Scoring and Diagnostic Laparoscopy for Suspected Appendicitis

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 &#50 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.