Development and validation of a risk score predicting acute uncomplicated appendicitis

Area of Science:

• Emergency Medicine
• Surgical Pathology
• Diagnostic Accuracy

Background:

• Acute appendicitis (AA) is a common surgical emergency.
• Distinguishing uncomplicated AA (UCAA) from complicated AA (CAA) is crucial for appropriate management.
• Predictive factors for UCAA require further identification.

Purpose of the Study:

• To identify independent predictive factors for UCAA.
• To develop and validate a predictive score for UCAA.

Main Methods:

• Retrospective study of 335 patients operated on for AA.
• Logistic regression analysis to identify predictive factors.
• Score validation on an independent cohort of 236 patients.

Main Results:

• Independent predictors for CAA identified: prolonged pain duration, right lower quadrant guarding, and elevated CRP (>86.8 mg/l).
• Developed score demonstrated high accuracy (AUC=0.884) in predicting CAA.
• Validated score showed significant predictive power.

Conclusions:

• Patients with symptom duration <2 days, no RLQ guarding, and CRP <86.8 mg/l have a 96% risk of UCAA.
• The developed score aids in differentiating UCAA from CAA.
• Clinical application of the score can optimize appendicitis management.