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Review: inflammatory response variables, descriptors of peritoneal irritation, and migration of pain are most discriminatory of appendicitis

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 Q In adult patients admitted to hospital with suspected appendicitis, what is the diagnostic value of elements of disease history, clinical findings, and laboratory test results?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★☆☆ Internal Medicine ★★★★★☆☆ Emergency medicine ★★★★★☆☆


Embedded ImageData sources:

Medline (to June 1, 2003), bibliographies of relevant studies, and personal files.

Embedded ImageStudy selection and assessment:

published studies on the clinical and laboratory diagnosis of appendicitis in patients admitted to hospital with suspected appendicitis. Results had to be presented so that likelihood ratios and areas under the receiver operating characteristic (ROC) curve could be calculated. Studies of children, patients with abdominal pain, patients having surgery, or comparisons of patients with verified appendicitis and healthy persons were not eligible.

Embedded ImageOutcomes:

ROC areas, and positive and negative likelihood ratios were used to describe the diagnostic performance of variables for diagnosing appendicitis.


24 studies (5833 patients) met the selection criteria, which described 28 diagnostic variables for diagnosing appendicitis in patients with suspected appendicitis. The proportion of patients with a diagnosis of appendicitis ranged from 27–61% (median 41%). In 23 studies, the diagnosis was confirmed by histopathological examination. Certain variables, including inflammatory …

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  • For correspondence: Dr R E Andersson, County Hospital Ryhov, Jönköping, Sweden.

  • Source of funding: Scientific Committee, Sweden.