Lindberg et al developed a clinical score for evaluating a patient for acute appendicitis. This is a based on the score of Fenyo (1987). The authors are from Stockholm, Sweden.
Patient selection: pediatric patients and adults
Parameters:
(1) gender
(2) white blood cell (WBC) count
(3) duration of abdominal pain in hours
(4) progression of pain
(5) aggravation of pain by coughing
(6) vomiting
(7) migration of pain from umbilicus to right lower quadrant (RLQ)
(8) rebound tenderness
(9) rigidity of the abdominal wall
(10) tenderness outside of right lower quadrant (RLQ)
|
Parameter |
Finding |
Points |
|
gender |
male |
8 |
|
|
female |
-8 |
|
WBC count |
< 9,000 per µL |
-15 |
|
|
9,000 - 13,999 per µL |
2 |
|
|
>= 14,000 per µL |
10 |
|
duration of pain |
< 24 hours |
3 |
|
|
24 - 48 hours |
0 |
|
|
> 48 hours |
-12 |
|
progression of pain |
no |
-4 |
|
|
yes |
3 |
|
aggravation of pain by coughing |
no |
-11 |
|
|
yes |
4 |
|
vomiting |
no |
-5 |
|
|
yes |
7 |
|
migration of pain |
no |
-9 |
|
|
yes |
7 |
|
rebound tenderness |
no |
-10 |
|
|
yes |
5 |
|
rigidity of abdominal wall |
no |
-4 |
|
|
yes |
15 |
|
tenderness outside of RLQ |
no |
4 |
|
|
yes |
-6 |
total score =
= SUM(points for all 10 parameters) - 10
Interpretation:
• minimum score: - 84
• maximum score: 66
• The higher the score the more likely acute appendicitis is present.
|
Total Score |
Probability of Appendicitis |
Management |
|
>= -2 |
>= 45% |
consider surgery |
|
-3 to -16 |
17 - 44% |
observation with repeated exams |
|
<= -17 |
<= 16% |
observe or discharge home |
Performance:
• The overall sensitivity was 73% and specificity was 87%. The score was more sensitive in males and more specific in females.
Specialty: Gastroenterology, Pedatrics, Surgery, general
