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Diagnostic score in appendicitis

Validation of a diagnostic score (Eskelinen score) in patients in whom acute appendicitis is suspected

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Abstract

Background and aim

At times, the diagnosis of acute appendicitis may be difficult. However, for minimum morbidity to be obtained, early and accurate diagnosis is essential. This study aimed to validate a scoring system proposed by Eskelinen et al. as an aid in making the diagnosis of appendicitis.

Patients and methods

The prospectively documented data of a consecutive series of 2,359 patients admitted for suspicion of appendicitis were used for validation. Accuracy and positive predictive value were defined as the main overall performance parameters, as was the rate of unnecessary operations to assess changes of patient management. Overall performance was assessed by receiver–operator characteristics (ROC) analysis.

Results

Of 2,359 patients, 662 were proven to have acute appendicitis (prevalence of 28%). The overall sensitivity, specificity, positive and negative predictive value, and accuracy of the score were 0.79, 0.85, 0.68, 0.91 and 0.835 at a cut-off value of 55. Calibration of the score’s cut-off value to 57 yielded more favourable results (0.72, 0.91, 0.76, 0.9 and 0.86), and the rate of unnecessary operations declined from 26.6% to 15.4% (P<0.05, χ2). ROC analysis revealed an area index of 0.91.

Conclusion

The Eskelinen score delivered acceptable clinical results only after calibration to a cut-off value of 57. The data from this study suggest the investigation of whether a calibrated score might be particularly instrumental in the pre-admission evaluation of the patient in whom appendicitis is suspected.

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Acknowledgement

This work was in part supported by a grant from the German Ministry of Education, Science, Research and Technology within the MEDWIS-2-Project on ‘Direkte Entscheidungsunterstützung bei akuten Bauchschmerzen’.

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Authors and Affiliations

  1. Institute of Theoretical Surgery, Philipps University of Marburg, Baldingerstrasse, 35033, Marburg, Germany

    H. Sitter

  2. Department of Surgery, Philipps University of Marburg, Marburg, Germany

    S. Hoffmann, I. Hassan & A. Zielke

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  1. H. Sitter
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  2. S. Hoffmann
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  3. I. Hassan
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  4. A. Zielke
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Corresponding author

Correspondence to H. Sitter.

Appendix

Appendix

Clinical parameters and their weights by the Eskelinen score

For each of the listed symptoms/signs one or two points are given whenever the respective criterion is fulfilled, then multiplied by the respective factor and added to give a final sum (i.e. score value). The cut-off point (COP) for the diagnosis of acute appendicitis is 55.

Symptom/sign

Criterion, points

Factor

Tenderness

2 = RLQ, 1 = any other location

11.41

Rigidity

2 = Yes, 1 = no

6.62

Leucocyte count

2 = ≥10,000 G/l, 1 = <10,000 G/l

5.88

Rebound tenderness

2 = Yes, 1 = no

4.25

Pain at presentation

2 = RLQ, 1 = any other location

3.51

Duration of pain

2 = <48 h, 1 =≥ 48 h

2.13

where RLQ is right lower abdominal quadrant.

Example (points given in parentheses): a patient of 25 years of age is admitted to the emergency department with abdominal pain of 24-h duration (2×2.13) that was first noticed around the umbilicus but has since moved to the right lower abdominal quadrant (RLQ pain at presentation = 2×3.51). Micturition is reported to be not painful. During physical examination a tenderness in the RLQ is found (2×11.41), with rigidity (2×6.62) and rebound tenderness (2×4.25). The leucocyte count is 15,000 G/l (2×5.58). Total number of points: 67.0. Score diagnosis: acute appendicitis.

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Sitter, H., Hoffmann, S., Hassan, I. et al. Diagnostic score in appendicitis. Langenbecks Arch Surg 389, 213–218 (2004). https://doi.org/10.1007/s00423-003-0436-9

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  • DOI: https://doi.org/10.1007/s00423-003-0436-9

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