A new adult appendicitis score improves diagnostic accuracy of acute appendicitis--a prospective study

Abstract

Background: The aim of the study was to construct a new scoring system for more accurate diagnostics of acute appendicitis. Applying the new score into clinical practice could reduce the need of potentially harmful diagnostic imaging.

Methods: This prospective study enrolled 829 adults presenting with clinical suspicion of appendicitis, including 392 (47%) patients with appendicitis. The collected data included clinical findings and symptoms together with laboratory tests (white cell count, neutrophil count and C-reactive protein), and the timing of the onset of symptoms. The score was constructed by logistic regression analysis using multiple imputations for missing values. Performance of the constructed score in patients with complete data (n = 725) was compared with Alvarado score and Appendicitis inflammatory response score.

Results: 343 (47%) of patients with complete data had appendicitis. 199 (58%) patients with appendicitis had score value at least 16 and were classified as high probability group with 93% specificity.Patients with score below 11 were classified as low probability of appendicitis. Only 4% of patients with appendicitis had a score below 11, and none of them had complicated appendicitis. In contrast, 207 (54%) of non-appendicitis patients had score below 11. There were no cases with complicated appendicitis in the low probability group. The area under ROC curve was significantly larger with the new score 0.882 (95% CI 0.858-0.906) compared with AUC of Alvarado score 0.790 (0.758-0.823) and Appendicitis inflammatory response score 0.810 (0.779-0.840).

Conclusions: The new diagnostic score is fast and accurate in categorizing patients with suspected appendicitis, and roughly halves the need of diagnostic imaging.

Figure 1

ROC-curves presenting the comparison of the new Adult Appendicitis Score (AUC 0.882 (95% CI 0.858 – 0.906)) compared with Alvarado score (AUC 0.790 (0.758 – 0.823)) and Appendicitis inflammatory response score (AUC 0.810 (0.779 – 0.840)).