Open AccessScoring and diagnostic laparoscopy for suspected appendicitis
Author(s) -
Van Den Broek Wim T.,
Bijnen Bart B.,
Rijbroek Bram,
Gouma Dirk J.
Publication year - 2002
Publication title -
european journal of surgery
Language(s) - English
Resource type - Journals
eISSN - 1741-9271
pISSN - 1102-4151
DOI - 10.1080/11024150260284860
Subject(s) - medicine , laparoscopy , appendicitis , appendix , perforation , logistic regression , acute appendicitis , surgery , odds ratio , predictive value of tests , prospective cohort study , observational study , metallurgy , paleontology , materials science , punching , biology
Abstract Objective: To develop a reproducible scoring system to identify patients who present with a doubtful diagnosis of appendicitis and who would benefit from diagnostic laparoscopy. Design: Prospective observational study. Setting: Regional teaching hospital, The Netherlands. Subjects: 577 consecutive patients during the period 1994–5, and 343 who presented during the period 1996–7. Interventions: The variables that seemed to be predictive of acute appendicitis were abstracted from the earlier group, a logistic regression analysis applied, and score created. The score was validated on the 343 patients who presented during 1996–7, and then the groups were combined for further analysis. Main outcome measures: Reproducibility of the scoring system obtained by comparing odds ratios (OR) of the two groups; its effectiveness judged by comparing the delayed and normal appendicectomy rates. Results: The following variables were significantly correlated with the presence of acute appendicitis: white cell count 10 × 10 9 /L or more (score 3), rebound tenderness and male sex (score 2 each); and symptoms present for <48 hrs and temperature 38°C or more (score 1 each). The OR for the two groups were 1.80 and 1.76, respectively, indicating that score was reproducible. With a sensitivity of 93% and a specificity of 83% it would be at least as accurate as clinical judgment. The normal appendicectomy rate would be 7% instead of 9%, and the negative exploration rates (laparoscopy and primary appendicectomy) would both be 22%. The score would also result in a lower perforation rate (2% compared with 17%). Conclusion: The score can indicate when there is an indication for laparoscopy in patients with suspected appendicitis.