ACCURACY OF CLINICAL DIAGNOSIS IN ACUTE APPENDICITIS

Abstract

Introduction: About 7% in the general population there is lifetime risk of acute appendicitis (AA). Due to improvement in diagnostics and increasing surgical experience rate of negative appendectomies even in advanced medical centers fails to fall below 10% and the clinical diagnosis of appendicitis remains a diagnostic challenge. The clinical diagnosis of acute appendicitis is to balance diagnostic accuracy with appendiceal perforation. Centers with the most accurate diagnosis (89%) have a higher rate of appendiceal perforation (29%), and vice versa, presumably due to earlier operation. Although Appendicitis is difficult to proper diagnosis where there may not be classical symptoms and signs of appendicitis. There are different sign and symptoms for the diagnosis of acute appendicitis, there are number of causes leading to pain in right iliac fossa particularly in female patients. For diagnosis of the appendicitis is to facilitate the surgeon there are different scoring systems to avert negative appendicectomy. In the patients suffering from acute appendicitis classical symptoms occur just over half and accurate and timely diagnosis of atypical appendicitis which remains clinically challenging and one of the most commonly missed problems in the emergency department.  Whenever missing of consequence appendicitis that leading to perforation, significantly increases morbidity and prolongs hospital stay. Non perforated appendicitis is less than 1 percent of mortality rate which may be as high as 5 percent or more in young and elderly patients. Due to delay in diagnosis it will lead to complications like increases morbidity whereas overzealous diagnosis may lead to negative appendectomy rate.

Aim: The aim of this study is to assess the diagnostic accuracy of clinical and laboratory parameters in the diagnosis of AA.

Material and Methods: This study was conducted in the Department of Surgery, SSPM Medical College from during the period of one year.  All patients operated for appendicectomy during that period were included. All the patients’ complete clinical history was collected and also physical examinations were done. All patients’ data with the operative and discharge record were correlated with the case notes wherever necessary. Clinical findings such as, history of anorexia, pain followed by nausea, right lower quadrant pain, vomiting, rebound tenderness, guarding, rigidity and conventional appendectomies were carried out in this study. Data for age, sex, white blood cell count, abdominal USG results, histological findings and hospital stay were collected as Primary criterion for diagnosing acute appendicitis (AA).  Result: Even in the most experienced hands the diagnosis of appendicitis can be challenging, and is predominantly a clinical one. Accurate anamnesis and physical exam are important to prevent unnecessary surgery and avoid complications. Probability of appendicitis depends on age, clinical setting, and symptoms.

Conclusion:  Acute appendicitis in emergency setting may be successfully ruled in with high accuracy based on lack of appetite and absence of diarrhea, elevated with signs of localized peritonitis. However CRP did not contribute to the overall diagnostic accuracy AA and its protocols is of no value. For successful diagnosis thorough assessment that contains adequate evaluation of laboratory parameters in combination with clinical exam.

Keywords: Appendicitis; Diagnosis, C-reactive protein; Laboratory clinics