clinicolaboratory scoring system for the management of acute appendicitis

ABSTRACT

Despite widespread imaging techniques which have significantly improved the management of acute appendicitis, cost-effective clinical decision-making concerning this condition is still a matter of debate. The aim of this study was to design a simple scoring system based on routine clinical and paraclinical data in patients suspected of having acute appendicitis. In this cross-sectional study, 402 consecutive patients, clinically suspected of having acute appendicitis and who were referred for general surgery consultation were evaluated. Nine common clinical and laboratory data including abdominal guarding, fever, shifting pain, leukocytosis, rebound tenderness, tenderness on rectal examination, vomiting, right lower quadrant tenderness and anorexia/nausea were recorded in each case and individually evaluated for sensitivity, specificity, positive predicted value and accuracy based on final outcome. A score of 3 was attributed to sign/symptoms with an accuracy of >/= 80%, 2 to sign/symptoms with an accuracy of 60-70%, and 1 to sign/symptoms with an accuracy of 50-70%. By selecting a cut-off point of more than 7 for operation and 6-7 for observation, the proposed scoring system decreased the negative appendectomy rate to 6.6% and observation rate to 3.5% as compared to 29% and 18% respectively, in conventional decision making. Applying this scoring system can improve clinical decision-making in acute appendicitis and effectively reduce negative appendectomy rates without increasing the rate of complications