Leeuwenburgh et al developed a simple clinical rule for evaluating a patient with suspected appendicitis but non-diagnostic ultrasound studies. This can help to identify a patient who may or may not benefit from additional studies. The authors are from the University of Amsterdam, Kennemer Gasthuis Haarlem, Gelre Hospitals, Alkmaar Medical Centre, Sint Antonius Hospital, Sint Lucas Andreas Hospital and Haaglanden Medical Center in the Netherlands.
Patient selection: suspected appendicitis but non-diagnostic ultrasound results
Parameters:
(1) sex
(2) pain migration
(3) vomiting
(4) white blood cell count
Parameter
Finding
Points
sex
male
1
female
0
pain migration
to right lower quadrant
1
other
0
vomiting
no
0
yes
1
WBC count
<= 12,000 per µL
0
> 12,000 per µL
1
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• A score of 0 or 1 is low risk. The patient can be discharged from the Emergency Department and re-evaluated the next day.
• A score from 2 to 4 should have additional imaging studies (CT or MRI).
Performance:
• The area under the ROC curve is 0.80.
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