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Markers of severe appendicitis
H Y Tehrani1, J G Petros, R R Kumar
1Department of Surgery, St. Elizabeth's Medical Center of Boston, Massachusetts 02135, USA.
Abstract:
Appendicitis is a common surgical disease that often presents with vague, inconclusive symptoms. Despite the development of technologically advanced diagnostic modalities, perforation has usually occurred before the surgeon sees the patient. Morbidity, length of stay, and hospital costs associated with appendiceal perforation have not changed markedly in the past 50 years. To evaluate prognostic markers for severe appendicitis, we reviewed 18 years' worth of records of patients with appendicitis who were admitted to St. Elizabeth's Medical Center of Boston and found that the combination of history and physical examination has withstood the test of time. We found that advancing age, duration of symptoms for 36 or more hours, white blood cell count, shift left in white blood cell count, and fever were significantly related to severe appendicitis. An abnormal plain film was a marker if fever coexisted.
Insights
Key indicators for severe appendicitis include older age, prolonged symptoms (36+ hours), elevated white blood cell count, and fever. Clinical assessment remains crucial for diagnosing appendicitis accurately.
Area of Science:
- Surgical pathology
- Diagnostic markers
- Clinical decision-making
Background:
- Appendicitis is a frequent surgical condition with often non-specific symptoms, leading to delayed diagnosis and perforation.
- Despite advanced diagnostics, outcomes for perforated appendicitis have seen little improvement over five decades.
- Identifying prognostic markers for severe appendicitis is crucial for timely intervention.
Purpose of the Study:
- To evaluate prognostic indicators associated with severe appendicitis.
- To determine factors predicting advanced disease at presentation.
Main Methods:
- Retrospective review of 18 years of patient records from St. Elizabeth's Medical Center of Boston.
- Analysis of clinical data, including patient history, physical examination findings, laboratory results, and imaging.
- Statistical evaluation to identify significant correlations with severe appendicitis.
Main Results:
- A combination of patient history and physical examination remains a highly effective diagnostic tool.
- Significant prognostic markers for severe appendicitis identified: advancing age, symptom duration of 36 hours or more, elevated white blood cell count, left shift in white blood cell count, and fever.
- Abnormal plain film findings were indicative of severe appendicitis when accompanied by fever.
Conclusions:
- Clinical evaluation is paramount in diagnosing appendicitis, even with advanced imaging available.
- Specific clinical and laboratory findings can predict the severity of appendicitis, aiding in early management decisions.
- Prognostic markers identified can help stratify patients and potentially improve outcomes for severe appendicitis.