Classifying patients suspected of appendicitis with regard to likelihood - 18/08/11
, Matthew Briggs, Ph.D., Paris A. Datillo, R.N., Shawn K. Van Deusen, M.D., Theodore J. Gaeta, D.O., M.P.H.
Corresponding author. Tel.: +1-718-780-5040; fax: +1-718-780-3153Abstract |
Background |
We sought to develop a clinical predictive model for acute appendicitis and contrast it with current clinical practice.
Methods |
A prospective observational study of patients presenting with signs or symptoms consistent with acute appendicitis. Random-partition modeling was used to develop an appendicitis likelihood model (ALM).
Results |
Four hundred thirty-nine patients were enrolled, 101 with appendicitis, and 338 with other diagnoses. The ALM classified patients as “low likelihood” if they had a white blood cell count <9,500 and either no right lower–quadrant tenderness or a neutrophil count <54%. Patients were classified as “high likelihood” if they had a white blood cell count >13,000 with rebound tenderness or both voluntary guarding and neutrophil count >82%. The ALM outperformed actual clinical practice with regard to “missed” appendicitis, negative laparotomies, and total number of imaging studies.
Conclusion |
The ALM may permit more judicious use of advanced radiographic imaging with lower nontherapuetic laparotomy rates.
Le texte complet de cet article est disponible en PDF.Keywords : Appendicitis, Clinical scoring, Diagnosis
Plan
Vol 191 - N° 4
P. 497-502 - avril 2006 Retour au numéro
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