Evidence-based management of suspected appendicitis in the emergency department

Appendicitis is the most common cause of acute abdominal pain requiring surgical treatment in persons under 50 years of age, with a peak incidence in the second and third decades. Women have a greater risk of misdiagnosis and a higher negative appendectomy rate. Atypical presentations of appendicitis are commonly misdiagnosed, resulting in increased morbidity, mortality, and potential litigation. The variability of presentation relates to the varied anatomical location and the visceral innervation of the appendix. Patients presenting with possible appendicitis should be risk stratified based on history, physical examination, and laboratory data. An elevated white blood cell (WBC) count alone (> 10,000 cells/mm3) offers poor diagnostic utility; however, combining WBC count > 10 and C-reactive protein (CRP) level > 8 achieves notable predictive power in the diagnosis of acute appendicitis. Imaging studies play a vital role in diagnosis, particularly in equivocal presentations.