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Subject Area

Internal Medicine

Article Type

Original Study

Abstract

Context Appendicitis is a common cause of abdominal pain. Nevertheless, diagnosis of acute appendicitis is still a challenge, with the hazards of either negative appendectomy or complicated appendicitis. Using an optimum scoring system, such as adult appendicitis score (AAS), can increase the diagnostic accuracy eliminating the need for potentially harmful and costly imaging studies. Aims The aim was to test the reliability of AAS in diagnosis of acute appendicitis. Settings and design This was a prospective, noninterventional study in the emergency department of Menoufia University hospitals. Patients and methods Eligible patients who presented with right lower quadrant pain in the period from January 2016 to April 2017 were enrolled in the study. History taking, clinical examination, and laboratory testing (white cell count, neutrophil count, and C-reactive protein) were carried out to test the reliability of the AAS, and it was compared with the Alvarado score and appendicitis inflammatory response score. Sensitivity and specificity, as well as negative and positive predictive values were calculated for each score. Correlation analysis was conducted between each score results and final pathological results. Receiver operating characteristic curves were plotted to estimate the reliability. Results AAS was the most specific one at score 16, with specificity 97.9% and positive and predictive value 97.4%, whereas the appendicitis inflammatory response score was the most sensitive at score 5, with sensitivity and negative predictive values of 100%. Using the receiver operating characteristic curves showed the AAS was the most reliable, with area under the curve of 0.936 (P = 0.00). Conclusion AAS is a reliable score to risk stratify patients with suspected acute appendicitis, guiding only intermediate-risk cases to further imaging. At score greater than or equal to 18, cases can be directed confidently to surgery without delay.

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