Is preoperative distinction between complicated and uncomplicated acute appendicitis feasible without imaging?

• Published in: Surgery 2016-09, Vol.160 (3), p.789-795
• Main Authors: Lietzén, Elina, MD, Mällinen, Jari, MD, Grönroos, Juha M., MD, PhD, Rautio, Tero, MD, PhD, Paajanen, Hannu, MD, PhD, Nordström, Pia, MD, PhD, Aarnio, Markku, MD, PhD, Rantanen, Tuomo, MD, PhD, Sand, Juhani, MD, PhD, Mecklin, Jukka-Pekka, MD, PhD, Jartti, Airi, MD, PhD, Virtanen, Johanna, MD, PhD, Ohtonen, Pasi, MSc, Salminen, Paulina, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anti-Bacterial Agents - therapeutic use; Appendectomy; Appendicitis - blood; Appendicitis - diagnosis; Appendicitis - therapy; Biomarkers - blood; Body Temperature; C-Reactive Protein - metabolism; Cohort Studies; Diagnosis, Differential; Feasibility Studies; Female; Humans; Leukocyte Count; Male; Middle Aged; Predictive Value of Tests; ROC Curve; Surgery; Tomography, X-Ray Computed; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2016.04.021

Background One of the main aims of appendicitis research is the differential diagnostics between complicated and uncomplicated acute appendicitis that enable provision of the optimal treatment for each patient. Methods Data in the present study were collected prospectively in our randomized antibiotic treatment for uncomplicated acute appendicitis trial (APPAC) comparing surgery and antibiotic treatment for uncomplicated acute appendicitis (NCT01022567). We evaluated 705 patients who had acute appendicitis on computed tomography. Patients with uncomplicated acute appendicitis ( n  = 368) were compared with all complicated acute appendicitis patients ( n  = 337), and subgroup analyses were performed between uncomplicated acute appendicitis and an appendicolith appendicitis (CA1; n  = 256) and uncomplicated acute appendicitis and perforation and/or abscess (CA2; n  = 78). Age, sex, body temperature (°C), duration of symptoms, white blood cell count (E9/L), and C-reactive protein (mg/L) were recorded on admission. Receiver operating characteristic curves were calculated for white blood cell count, C-reactive protein, and temperature. Results CA2 patients had significantly greater C-reactive protein levels (mean 122 and 47, respectively, P  24 hours before admission ( P  0.7), but no optimum cutoff points could be identified. Conclusion In clinical decision making, neither clinical findings nor laboratory markers are reliable enough to estimate the severity of the acute appendicitis accurately or to determine the presence of an appendicolith. The current results emphasize the role of computed tomography in the differential diagnosis of complicated and uncomplicated acute appendicitis.