Is it Possible to Make a Useful Scoring System for the Diagnosis of Acute Appendicitis?

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  • 実用に耐えうる急性虫垂炎診断スコアは作成できるか？

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We conducted a prospective study of 561 patients hospitalized with abdominal pain suggestive of acute appendicitis. History, signs, symptoms, leukocytosis and CT findings were analyzed for sensitivity and specificity. The result of a multivariate analysis of these factors revealed five factors which were found to be useful in making the diagnosis of acute appendicitis, as follows : age ; CT findings (distended appendix, appendicolith, periappendiceal inflammatory changes) ; and the inflammatory changes around the ascending colon (negative finding). Based on this weighting, we devised a practical diagnostic score that may help in excluding catarrhal appendicitis and diagnosing only phlegmonous and gangrenous appendicitis for operation. As a result, the sensitivity and specificity were only 77.2% and 75.6%, respectively. The actual comprehensive diagnostic sensitivity and specificity of 88% and 88.7%, respectively, were 10% greater than the sensitivity and specificity by the scoring system. This difference was equivalent to the overall judgment based on the experience of the surgeons, and appeared impossible to fill by the diagnostic score with statistical analysis.

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