THE VALUE OF HISTORY AND CLINICAL EXAMINATION IN THE DIAGNOSIS OF ACUTE APPENDICITIS IN CHILDHOOD, WITH SPECIAL REFERENCE TO COMPUTER-BASEDDECISION-MAKING

Since the incidence of appendicitis is high in children, the present p aper describes the potential of a computer-based diagnostic score to i mprove the clinical diagnosis of acute appendicitis in children under the age of 15 years, as determined in a prospective clinical study of patients with acute abdominal pain. The role of clinical and computer- based decision making in the diagnosis of acute appendicitis in childr en was studied in connection with the Research Committee of the World Organization of Gastroenterology (OMGE) survey of acute abdominal pain . A total of 188 children under the age of 15 years who presented with acute abdominal pain were included in the study at the Central Hospit al of Savonlinna and at the University Hospital of Tampere: 23 preoper ative clinical history variables, 14 clinical signs and 3 tests were e valuated in a multivariate analysis to find the best combination of pr edictors of acute appendicitis in children. The most important indicat ors of acute appendicitis were rebound, tenderness, rigidity, leucocyt e count, location of pain at diagnosis, vomiting, aggravating factors and rectal digital tenderness. In order to sum up the contributions of diagnostic factors, a diagnostic score (DS) for children was develope d: DS = 3.06 (Rigidity, 1 = no vs 0 = yes) + 2.19 (Guarding, 1 = prese nt vs 0 = absent) + 1.75 (Pain at diagnosis, 1 = right lower abdomen o r 0 = other site) + 1.73 (Vomiting, 1 = yes, 0 = no)- 5.07. The sensit ivity of preoperative clinical examination in detecting acute appendic itis in children was 0.91, with a specificity of 0.74 and an efficienc y of 0.78. The sensitivity of the DS in detecting acute appendicitis i n children was 0.95 with a specificity of 0.86 and an efficiency of 0. 88. When the patients with a DS value between -1.15 and -1.13 were con sidered as nondefined (n = 25, follow-up required before the decision to operate), the sensitivity of the computer-aided diagnosis in detect ing acute appendicitis in children was 0.95 and its efficiency, 0.91. Children with a DS below -1.15 should not be operated on, while childr en with a DS between -1.15 and -1.13 should be followed up before the decision on whether to operate or not is made; children with DS above -1.13 should be operated on. The results suggest that computer-aided d ecision making improves diagnostic specificity and efficiency in detec tion of acute appendicitis in children with acute abdominal pain.