Evaluation of diagnostic scales for appendicitis in patients with lower abdominal pain
Keywords:
appendicitis/diagnosis, increasing scale, sensitivity and specificity, abdominal pain
Abstract
Introduction. Diagnosis of apendicitis is difficult; however several clinical scales have been developed that attempt to improve diagnostic accuracy.Objective. The operational characteristics of Alvarado and Fenyö scales were defined in patients with abdominal pain suggestive of appendicitis and were compare with clinical and pathological diagnoses.
Material and methods. A prospective trial assessed the diagnostic tests. Sign, symptoms, and laboratory tests were included in scales selected. Surgeon decision was maintained independent from the results of the scales. Sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratio for each scale was compared with the surgeon evaluation.
Results. The sample included 374 patients with approximately equal sexes. Of these 269 patients underwent surgery. Howeve, 16.9% of the male and 31.4% of female patients did not have appendicitis. For men, a diagnosis made by the surgeon had better sensitivity than scales (86.2% vs. 73% for Alvarado and 67.2% for Fenyö) without significant differences in specificity.
For women, surgeon and Alvarado scale diagnoses were similar, and better than Fenyö scale (77.1% vs. 79.5% for Alvarado and 47% for Fenyö), but specificity was higher for Fenyö scale (92.9% vs. 71.4% for Alvarado and 75.9% for surgeon). Accuracy in diagnosis of appendicitis increases with a higher Alvarado score.
Conclusion. For men with abdominal pain on right lower quadrant, surgeon diagnosis is more accurate than scales. For women, Fenyö scale offers a better sensitivity. Alvarado score can facilitate decision-making in patients with these abdominal symptoms.
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References
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11. Snyder BK, Hayden SR. Accuracy of leukocyte count in the diagnosis of acute appendicitis. Ann Emerg Med. 1999;33:565-74.
12. Restrepo J, Olarte F. Apendicitis en el Hospital Universitario San Vicente de Paúl. Tribuna Médica. 1973;2:11-3.
13. Coleman C, Thompson JE, Bennion RS, Schmit PJ. White blood cell count is a poor predictor of severity of disease in the diagnosis of appendicitis. Am Surg. 1998;64:983-5.
14. Andersson RE, Hugander AP, Ghazi SH, Ravn H, Offenbartl SK, Nystrom PO, et al. Diagnostic value of disease history, clinical presentation and inflammatory parameters in appendicitis. World J Surg. 1999;23:133-40.
15. Gurleyic E, Gurleyic G, Unlamiser S. Accuracy of serum C reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum. 1995;38:1270-4.
16. Hallan S, Asberg A. The accuracy of C-reactive protein in diagnosing acute appendicitis -a meta-analysis. Scand J Clin Lab Invest. 1997;57:373-80.
17. Restrepo J, Jaime M, Aristizábal H. Apendicitis aguda. En: Olarte F, Aristizábal H, Botero M, editores. Cirugía. Abdomen Agudo. Primera edición. Medellín: Universidad de Antioquia; 1998. p.161-94.
18. Kraemer M, Kremer K, Leppert R, Yang Q, Ohmann C, Fuchs KH. Perforating appendicitis: Is it a separate disease? Eur J Surg. 1999;165:473-80.
19. Korner H, Sondenaa K, Soreide JA, Andersen E, Nysted A, Lende TH. Structured data collection improves the diagnosis of acute appendicitis. Br J Surg. 1998;85:341-4.
20. Korner H, Sondenaa K, Soreide JA, Andersen E, Nysted A, Lende T, et al. Incidence of acute nonperforated and perforated apendicitis: Age-specific and sex-specific analysis. World J Surg. 1997;21:313-7.
21. Andersson RE, Hugander A, Thulin AJ. Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendectomy rate. Eur J Surg. 1992;158:37-41.
22. Pieper R, Kager L, Nasman P. Acute appendicitis: A clinical study of 1018 cases of emergency appendectomy. Acta Chir Scand. 1982;148:51-62.
23. Andersson RE, Hugander A, Thulin A, Nystrom PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ. 1994;308:107-10.
24. John H, Neff U, Kelemen M. Appendicitis diagnosis today: Clinical and ultrasonic deductions. World J Surg. 1993;17:243-9.
25. Balthazar EJ, Rofsky NM, Zucker R. Appendicitis: The impact of computed tomography imaging on the negative appendectomy and perforation rates. Am J Gastroenterol. 1998;93:768-71.
26. Galindo Gallego M, Fadrique B, Nieto MA, Calleja S, Fernandez Acenero M, Ais G, et al. Evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis. Br J Surg. 1998;85:37-40.
27. Weston AR, Jackson TJ, Blamey S. Diagnosis of appendicitis in adults by ultrasonography or computed tomography: a systematic review and meta-analysis. Int J Technol Assess Health Care. 2005;21:368-79.
28. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004;141:537-46.
29. Obermaier R, Benz S, Asgharnia M, Kirschner R, Hopt UT. Value of ultrasound in the diagnosis of acute appendicitis: interesting aspects. Eur J Med Res. 2003;8:451-6.
30. Orr RK, Porter D, Hartman D. Ultrasonography to evaluate adults for appendicitis: decision making based on meta-analysis and probabilistic reasoning. Acad Emerg Med. 1995;2:644-50.
