The history is important in patients with suspected acute appendicitis

Background/Aims: The clinical diagnosis of acute appendicitis is incorrect in 20-30% of patients undergoing surgery. We analysed the clinical importan ce of nine commonly used symptoms and signs in 544 consecutive patients wit h regard to the correct diagnosis of acute appendicitis. Methods: Open popu lation-based prospective study. The degree of the surgeon's certainty of th e preoperative diagnosis was assessed. The final diagnosis was based on his tology, Logistic regression was used to analyze the independent value of ni ne symptoms and signs to predict acute appendicitis by calculating odds rat io (OR) with 95% confidence intervals (CI). Results: In 434 of 544 patients (80%) acute appendicitis was confirmed. A history of nausea or vomiting (O R = 2.3; CI = 1.11 to 4.76) and pain migration to right iliac fossa (OR = 1 .9; CI = 1.12 to 3.22) were significant predictors of acute appendicitis. P ain migration was found to be an independent predictor in females and nause a or vomiting in males. In the group of patients (29%) with an uncertain pr eoperative diagnosis, pain migration predicted a correct diagnosis in femal es (OR = 4.7; CI = 1.2 to 18), while tenderness over McBurney's point was a significant predictor in males (OR = 8.3; CI = 1.1 to 63), Conclusions: A history of pain migration and nausea or vomiting were independent predictor s for the correct diagnosis of acute appendicitis in patients undergoing su rgery. Thus, patient history is important in this patient group. Copyright (C) 2000 S. Karger AG, Basel.