Christian and Christian developed a simple scoring system for evaluating patients for acute appendicitis. The purpose of the score was to reduce the number of negative appendectomies. The authors are from St. Martha's Hospital in Bangalore, India.
Patients: ranged from 7 to 56 years of age
Parameters:
(1) abdominal pain
(2) vomiting
(3) right lower quadrant tenderness
(4) low grade fever
(5) polymorphonuclear (PMN) leukocytosis
|
Parameter |
Finding |
Points |
|
abdominal pain within 48 hours of presentation |
absent |
0 |
|
|
present |
1 |
|
vomiting |
none |
0 |
|
|
one or more episodes |
1 |
|
right lower quadrant tenderness |
absent |
0 |
|
|
present |
1 |
|
low grade fever |
no fever |
0 |
|
|
fever <= 38.8°C |
1 |
|
|
fever > 38.8°C |
0 |
|
PMN leukocytosis |
WBC count >= 10,000 per µL with >= 75% neutrophils |
1 |
|
|
else |
0 |
where:
• Pain limited to the right iliac fossa alone was not considered abdominal pain.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
|
Findings Present |
Management |
|
abdominal pain AND >= 3 other findings |
appendectomy |
|
abdominal pain and 2 of the other findings |
active observation; if one additional finding developed then an appendectomy was performed ELSE |
|
else |
not admitted for observation |
Performance:
• The negative appendectomy rate was much lower in patients treated according to this protocol.
• There were no cases of acute appendicitis in the patients not admitted, but the numbers were relatively small (12 patients).
Specialty: Gastroenterology, Pedatrics, Surgery, general
