A1 Refereed original research article in a scientific journal
Is preoperative distinction between complicated and uncomplicated acute appendicitis feasible without imaging?
Authors: Elina Lietzén, Jari Mällinen, Juha M. Grönröös, Tero Rautio, Hannu Paajanen, Pia Nordström, Markku Aarnio, Tuomo Rantanen, Juhani Sand, Jukka-Pekka Mecklin, Airi Jartti, Johanna Virtanen, Pasi Ohtonen, Paulina Salminen
Publisher: MOSBY-ELSEVIER
Publication year: 2016
Journal: Surgery
Journal name in source: SURGERY
Journal acronym: SURGERY
Volume: 160
Issue: 3
First page : 789
Last page: 795
Number of pages: 7
ISSN: 0039-6060
DOI: https://doi.org/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 (8C), 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 < .001) and longer duration of symptoms than uncomplicated acute appendicitis
patients; 81% of CA2 patients and 38% of uncomplicated acute appendicitis patients had symptoms
>24 hours before admission (P < .001). In receiver operating characteristic analysis, C-reactive
protein and temperature had clinically significant results only in comparison with uncomplicated
acute appendicitis and CA2 (area under the curve >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. (Surgery
2016;160:789-95.)
