A new adult appendicitis score improves diagnostic accuracy of acute appendicitis - a prospective study

BMC Gastroenterology

Ari Leppäniemi¹  Panu Mentula¹  Henna E Sammalkorpi¹ 

[1] Department of Abdominal Surgery, Helsinki University Central Hospital, PL 340, 00029 HUS, Helsinkii, Finland

关键词: Adults;    Diagnostic score;    Appendicitis score;    C-reactive protein/analysis;    Blood cell count;    Appendicitis/diagnosis;    Abdomen Acute/etiology;    Abdomen Acute;    Abdominal pain;    Sensitivity and specificity;    Appendicitis;   

Others  :  854729
DOI  :  10.1186/1471-230X-14-114

 received in 2013-10-03, accepted in 2014-06-12,  发布年份 2014

【 摘 要 】

Background

The aim of the study was to construct a new scoring system for more accurate diagnostics of acute appendicitis. Applying the new score into clinical practice could reduce the need of potentially harmful diagnostic imaging.

Methods

This prospective study enrolled 829 adults presenting with clinical suspicion of appendicitis, including 392 (47%) patients with appendicitis. The collected data included clinical findings and symptoms together with laboratory tests (white cell count, neutrophil count and C-reactive protein), and the timing of the onset of symptoms. The score was constructed by logistic regression analysis using multiple imputations for missing values. Performance of the constructed score in patients with complete data (n = 725) was compared with Alvarado score and Appendicitis inflammatory response score.

Results

343 (47%) of patients with complete data had appendicitis. 199 (58%) patients with appendicitis had score value at least 16 and were classified as high probability group with 93% specificity.Patients with score below 11 were classified as low probability of appendicitis. Only 4% of patients with appendicitis had a score below 11, and none of them had complicated appendicitis. In contrast, 207 (54%) of non-appendicitis patients had score below 11. There were no cases with complicated appendicitis in the low probability group. The area under ROC curve was significantly larger with the new score 0.882 (95% CI 0.858 – 0.906) compared with AUC of Alvarado score 0.790 (0.758 – 0.823) and Appendicitis inflammatory response score 0.810 (0.779 – 0.840).

Conclusions

The new diagnostic score is fast and accurate in categorizing patients with suspected appendicitis, and roughly halves the need of diagnostic imaging.

【 授权许可】

   
2014 Sammalkorpi et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Addiss DG, Shaffer N, Fowler BS, Tauxe RV: The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990, 132(5):910-925.
• [2]Korner H, Sondenaa K, Soreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH: Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg 1997, 21(3):313-317.
• [3]Hoffmann J, Rasmussen OO: Aids in the diagnosis of acute appendicitis. Br J Surg 1989, 76(8):774-779.
• [4]Raja AS, Wright C, Sodickson AD, Zane RD, Schiff GD, Hanson R, Baeyens PF, Khorasani R: Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology 2010, 256(2):460-465.
• [5]Seetahal SA, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Frederick W, Cornwell EE, Chang DC, Siram SM: Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg 2011, 201(4):433-437.
• [6]Flum DR, Koepsell T: The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 2002, 137(7):799-804. discussion 804
• [7]Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR: Mortality after appendectomy in Sweden, 1987–1996. Ann Surg 2001, 233(4):455-460.
• [8]Rao PM: Imaging of acute right lower abdominal quadrant pain. Clin Radiol 1998, 53(9):639-649.
• [9]Cuschieri J, Florence M, Flum DR, Jurkovich GJ, Lin P, Steele SR, Symons RG, Thirlby R, The SCOAP Collaborative. The SCOAP Collaborative included: Negative appendectomy and imaging accuracy in the Washington state surgical care and outcomes assessment program. Ann Surg 2008, 248(4):557-563.
• [10]Coursey CA, Nelson RC, Patel MB, Cochran C, Dodd LG, Delong DM, Beam CA, Vaslef S: Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology 2010, 254(2):460-468.
• [11]Wagner PL, Eachempati SR, Soe K, Pieracci FM, Shou J, Barie PS: Defining the current negative appendectomy rate: For whom is preoperative computed tomography making an impact? Surgery 2008, 144(2):276-282.
• [12]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(5):556-562.
• [13]Busch M, Gutzwiller FS, Aellig S, Kuettel R, Metzger U, Zingg U: In-hospital delay increases the risk of perforation in adults with appendicitis. World J Surg 2011, 35(7):1626-1633.
• [14]Hall EJ: Cancer risks from diagnostic radiology. Br J Radiol 2008, 81(965):362-378.
• [15]Alvarado A: A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986, 15(5):557-564.
• [16]Andersson M, Andersson RE: The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg 2008, 32(8):1843-1849.
• [17]Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, Tan LT, Ang SH, Telisinghe PU: Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J 2011, 52(5):340-345.
• [18]Lintula H, Kokki H, Kettunen R, Eskelinen M: Appendicitis score for children with suspected appendicitis. A randomized clinical trial. Langenbecks Arch Surg 2009, 394(6):999-1004.
• [19]Lintula H, Kokki H, Pulkkinen J, Kettunen R, Grohn O, Eskelinen M: Diagnostic score in acute appendicitis. Validation of a diagnostic score (Lintula score) for adults with suspected appendicitis. Langenbecks Arch Surg 2010, 395(5):495-500.
• [20]Samuel M: Pediatric appendicitis score. J Pediatr Surg 2002, 37(6):877-881.
• [21]Kiely N, Williams N: Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl 1995, 77(2):157.
• [22]Lubin BH: Reference Values in Infancy and Childhood. In Hematology of Infancy and Childhood. 3rd edition. Edited by Nathan DG, Oski FA. Philadelphia: W.B. Saunders Company; 1987:1677-1697.
• [23]Scholer SJ, Pituch K, Orr DP, Dittus RS: Clinical outcomes of children with acute abdominal pain. Pediatrics 1996, 98(4 Pt 1):680-685.
• [24]van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA: Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 2008, 249(1):97-106.