THE DIAGNOSTIC ACCURACY OF CLINICALAND LABORATORY PARAMETERS IN THE DIAGNOSIS OF ACUTE APPENDICITIS IN THE ADULT EMERGENCY DEPARTMENT POPULATION

Abstract

The aim of the study was to identify the optimal combination of clinical and laboratory parameters that should facilitate the emergency department surgeon's denite decision. The study group comprised 120 patients with suspicion of acute appendicitis (AA). In 60 patients the AAdiagnosis was conrmed intraoperative and by histological analysis. Clinical parameters included: appetite, vomiting, diarrhoea, dysuria, signs of localized peritonitis and pain migration. Measured laboratory parameters were: C-reactive protein (CRP), complete blood count (CBC) and the urine test strip. The control group of patients were more likely to present following symptoms: no changes in appetite (P < 0.001), diarrhoea (P = 0.009) and dysuria (P = 0.047). CRP and white blood cell count (WBC) were signicantly higher in the group with conrmed AA compared to the control group (44.7 vs. 6.6, and 13.6 ± 3.9 vs. 9.0 ± 3.4, respectively; P< 0.001). The multivariate logistic regression analysis identied lack of appetite (P= 0.013), absence of diarrhoea (P= 0.004), and positive nding of signs of localized peritonitis (P= 0.013), as well as WBCs (P< 0.001) and negative urine test strip results (P = 0.009) as statistically signicant predictors of AA. The highest percentage of correctly classied cases (82%) was achieved by combination of common clinical exam and basic inexpensive laboratory parameters (WBCs and urine test strip). Acute appendicitis in the emergency setting may be successfully ruled in based on elevated WBCs and negative urine test strip in combination with signs of localized peritonitis, lack of appetite and absence of diarrhoea. Since CRP did not contribute to the overall diagnostic accuracy, its use in AA diagnostic protocols is of no value.