[Fewer negative appendectomies thanks to improved clinical diagnosis]

108 consecutive patients presenting with suspected acute appendicitis were studied prospectively. To improve clinical performance, 19 clinical criteria were evaluated. For cases with unclear diagnostic situations laparoscopy was performed. With 10 of the above mentioned criteria the score published by de Dombal, which can reach a maximal value of 7 points, was calculated. For data processing the rate of negative appendectomies as well as the de Dombal score were used. 61 appendectomies with 7 (11.5%) perforations, 48 (78.7%) acute inflammations and 6 (9.8%) normal appendices have been performed. 39 (36.1%) patients with non-specific abdominal pain were observed for 3 +/- 2 days before discharge, while 7 (11.5%) had another surgical disease. In the appendectomized patients the score was 4.3 +/- 1.1 with perforation, 4.4 +/- 1.0 with acute inflammation and 3.8 +/- 1.3 with a normal appendix (p = ns). The score for non-specific abdominal pain in patients not undergoing surgery was significantly lower (2.2 +/- 1.2; p less than 0.01). Patients with other surgical diseases had a score of 3.1 +/- 1.1 with no significant difference from patients who had undergone appendectomy or from those with non-specific abdominal pain. Laparoscopy was performed in 16 (14.8%) patients. 9 patients had appendicitis, 4 non-specific abdominal pain and 3 another surgical disease. Improved clinical examination significantly (p less than 0.05) reduced negative appendectomies from 20.3% to 9.8% without a rise in the rate of perforation due to prolonged observation. The 6 patients with negative appendectomy could not be identified even by improved clinical examination.