Primary care evaluation of acute appendicitis : an adjunct scoring system of clinical parameters /
Ma. Muriel M. Lamirez
Design Retrospective design Setting Tertiary hospital Patients Sixty patients from January to March 1995 and sixty patients from October to December, 1995 clinically diagnosed as acute appendicitis at an Adult Ambulatory Care Unit of a university hospital. Interventions Charts of patients included in the study were retrieved from the medical records section; each chart was reviewed noting the chief complaint, symptoms, signs, clinical and differential diagnosis at AACU and surgery ER, laboratory examinations done prior to consultation at the ambulatory care unit and at the surgery-ER, the final disposition at AACU and Surgery and the post-operative diagnosis. Codes were assigned to each of the parameters and which were then converted to whole number scores. Sensitivity and specificity of the score were then plotted in a receiver operator curve. Results From the sample population, 79.16% were post-operatively diagnosed as acute appendicitis, 20.83% were not acute appendicitis, and 2.5% went home against medical advise thus, with unknown final diagnosis. Negative appendectomies were at 4.16%. Eight of the clinical parameters had coefficients of 1 above and -1 and lower; score of tenderness and hypogastric tenderness; score of -2 for epigastric tenderness; and score of -3 for periumbilical tenderness. Patients with score less than 3 have high sensitivity (94-99% for acute appendicitis and low specificity (64-80%) and may be observed, worked up for causes of acute abdomen and maybe safely sent home once cleared. A score of 3 and above has increased specificity (88-90%) for acute appendicitis and will be referred for possible surgical intervention.
The Filipino Family Physician, 1997 35 ( 2 ) pages 39-44