A New Simple Scoring System for the Diagnosis of Acute Appendicitis.

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Authors: 

1 Zakaur Rab Siddiqui, Registrar, Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.

2 Tanwir Khaliq, Associate Professor, Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.

3  Syed Aslam Shah, Professor, Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.

Posted in JPMS Volume 1, Issue 2. July-September, 2011; © 2011 Journal of Pakistan Medical Students. Orignial article.

ABSTRACT

Background: This study aimed to present a simple scoring system incorporating ultrasound (US) examination, clinical, and laboratory data for improving diagnostic accuracy of acute appendicitis (AA), and to evaluate the performance of this scoring system in comparison to other scoring systems. A 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 in terms of accuracy.

Methods: 134 (70 males and 64 females) patients with suspected acute appendicitis were included in the study (mean age 28.7 ± 11.9 years). Demographic, clinical, and laboratory characteristics of the patients with suspected appendicitis were assessed using SPSS and four independent, statistically significant (p<0.01) predictors of the presence of AA were expressed as an integer-based scoring system.

Results: Among 134 subjects, 72 went on to surgery and 58 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/uL. In the study, the cut-off of ? 8 points for AA was used and sensitivity, specificity and accuracy of the proposed score were 95.4%, 97.4% and 96.5% respectively.

Conclusion: The proposed scoring system introduces a quantitative combination of the clinical, laboratory, and imaging data, which may enhance the diagnostic accuracy of AA especially in those geographical regions where ultrasound scanning is readily available.

Key words: Acute Appendicitis, ultrasound, scoring system