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 ed 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 × 109/L or more (score 3), rebound tenderness and male sex (score 2 each); and symptoms present for