This study adds weight to the value of a broad skill set in provision of surgical services in a rural setting.

Background The diagnosis of acute appendicitis (AA) remains a clinical one, with selective use of adjunct imaging. Patients with equivocal clinical presentation often undergo a diagnostic laparoscopy. To help reduce negative appendicectomy rates in women, we aimed to develop a simple scoring system based on the Alvarado score (AS) and ultrasound scan (US), as a diagnostic aid for AA in females. Methods All patients who underwent appendicectomy for AA at The Alfred Hospital Melbourne between 1 July 2012 and 30 June 2017 were included for this case–control study. Logistic regression was used to identify pre‐operative parameters predictive of AA. Histopathological identification of AA was interpreted as the gold standard. Statistical analysis was performed using IBM SPSS Statistics V26. Results A total of 1194 patients were included, with 26% negative appendicectomy rate in women. Of the 8 parameters in the AS, logistic regression identified migratory pain, leukocytosis and leukocyte left shift as most significant predictors for AA. These three parameters were used in a 3‐point test which carried a sensitivity of 92.1% and specificity of 28.7%. In women, a negative or non‐diagnostic US improved the negative predictive value of the 3‐point test from 57% to 82%. Conclusion The 3‐point abbreviated AS in combination with US may be clinically useful in women to exclude appendicitis without diagnostic laparoscopy. Further large‐scale prospective studies are required to validate the utility across different subgroups.

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