Acute Appendicitis: The Reliability of Diagnosis by Clinical Assessment Alone

Kalliakmanis, V; Pikoulis, Emmanuel; Karavokyros, Ioannis; Felekouras, E; Morfaki, P.; Haralambopoulou, G.; Panogiorgou, T.; Gougoudi, Evagelia; Diamantis, Theodoros; Leppäniemi, Ari; Tsigris, Christos

doi:10.1177/145749690509400305

Cited by 29 publications

(20 citation statements)

References 37 publications

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“…Additionally, similar results were obtained , Kalliakmanis et al 9 and Chandrasegaram et al 10 Those series stated that appendicitis is higher in the second decade. However, different results are concluded by Makaju et al 4 and Zulfikar et al…”

Section: Discussionsupporting

confidence: 78%

Histopathologic Distribution of Appendicitis at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, in 2012

Zhafira¹,

Yulianti²,

Wastaman³

2017

amj

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Background: Appendicitis is a medical emergency and a common cause of emergency surgeries worldwide. Its frequency is varied based on many factors, including age and sex. Histopathologic examination is a gold standard for diagnosis, and complications like gangrene formation and perforation lead to high mortality and morbidity in almost all age groups. This study was conducted to describe the distribution pattern of appendicitis according to age, sex, and histopathologic type. Methods: This cross-sectional study was carried out in the Department of Pathology Anatomy, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from August-October 2013. Secondary data were obtained from medical records of January 1st to December 31st, 2012. A total of 503 out of 516 cases were included to be reviewed. Age, sex, and histopathologic type from medical records were then evaluated. Any specific case and perforation were also noted. Results: Data showed the highest prevalence of appendicitis occurred in the 10-19 age group (28.4%) and in the female group (52.3%). Acute appendicitis was more common than chronic appendicitis in both sexes and all age groups. Perforation rate was high (41.4%), and was more prevalent in male (54.9%) and in the 0-9 age group (65.7%). Conclusions: Appendicitis, both acute and chronic, is more distributed in the second decade, and is slightly more prevalent in females. Acute cases are more common than chronic. Perforation rate is significant and peaks in the first decade and in males. [AMJ.2017;4(1):36-41]

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Section: Discussionsupporting

confidence: 78%

Histopathologic Distribution of Appendicitis at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, in 2012

Zhafira¹,

Yulianti²,

Wastaman³

2017

amj

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“…Currently, appendicitis is stratified as CAP or UAP based on radiological, intra-or postoperative histological findings [16][17][18] . However, the difficulty lies in stratifying patients as uncomplicated pre-operatively.…”

Section: Discussionmentioning

confidence: 99%

An Appraisal of Inflammatory Markers in Distinguishing Acute Uncomplicated and Complicated Appendicitis

et al. 2016

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Background: It remains difficult to distinguish between complicated appendicitis (CAP) and uncomplicated appendicitis (UAP). There is a paucity of studies utilizing inflammatory markers to stratify the severity of acute appendicitis. This study aimed to evaluate and demonstrate the potential clinical utility of inflammatory markers as adjuncts in distinguishing CAP and UAP. Methods: A comparative observational study was performed. Patients diagnosed with acute appendicitis were categorized as (a) complicated (necrosis, perforation, abscess) and (b) uncomplicated (inflamed, edematous). Hematological indices were combined to generate the following ratios: white cell lymphocyte ratio (WLR), white cell neutrophil ratio (WNR) and neutrophil lymphocyte ratio (NLR). Parameter accuracy was assessed using summary receiver operating characteristic (sROC) curves, classification and regression tree analysis and confusion matrix generation. Results: On sROC analysis, neutrophils (area under the curve (AUC) 0.79, p < 0.001), WLR (AUC 0.79, p < 0.001) and NLR (AUC 0.79, p < 0.001) were the most accurate parameters in distinguishing CAP and UAP. White cell count (WCC; AUC 0.76, p < 0.001) and C-reactive protein (AUC 0.75, p < 0.001) were less accurate. WCC >12.25 (sensitivity 70%, specificity 68%) and NLR >5.47 (sensitivity 78%, specificity 70%) were the most accurate in identifying CAP. Conclusion: Inflammatory marker cutoff points can be generated and utilized to differentiate between UAP and CAP. This may be useful when deciding between conservative and operative management.

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“…To improve the diagnostic accuracy, scoring systems and computer-aided diagnostic programs have been tested, often with fairly good results, but they have not been used commonly in clinical routine practice. Even though the use of computed tomography (CT) and ultrasonography as a diagnostic tool has increased over the last few years [4], the diagnosis of appendicitis is still often based on the patient's history, clinical examination, and laboratory tests alone [5]. Many of the symptoms that have traditionally been associated with appendicitis, namely nausea, loss of appetite, and right-sided rectal tenderness, have been shown to have only low or no diagnostic value [6].…”

Section: Introductionmentioning

confidence: 99%

Manifestations of Acute Appendicitis: A Prospective Study on Acute Abdominal Pain

Laurell

Hansson²,

Gunnarsson³

2013

Dig Surg

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Background/Aims: The aim of this prospective study was to identify the clinical symptoms and signs most important for the prediction of appendicitis among patients with acute abdominal pain. Methods: Clinical findings in 2,478 patients admitted to the emergency department of Mora Hospital from February 1997 to June 2000, with acute abdominal pain of up to 7 days' duration, were registered in a database. The medical records were reviewed after 1 year. Results: A total of 432 patients were suspected of having appendicitis and in 221 this diagnosis was confirmed. Some 53 patients, with another preliminary diagnosis, were eventually found to suffer from appendicitis, making a total of 274 patients with appendicitis. Appendectomy was performed in 316 patients and was negative in 14%. Clinical diagnosis of appendicitis had a sensitivity of 0.81, a specificity of 0.90, a positive predictive value of 0.51, a positive likelihood ratio of 8.1, and a diagnostic accuracy of 0.89. The highest odds ratios were found for isolated tenderness in the right iliac fossa (3.29), rebound tenderness (3.00), right-sided rectal tenderness (2.53), migration of pain to the right iliac fossa (2.18), and local guarding (2.11). Conclusion: Clinical findings indicating localised inflammation in the right iliac fossa were reliable in predicting acute appendicitis. The patients' history of pain combined with a careful clinical examination still plays an important role in detecting appendicitis among patients with acute abdominal pain.

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Acute Appendicitis: The Reliability of Diagnosis by Clinical Assessment Alone

Cited by 29 publications

References 37 publications

Histopathologic Distribution of Appendicitis at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, in 2012

Histopathologic Distribution of Appendicitis at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, in 2012

An Appraisal of Inflammatory Markers in Distinguishing Acute Uncomplicated and Complicated Appendicitis

Manifestations of Acute Appendicitis: A Prospective Study on Acute Abdominal Pain

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