Objective: This study aimed to evaluate the diagnostic value of clinical, physical examination, and laboratory findings for acute appendicitis, to create a novel scale using the most meaningful parameters, and to compare it with current diagnostic scores.
Material and Methods: This was a single-center, retrospective, observational study. Between July 2011 and January 2015, 172 patients aged ≥18 years who visited the emergency department and underwent surgery with a diagnosis of acute appendicitis were included in the study. Patients were divided into two groups, acute appendicitis and negative appendectomy, according to the histopathology reports. ROC analyses of age, sex, clinical characteristics, physical examination results, and laboratory findings were performed, and the areas under the curves were obtained according to the diagnostic groups. Clearmine (CRP, leukocyte, anorexia, rebound tenderness, migration of pain, neutrophil) scores and other scales were compared in terms of diagnostic value for acute appendicitis.
Results: A total of 110 patients were male. The mean age was 34.2±15.8 years. The negative appendectomy rate was 16.3%. Among the clinical presentations, migration of pain (AUC:0.78) and anorexia (AUC:0.75) had the highest diagnostic value. The parameters with the highest diagnostic value were rebound tenderness (AUC:0.68) among physical examination findings and neutrophil count (AUC:0.71), leukocyte count (AUC:0.70), and CRP (AUC:0.68) among laboratory findings. The Clearmine score reached the highest diagnostic value for acute appendicitis when the cutoff was ≥6 points (AUC:0.92). Other scales, including Alvarado, Andersson, Ohmann, and Tzanakis, had lower AUCs.
Conclusion: Compared with other acute appendicitis diagnostic scales currently used in the literature, the Clearmine score has greater diagnostic value; it is practical and useful for use in the emergency department.
Keywords: Acute appendicitis, Clearmine score, emergency medicine, missed appendicitis, negative appendectomy
