Which symptoms are significant for the patients of a suspected acute appendicitis with right lower quadrant pain?

Ali Kagan Coskun, MD¹, Oner Mentes, MD¹, Rahman Senocak, MD¹, Sahin Kaymak, MD¹, Subutay Peker, MD¹, Yasemin Yavuz², Ali Harlak, MD¹, Orhan Kozak, MD¹. ¹GATA, ²Ankara University

Any delay or incorrect management of acute appendicitis could cause an increase for morbidity and mortality with an elevation of healthcare costs. Therefore in order to diagnose acute appendicitis correctly at early stage, contribution of the improved scoring system is important. This study aimed to investigate the reliability of different scores of acute appendicitis for local population and to evaluate the most significant symptoms of patients with right lower quadrant pain .

Methods: Two hundered and two patients patients suspected of acute appandicitis aged 18-69 were included in this retrospective study.The patients data for calculating the scores of Ohmann, Lintula, Alvarado and Eskelinen were taken from hospital records and surgeons notes. The most significant symptoms of patients with right lower quadrant pain were evaluated.

Results: The mean age of patients( 75.2% males, 24.8% females) was 26.2&plusnm;7.1 years. ROC curve analysis was performed and area under the curve was 0.867 for Ohmann score, 0.685 for Lintula score, 0.797 for Alvarado score and 0.731 for Eskelinen score. When we evaluated the symptoms of the patients with right lower quadrant pain, the most significant symptoms were three. They are steady pain, white blood cell count >10500, bowel sounds (absent, tingling or high-pitched bowel). ROC curve analysies were also performed for them, area under the curve was 0.956

Conclusion: Patients with symptoms of right lower quadrant steady pain, white blood cell count >10500, bowel sounds (absent, tingling or high-pitched bowel) should be examined particularly and followed up carefully to avoid morbidity and mortality. By using these parameters, a decrease in the negative appendicectomy rate and correct management could be provided.