Appendicitis: trends and risks, 1996

Current changes in the clinical diagnosis and management of acute appendicitis relate to managed care policies and procedures, newer diagnostic techniques, laparoscopy, scoring analysis of clinical data, and nonoperative treatment. Analysis of results of studies using ultrasonography, computed tomography, radionuclide scanning, and diagnostic scoring continues with the intent of developing improved sensitivity and specificity in predicting the presence of acute appendicitis, but it is still not possible to achieve an accurate, uniform, definitive preoperative diagnosis of the disease. The addition of current diagnostic procedures has probably shortened the period of observation for doubtful cases of acute appendiceal inflammation and has established the presence of the disease by means other than clinical examination, interpretation of symptoms, and laboratory tests. Diagnostic scoring systems have been described with enthusiasm, but they are not generally popular and require considerable effort to be clinically useful. The use of laparoscopy and laparoscopic appendectomy is exciting and very in tune with the modern trend in abdominal surgery. However, increasing concern has been expressed that diagnostic advances will be paralleled by delays in patient treatment. Since some delays have been described for management and treatment of acute appendicitis, any delays related to new trends in health care system organization should be monitored carefully.