Research forum abstract65 Comparison of Appendicitis Clinical Scoring Systems With Physician-Determined Likelihood of Appendicitis
Section snippets
Background
Appendicitis is a common cause for abdominal pain in patients seen in the emergency department. While computed tomography often helps in the diagnosis, it also exposes patients to ionizing radiation, which increases their lifetime risk of cancer. In order to avoid this exposure, yet enhance the predictive power of history and physical exam, various clinical scoring systems have been developed.
Study Objectives
This study aims to compare the diagnostic accuracy of three clinical scoring systems for the diagnosis of appendicitis: the Alvarado score, modified Alvarado score, and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score. Physician-determined likelihood of appendicitis was also evaluated.
Methods
This is a HIPAA-compliant, IRB-approved prospective study of patients presenting with abdominal pain to an academic emergency department with an annual census of 48,000. Patients were eligible for enrollment if they were over 11 years old and had a computed tomography (CT) ordered to evaluate for appendicitis. For every enrollee, all clinical parameters needed to calculate the clinical scores were recorded by the assigned physician on a standardized data collection sheet prior to the patient
Results
We enrolled 236 patients from 2/2012-2/2014, including 142 (60.1%) women and 165 (69.9%) patients under age 40. The prevalence of appendicitis in this cohort was 35.6%. The AS had a sensitivity of 0.52 (0.46-0.59), specificity 0.74 (0.69-0.80), PPV 0.53 (0.47-0.59), and NPV 0.74 (0.68-0.79). The MAS had a sensitivity of 0.38 (0.32-0.44), specificity 0.82 (0.77-0.87), PPV 0.53 (0.47-0.60), and NPV 0.70 (0.65-0.76). The RIPASA score had a sensitivity of 0.75 (0.69-0.81), specificity 0.37
Conclusion
None of the three clinical scoring systems were particularly sensitive or specific for the diagnosis of appendicitis, nor did they agree with each other or the physician’s impression. Further, physician clinical impression was as accurate as the scoring systems.