Jahn et al developed a score to determine the risk of acute appendicitis based on clinical findings. The authors are from Odense University Hospital and Bispebjerg University Hospital in Denmark.
Parameters:
(1) total white blood cell count
(2) pain migration to right lower quadrant
(3) onset of pain
(4) change in intensity of pain
(5) change in pain with movement
(6) change in pain with coughing
(7) anorexia
(8) vomiting
(9) indirect tenderness (Rovsing's sign = pressure on the left lower quadrant over a point symmetrical to McBurney's point elicits acute pain at McBurney's point)
(10) muscle spasm (rigidity or guarding)
(11) sex
|
Parameter |
Findings |
Points |
|
total white blood cell count |
<= 10,000 per µL |
-14 |
|
|
> 10,000 per µL |
10 |
|
pain migration to right lower quadrant |
no |
-8 |
|
|
yes |
6 |
|
onset of pain |
sudden |
-7 |
|
|
gradual |
2 |
|
change in pain intensity |
decreasing |
-11 |
|
|
same (no change) |
-11 |
|
|
increasing |
5 |
|
pain aggravated by movement |
no |
-10 |
|
|
yes |
3 |
|
pain aggravated by coughing |
no |
-9 |
|
|
yes |
3 |
|
anorexia |
no |
-8 |
|
|
yes |
2 |
|
vomiting |
no |
-3 |
|
|
yes |
5 |
|
indirect tenderness |
no |
-6 |
|
|
yes |
5 |
|
muscle rigidity or guarding |
no |
-3 |
|
|
yes |
9 |
|
sex |
female |
-5 |
|
|
male |
4 |
total score =
= SUM(points for all 11 clinical findings)
Interpretation:
• minimum score: -84
• maximum score: 54
• The risk of appendicitis increases as the score increases.
|
Score |
Risk Group |
Result |
|
<= -20 |
low |
7 of 69 false negative, none in advanced stages |
|
-19 to 15 |
intermediate |
28 of 87 true positive |
|
>= 16 |
high |
8 of 67 false positive |
Performance:
• The low risk group had a sensitivity of 93% and specificity of 48%.
• The high risk group had a sensitivity of 63% and 94% specificity.
• Ultrasonography had a sensitivity of 49% and specificity of 88%.
Specialty: Gastroenterology, Pedatrics, Surgery, general
