SEX-SPECIFIC DIAGNOSTIC SCORES FOR ACUTE APPENDICITIS

The role of clinical and computer-based decisions in the diagnosis of acute appendicitis was studied in connection with the survey of acute abdominal pain by the Research Committee of the World Organization of Gastroenterology (OMGE). One thousand three hundred and thirty-three p atients presenting with acute abdominal pain were included in the stud y. Twenty-two preoperative clinical history variables, 14 clinical sig ns, and 3 tests were evaluated in a multivariate analysis to find the best combination of independent predictors of acute appendicitis for m ales and females. Independent predictors of acute appendicitis in male s were tenderness, previous abdominal surgery, rebound, rigidity, loca tion of pain at diagnosis, guarding, and body temperature. To sum up t he contributions of the most significant diagnostic factors, a diagnos tic score (DS) was built. When the male patients with a DS value betwe en -2.00 and -0.48 were considered nondefined (n = 75, follow-up requi red before deciding to operate), the sensitivity of the computer-aided diagnosis in detecting acute appendicitis in males was 0.95, with a s pecificity of 0.89 and an efficiency of 0.91. In males whose leucocyte count was available (n = 476), previous abdominal surgery, leucocytos is, location of pain at diagnosis, tenderness, rigidity, rebound, guar ding, rectal digital tenderness, and body temperature predicted signif icantly acute appendicitis. The DS reached a sensitivity of 0.94 (the cut-off level was -1.74), with a specificity of 0.80 and an efficiency of 0.84. When the male patients with a DS value between -1.74 and -0. 14 were considered nondefined (n = 67, follow-up required before decid ing to operate), the sensitivity of the computer-aided diagnosis in de tecting acute appendicitis in males was 0.93, with a specificity of 0. 93 and an efficiency of 0.93. The most important independent predictor s of acute appendicitis in females were tenderness, rigidity, guarding , location of pain at diagnosis, and renal tenderness. When the patien ts with a DS value between -2.03 and -0.49 were considered nondefined (n = 123, follow-up required before deciding to operate), the sensitiv ity of the computer-aided diagnosis in detecting acute appendicitis in females was 0.93, with a specificity of 0.92 and an efficiency of 0.9 2. In females whose leucocyte count was available (n = 575) the most i mportant independent predictors of acute appendicitis were tenderness, rigidity, guarding, leucocytosis, location of pain at diagnosis, and renal tenderness. When the patients with a DS value between -2.33 and -0.41 were considered nondefined (n = 77, follow-up required before de ciding to operate), the sensitivity of the computer-aided diagnosis in detecting acute appendicitis in females was 0.93, with a specificity of 0.91 and an efficiency of 0.92. The results suggest that the use of computer-aided decisions improves diagnostic sensitivity, specificity , efficiency, and LR+ in detecting acute appendicitis in females with acute abdominal pain.