Improved diagnostic accuracy in patients with suspected appendicitis

Abstract

Background: Studies during the 1990s showed that it was
possible to reduce the rate of negative appendectomies by using
various diagnostic methods. The present study aims to evaluate
the effect on diagnostic accuracy of implementation of repeated
clinical examination and blood tests in a small county hospital
without possibilities of radiological assistance on a 24-hour
basis.
Methodology: Prospective study of all appendectomies performed
at Ystad General Hospital, Sweden. Leukocyte count
and C-reactive protein levels were analysed in all patients.
Patients with suspicion of acute appendicitis were admitted
for active observation, repeated clinical examination and
analyses of leukocyte counts and CRP levels.
Results: 533 appendectomies were performed during 1996-
2000 and compared with the index year 1995. Diagnostic
accuracy increased from 73% to 90% (p<0.01). The rates
of perforations and complications did not change during
the study period, being 12.4% and 5.1%, respectively. Coinciding
with the increased accuracy, a drop in the number
of appendectomies performed and a longer time interval
from admittance to the start of operation was seen.
Conclusion: Through repeated clinical examinations and
blood tests it was prospectively possible to achieve an increase
in diagnostic accuracy in patients with suspicion of
acute appendicitis without any noticeable side effects.
Department of Surgery, 1Ystad General Hospital and 2Lund
University Hospital, Sweden
Author for correspondence:
Roland Andersson, MD, PhD, Department of Surgery, Lund
University Hospital, SE-221 85 Lund, Sweden, Tel. +4646172359,
Fax: +4646147298, e-mail: Roland.Andersson@kir.lu.se
Key words: appendicitis, repeated examinations, blood tests,
diagnostic accuracy