title: How to diagnose an acutely inflamed appendix; a systematic review of the latest evidence.
abstract: Acute appendicitis is the most common condition that presents with an acute abdomen needing emergency surgery. Despite this common presentation, correctly diagnosing appendicitis remains a challenge as clinical signs or positive blood results can be absent in 55% of the patients. The reported proportion of missed diagnoses of appendicitis ranges between 20% and 40%. A delay or mis-diagnosis of appendicitis can result in severe complications such as perforation, abscess formation, sepsis, and intra-abdominal adhesions. Literature has shown that patients who had a negative appendectomy suffer post-op complications and infections secondary to hospital stays; there have even been reported cases of fatality. It is therefore crucial that timely and accurate diagnosis of appendicitis is achieved to avoid complications of both non-operating as well as unnecessary surgical intervention. The aim of this review is to systematically report and analyse the latest evidence on the different approaches used in diagnosing appendicitis. We include discussions of clinical scoring systems, laboratory tests, latest innovative bio-markers and radiological imaging.
authors.affiliation: Department of Surgery, Worcester Royal Hospital, UK. Electronic address: adnankabir58@hotmail.com.
authors.forename: S A
authors.initials: SA
authors.lastname: Kabir
authors.affiliation: Department of Surgery, Oxford University Hospitals NHS Trust, UK.
authors.forename: S I
authors.initials: SI
authors.lastname: Kabir
authors.affiliation: Department of Surgery, Worcester Royal Hospital, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sun
authors.affiliation: Department of Surgery, Worcester Royal Hospital, UK.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Jafferbhoy
authors.affiliation: Department of Surgery, Worcester Royal Hospital, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Karim
mesh_terms: D000208:Acute Disease; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D001065:Appendix / Q000473:pathology*; D015415:Biomarkers; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers
keywords: ALVARADO score; CT and appendicitis; Diagnosis of appendicitis; Imaging and appendicitis; Laboratory markers in appendicitis; Novel markers in appendicitis; USS and appendicitis