The usefulness of scores in the diagnosis of appendicitis

The diagnosis of acute appendicitis relies largely on clinical experience; the performance of complementary tests is oftentimes unnecessary. We have created a score based on clinical and laboratory findings which can reliably categorize three zones of diagnostic probability: probable, doubtful., or improbable. Only the intermediate category requires complementary imaging. Alvarado first developed a scoring system based on operative findings and this has been modified and improved by others. In our experience, the scoring system of Francois has been most useful. This score is based on simple clinical data and findings such as age, sex, duration of symptoms, leucocytosis, palpable mass on rectal exam, and urinary symptoms. We have validated this score in a cohort of 202 patients presenting with right lower quadrant abdominal, pain and found a sensitivity of 94.7% and a negative predictive value of 97.4% for patients falling into the probable and improbable categories. Management of patients with either very high or very low scores can proceed more expeditiously and with less expense. Diagnostic imaging can be reserved for those patients with intermediate scores where the diagnosis is in doubt. We have established a clinical pathway in our emergency department based on this scoring system. (C) 2009 Elsevier Masson SAS. All rights reserved.