2. Old JL, Dusing RW, Yap W, Dirks J. Imaging for suspected appendicitis. Am Fam Physician. 2005;71:71-8.
3. Winn RD, Laura S, Douglas C, Davidson P, Gani JS. Protocol-based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics. ANZ J Surg. 2004;74:324-9.
4. Zielke A, Sitter H, Rampp T, Bohrer T, Rothmund M. Clinical decision-making, ultrasonography, and scores for evaluation of suspected acute appendicitis. World J Surg. 2001;25:578-84.
5. Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg. 1995;161:273-81.
6. Ohmann C, Franke C, Yang Q. Clinical benefit of a diagnostic score for appendicitis: results of a prospective interventional study. German Study Group of Acute Abdominal Pain. Arch Surg. 1999;134:993-6.
7. Muris JW, Starmans R, Wolfs GG, Pop P, Knottnerus JA. The diagnostic value of rectal examination. Fam Pract. 1993;10:34-7.
8. Ramírez J, Deus J. Practical score decision making in doubtful cases of appendicitis. Br J Surg. 1994;81:680-3.
9. Anderson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91:28-37.
10. Middleton SB, Whitbread T, Morgans BT, Mason PF. Combination of skin temperature and a single white cell count does not improve diagnostic accuracy in acute appendicitis. Br J Surg. 1996; 83: 499.
11. Snyder BK, Hayden SR. Accuracy of leukocyte count in the diagnosis of acute appendicitis. Ann Emerg Med. 1999;33:565-74.
12. Restrepo J, Olarte F. Apendicitis en el Hospital Universitario San Vicente de Paúl. Tribuna Médica. 1973;2:11-3.
13. Coleman C, Thompson JE, Bennion RS, Schmit PJ. White blood cell count is a poor predictor of severity of disease in the diagnosis of appendicitis. Am Surg. 1998;64:983-5.
14. Andersson RE, Hugander AP, Ghazi SH, Ravn H, Offenbartl SK, Nystrom PO, et al. Diagnostic value of disease history, clinical presentation and inflammatory parameters in appendicitis. World J Surg. 1999;23:133-40.
15. Gurleyic E, Gurleyic G, Unlamiser S. Accuracy of serum C reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum. 1995;38:1270-4.
16. Hallan S, Asberg A. The accuracy of C-reactive protein in diagnosing acute appendicitis -a meta-analysis. Scand J Clin Lab Invest. 1997;57:373-80.
17. Restrepo J, Jaime M, Aristizábal H. Apendicitis aguda. En: Olarte F, Aristizábal H, Botero M, editores. Cirugía. Abdomen Agudo. Primera edición. Medellín: Universidad de Antioquia; 1998. p.161-94.
18. Kraemer M, Kremer K, Leppert R, Yang Q, Ohmann C, Fuchs KH. Perforating appendicitis: Is it a separate disease? Eur J Surg. 1999;165:473-80.
19. Korner H, Sondenaa K, Soreide JA, Andersen E, Nysted A, Lende TH. Structured data collection improves the diagnosis of acute appendicitis. Br J Surg. 1998;85:341-4.
20. Korner H, Sondenaa K, Soreide JA, Andersen E, Nysted A, Lende T, et al. Incidence of acute nonperforated and perforated apendicitis: Age-specific and sex-specific analysis. World J Surg. 1997;21:313-7.
21. Andersson RE, Hugander A, Thulin AJ. Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendectomy rate. Eur J Surg. 1992;158:37-41.
22. Pieper R, Kager L, Nasman P. Acute appendicitis: A clinical study of 1018 cases of emergency appendectomy. Acta Chir Scand. 1982;148:51-62.
23. Andersson RE, Hugander A, Thulin A, Nystrom PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ. 1994;308:107-10.
24. John H, Neff U, Kelemen M. Appendicitis diagnosis today: Clinical and ultrasonic deductions. World J Surg. 1993;17:243-9.
25. Balthazar EJ, Rofsky NM, Zucker R. Appendicitis: The impact of computed tomography imaging on the negative appendectomy and perforation rates. Am J Gastroenterol. 1998;93:768-71.
26. Galindo Gallego M, Fadrique B, Nieto MA, Calleja S, Fernandez Acenero M, Ais G, et al. Evaluation of ultrasonography and clinical diagnostic scoring in suspected appendicitis. Br J Surg. 1998;85:37-40.
27. Weston AR, Jackson TJ, Blamey S. Diagnosis of appendicitis in adults by ultrasonography or computed tomography: a systematic review and meta-analysis. Int J Technol Assess Health Care. 2005;21:368-79.
28. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004;141:537-46.
29. Obermaier R, Benz S, Asgharnia M, Kirschner R, Hopt UT. Value of ultrasound in the diagnosis of acute appendicitis: interesting aspects. Eur J Med Res. 2003;8:451-6.
30. Orr RK, Porter D, Hartman D. Ultrasonography to evaluate adults for appendicitis: decision making based on meta-analysis and probabilistic reasoning. Acad Emerg Med. 1995;2:644-50.
How to Cite
1.
Sanabria Álvaro, Domínguez LC, Bermúdez C, Serna A. Evaluation of diagnostic scales for appendicitis in patients with lower abdominal pain. Biomed. [Internet]. 2007 Sep. 1 [cited 2026 Mar. 7];27(3):419-28. Available from: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/204
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