A 3-Year Study of Predictive Factors for Positive and Negative Appendicectomies

• Published in: Journal of investigative surgery 2019-07, Vol.32 (5), p.469-473
• Main Authors: Chang, Dwayne T. S., Maluda, Melissa, Lee, Lisa, Premaratne, Chandrasiri, Khamhing, Srisongham
• Format: Article
• Language: English
• Subjects: appendicitis; hematologic tests; predictive value of tests; radiology
• ISSN: 0894-1939; 1521-0553
• DOI: 10.1080/08941939.2018.1441341

Background: Early and accurate identification or exclusion of acute appendicitis is the key to avoid the morbidity of delayed treatment for true appendicitis or unnecessary appendicectomy, respectively. We aim (i) to identify potential predictive factors for positive and negative appendicectomies; and (ii) to analyse the use of ultrasound scans (US) and computed tomography (CT) scans for acute appendicitis. Materials and Methods: All appendicectomies that took place at our hospital from the 1st of January 2013 to the 31st of December 2015 were retrospectively recorded. Test results of potential predictive factors of acute appendicitis were recorded. Statistical analysis was performed using Fisher exact test, logistic regression analysis, sensitivity, specificity, and positive and negative predictive values calculation. Results: 208 patients were included in this study. 184 patients had histologically proven acute appendicitis. The other 24 patients had either nonappendicitis pathology or normal appendix. Logistic regression analysis showed statistically significant associations between appendicitis and white cell count, neutrophil count, C-reactive protein, and bilirubin. Neutrophil count was the test with the highest sensitivity and negative predictive values, whereas bilirubin was the test with the highest specificity and positive predictive values (PPV). US and CT scans had high sensitivity and PPV for diagnosing appendicitis. Conclusions: No single test was sufficient to diagnose or exclude acute appendicitis by itself. Combining tests with high sensitivity (abnormal neutrophil count, and US and CT scans) and high specificity (raised bilirubin) may predict acute appendicitis more accurately.