Graham developed a clinical scoring index to identify patients with acute appendicitis who have perforated or developed gangrenous appendicitis. The author is from Bangour General Hospital in West Lothian.
Parameters:
(1) lower abdominal pain
(2) duration of history in hours
(3) pattern of pain
(4) guarding and rebound tenderness
(5) temperature
(6) pulse rate
(7) WBC count
|
Parameter |
Finding |
Points |
|
lower abdominal pain |
absent at onset |
0 |
|
|
present at onset |
1 |
|
duration of symptoms |
<= 24 hours |
0 |
|
|
> 24 hours |
1 |
|
pain |
decreasing or stable |
0 |
|
|
increasing in severity |
1 |
|
guarding and rebound tenderness |
absent |
0 |
|
|
present |
1 |
|
temperature |
<= 37.5°C |
0 |
|
|
> 37.5°C |
1 |
|
pulse rate |
<= 90 beats per minute |
0 |
|
|
> 90 beats per minute |
1 |
|
WBC count |
<= 14,000 per µL |
0 |
|
|
> 14,000 per µL |
1 |
clinical scoring index =
= SUM(points for all 7 parameters)
Interpretation:
• minimum index: 0
• maximum index: 7
• A score <= 2 was seen with acute appendicitis without perforation or gangrene.
• A score >= 3 was seen with perforation or gangrenous appendicitis.
Performance:
• The diagnostic accuracy was 89%.
Specialty: Gastroenterology, Pedatrics, Surgery, general
