Acute Appendicitis: The Reliability of Diagnosis by Clinical Assessment Alone

Acute Appendicitis: The Reliability of Diagnosis by Clinical Assessment Alone

Background and Aims: This prospective study aimed to review the trustworthiness of the initial clinical assessment in acute appendicitis without employment of imaging modalities, laparoscopy or any other adjunct diagnostic test. Patients and Methods: 717 patients were operated on for appendicitis by...

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Published in:Scandinavian journal of surgery Vol. 94; no. 3; pp. 201 - 206
Main Authors: Kalliakmanis, V., Pikoulis, E., Karavokyros, I. G., Felekouras, E., Morfaki, P., Haralambopoulou, G., Panogiorgou, T., Gougoudi, E., Diamantis, T., Leppäniemi, A., Tsigris, C.
Format: Journal Article
Language:English
Published: London, England SAGE Publications 01-09-2005
Subjects:
Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Appendectomy
Appendicitis - diagnosis
Appendicitis - surgery
Child
Female
Humans
Male
Medical History Taking
Middle Aged
Physical Examination
Prospective Studies
Reproducibility of Results
Acute appendicitis
acute abdomen
acute appendicitis diagnosis
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Summary:Background and Aims: This prospective study aimed to review the trustworthiness of the initial clinical assessment in acute appendicitis without employment of imaging modalities, laparoscopy or any other adjunct diagnostic test. Patients and Methods: 717 patients were operated on for appendicitis by six different surgeons. Initial clinical and laboratory examination were evaluated in relation to the intraoperative and the pathological appreciation of the appendiceal inflammation. Results: 598 patients were found to have appendicitis, 34 a different condition, 41 had both appendicitis and an additional condition and 44 no pathology. 6% of the laparotomies and 11 % of the appendectomies were unnecessary. The severity of the inflammation correlated significantly with periumbilical pain, pain migrating to right lower quadrant, loss of appetite, fever, rebound tenderness, local rigidity, polymorphonuclear predominance on deferential, polymorhonucleosis and leukocytosis. Leukocytosis was less frequent in aged patients. All the six surgeons were found to be equally reliable, although they all underestimated the setting compared to the pathologists. Patients with a long duration of symptoms had milder forms of inflammation and increased percentage of unanticipated abdominal conditions. Conclusions: Appendicitis can be reliably diagnosed clinically without employment of adjunct tests. These can be reserved for equivocal cases.
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ISSN:1457-4969
1799-7267
DOI:10.1177/145749690509400305