pain Measurement / Q000379:methods