Abstract
This study aimed (1) to develop a simple scoring system incorporating ultrasound (US) examination and clinical or laboratory predictors for increasing diagnostic accuracy in acute appendicitis (AA), and (2) to evaluate the performance of the scoring system as compared to that of previous models. Fifteen variables including US assessment for patients admitted with suspected AA were considered in multivariate analysis using the finding of AA at operation as the end point (internal study). The new score, together with 11 previous ones, was applied to a prospective independent population of subjects with suspected AA, and the respective performances were compared (external validation study). Among 303 patients (170 males, mean age 28.3 ± 13.3 years) of the internal study, 161 went on to surgery, and 130 had AA at operation. Four independent correlates of AA were identified and used for the derivation of the following integer-based scoring system: number of points = 6 for US demonstrating AA + 4 for tenderness in the right lower quadrant + 3 for rebound tenderness + 2 for leukocyte count >12,000/μl. In the external study (201 subjects, 105 males, mean age 28.7 ± 11.9 years, 109 operated, 87 with AA), when the cut-off of ≥ 8 points for AA was used, sensitivity, specificity, accuracy, and area under the curve of the proposed score were 95.4%, 97.4%, 96.5%, and 93%, respectively, exceeding noticeably the previous models. The proposed scoring system introduces a quantitative combination of the clinical evaluation with US imaging and a marker of inflammatory response, which may enhance the diagnostic accuracy for subjects with suspected AA especially in geographical areas where CT scanning is not readily available on a 24-hour basis.
Similar content being viewed by others
References
Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br. J. Surg. 2004;91:28–37
Van Way CW 3rd, Murphy JR, Dunn EL, et al. A feasibility study of computer aided diagnosis in appendicitis. Surg. Gynecol. Obstet. 1982;155:685–688
Teicher I, Landa B, Cohen M, et al. Scoring system to aid in diagnoses of appendicitis. Ann. Surg. 1983;198:753–759
Arnbjörnsson E. Scoring system for computer-aided diagnosis of acute appendicitis. The value of prospective versus retrospective studies. Ann. Chir. Gynaecol. 1985;74:159–166
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann. Emerg. Med. 1986;15:557–564
Fenyö G. Routine use of a scoring system for decision-making in suspected acute appendicitis in adults. Acta Chir. Scand. 1987;153:545–551
Lindberg G, Feny G. Algorithmic diagnosis of appendicitis using Bayes’ theorem and logistic regression. In Bernardo JM, DeGroot MH, Lindley DV, Smith AF, editors. Bayesian Statistics 3, Oxford University Press, 1988, pp 665–668
Izbicki JR, Wilker DK, Mandelkow HK, et al. Retro- and prospective studies on the value of clinical and laboratory chemical data in acute appendicitis. Chirurg 1990;61:887–894
de Dombal FT. Diagnosis of Acute Abdominal Pain. Churchill Livingstone, Edinburgh, l991;105–106
Christian F, Christian GP. A simple scoring system to reduce the negative appendectomy rate. Ann. R. Coll. Surg. Engl. 1992;74:281–285
Eskelinen M, Ikonen J, Lipponen P. A computer-based diagnostic score to aid in diagnosis of acute appendicitis: a prospective study of 1333 patients with acute abdominal pain. Theor. Surg. 1992;7:86–90
Ohmann C, Franke C, Yang Q, et al. Diagnostic score for acute appendicitis. Chirurg 1995;66:135–141
Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br. J. Surg. 1989;76:774–779
Kalan M, Talbot D, Cunliffe WJ, et al. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann. R. Coll. Surg. Engl. 1994;76:418–419
Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur. J. Surg. 1995;161:273–281
Ohmann C, Franke C, Yang Q. Clinical benefit of a diagnostic score for appendicitis: results of a prospective interventional study. German Study Group of Acute Abdominal Pain. Arch. Surg. 1999;134:993–996
Sitter H, Hoffmann S, Hassan I, et al. Diagnostic score in appendicitis. Validation of a diagnostic score (Eskelinen score) in patients in whom acute appendicitis is suspected. Langenbecks Arch. Surg. 2004;389:213–218
Orr RK, Porter D, Hartman D. Ultrasonography to evaluate adults for appendicitis: decision making based on meta-analysis and probabilistic reasoning. Acad. Emerg. Med. 1995;2:644–650
Franke C, Bohner H, Yang Q, et al. Ultrasonography for diagnosis of acute appendicitis: results of a prospective multicenter trial. Acute Abdominal Pain Study Group. World J. Surg. 1999;23:141–146
Rettenbacher T, Hollerweger A, Gritzmann N, et al. Appendicitis: should diagnostic imaging be performed if the clinical presentation is highly suggestive of the disease? Gastroenterology 2002;123:992–998
Wade DS, Marrow SE, Balsara ZN, et al. Accuracy of ultrasound in the diagnosis of acute appendicitis compared with the surgeon’s clinical impression. Arch. Surg. 1993;128:1039–1046
Zielke A, Hasse C, Sitter H, et al. Influence of ultrasound on clinical decision making in acute appendicitis: a prospective study. Eur. J. Surg. 1998;164:201–209
Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000;215:337–348
Lee SL, Walsh AJ, Ho HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch. Surg. 2001;136:556–562
Stephens PL, Mazzucco JJ. Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis. Conn. Med. 1999;63:137–140
Obermaier R, Benz S, Asgharnia M, et al. Value of ultrasound in the diagnosis of acute appendicitis: interesting aspects. Eur. J. Med. Res. 2003;8:451–456
Puig S, Hormann M, Rebhandl W, et al. US as a primary diagnostic tool in relation to negative appendectomy: six years experience. Radiology 2003;226:101–104
Bendeck SE, Nino-Murcia M, Berry GJ, et al. Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 2002;225:131–136
Lim HK, Bae SH, Seo GS. Diagnosis of acute appendicitis in pregnant women: value of sonography. A.J.R. Am. J. Roentgenol. 1992;159:539–542
Chesbrough RM, Burkhard TK, Balsara ZN, et al. Self-localization in US of appendicitis: an addition to graded compression. Radiology 1993;187:349–351
Amgwerd M, Rothlin M, Candinas D, et al. Ultrasound diagnosis of appendicitis by surgeons: a matter of experience? A prospective study. Langenbecks Arch. Chir. 1994;379:335–340
Rao PM, Rhea JT, Novelline RA, et al. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N. Engl. J. Med. 1998;338:141–146
Pickuth D, Heywang-Kobrunner SH, Spielmann RP. Suspected acute appendicitis: is ultrasonography or computed tomography the preferred imaging technique? Eur. J. Surg. 2000;166:315–319
Wise SW, Labuski MR, Kasales CJ, et al. Comparative assessment of CT and sonographic techniques for appendiceal imaging. A.J.R. Am. J. Roentgenol. 2001;176:933–941
Terasawa T, Blackmore CC, Bent S, et al. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann. Intern. Med. 2004;141:537–546
Schuler JG, Shortsleeve MJ, Goldenson RS, et al. Is there a role for abdominal computed tomographic scans in appendicitis? Arch. Surg. 1998;133:373–376
Rao PM, Rhea JT, Rattner DW, et al. Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann. Surg. 1999;229:344–349
Jones K, Pena AA, Dunn EL, et al. Are negative appendectomies still acceptable? Am. J. Surg. 2004;188:748–754
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tzanakis, N.E., Efstathiou, S.P., Danulidis, K. et al. A New Approach to Accurate Diagnosis of Acute Appendicitis. World J. Surg. 29, 1151–1156 (2005). https://doi.org/10.1007/s00268-005-7853-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-005-7853-6