Diagnostic pathways in acute appendicitis: Clinical score plus ultrasound outperform CT scan or upfront surgery, especially in doubtful cases

Background Controversies remain on the diagnostic strategy in suspected AA, considering the different settings worldwide. Material and Methods A prospective observational international multicentric study including patients operated for suspected AA with a definitive histopathological analysis was conducted. Three groups were analyzed: (1) No radiology; (2) Ultrasound, and (3) Computed tomography. The aim was to analyze the performance of three diagnostic schemes. Results Three thousand and one hundred twenty three patients were enrolled; 899 in the no radiology group, 1490 in the US group, and 734 in the CT group. The sex ratio was in favor of males (p