TITLE:
Diagnosis of Acute Appendicitis in Adults: Role of a Simple Clinical Diagnostic Triad
AUTHORS:
Kassem Alubaidi, Malik Aikoye, P. S. Basnyat
KEYWORDS:
Acute Appendicitis, Diagnostic Triad
JOURNAL NAME:
Surgical Science,
Vol.7 No.4,
April
15,
2016
ABSTRACT: Objectives: Acute appendicitis remains the commonest intra-abdominal
surgical emergency. This study sought to identify the clinical factors that are
most reliable in the diagnosis of acute appendicitis. Methods: This was a
retrospective review of consecutive adult appendicectomies over a 6 months
period. The frequency of different clinical parameters was assessed to
determine the most reliable predictors of acute appendicitis. A simple triad of
3 of the most frequent clinical parameters was examined for diagnostic
potential by calculating its sensitivity, specificity, positive predictive
value and negative predictive value. Results: There were a total of 124
patients. The median age was 33 years while the gender distribution was 54
males to 70 females. The most common clinical parameters in the patients with
appendicitis were right iliac fossa tenderness or peritonism (100.0%), anorexia
(78.8%), nausea (75.9%), migratory abdominal pain i.e. pain migrating to right lower quadrant (55.7%), tachycardia
(41.3%) and pyrexia i.e. body
temperature of 37.8 degrees Celsius and above (22.1%). The simple triad of
anorexia, right iliac fossa tenderness and migratory abdominal pain showed
specificity for the diagnosis of acute appendicitis of 84.2% and sensitivity of
45.7%. The positive predictive value of this triad was 94.1% while the negative
predictive value was 21.9%. Conclusion: Our study reveals that the positivity
for this simple clinical triad strongly rules in the diagnosis of acute
appendicitis. Its specificity and positive predictive value compares with the
most reliable scoring systems for acute appendicitis in literature. Further
approaches to diagnosis such as imaging and diagnostic laparoscopy should be
considered when this triad is negative and appendicitis is suspected. This
simple diagnostic approach allows for prompt diagnosis and treatment which
expectedly would improve the morbidity associated with acute appendicitis.