Repeated clinical and laboratory examinations in patients with an equivocal diagnosis of appendicitis

In-hospital observation with repeated clinical examinations is commonly use d in patients with an equivocal diagnosis of appendicitis. It is not known if repeated measurements of temperature and laboratory examinations have an y diagnostic importance in this situation. The importance of repeated measu rements of the body temperature, white blood cell (WBC) and differential ce ll counts, C-reactive protein concentration (CRP) and of the surgeon's repe ated assessments was prospectively analyzed in 420 patients with an equivoc al diagnosis of appendicitis at admission who were reexamined after a media n of 6 hours of observation. The final diagnosis was appendicitis in 137 pa tients. After observation the inflammatory response was increasing among pa tients with appendicitis and decreasing among patients without appendicitis . The variables discriminating power for appendicitis consequently increase d, from an area under the receiver operating characteristic (ROC) curve of 0.56 to 0.77 at admission, to 0.75 to 0.85 after observation. The ROC area of the surgeons' clinical assessment increased from 0.69 to 0.89. The WBC a nd differential cell counts were the best discriminators at the repeat exam ination. The change in the variables between the observations had weak disc riminating power and had no additional importance in addition to the actual level at the repeat examination. To conclude, the diagnostic information o f the temperature and laboratory examinations increased after observation. Repeated controls of the body temperature and laboratory examinations are t herefore useful in the management of patients with equivocal signs of appen dicitis, but the result of the examinations must be integrated with the cli nical assessment.