Score of Fenyo for the Diagnosis of Acute Appendicitis in an Adult

Fenyo developed a score for the diagnosis of acute appendicitis in adults with abdominal pain. The author is from Nacka Hospital in Sweden.

Parameters:

(1) gender

(2) temperature

(3) white blood cell (WBC) count

(4) duration of abdominal pain in hours

(5) migration of pain to the right lower quadrant (RLQ)

(6) onset of pain

(7) intensity of pain

(8) pain aggravation by movement

(9) pain aggravation by coughing

(10) anorexia

(11) nausea

(12) vomiting

(13) elevated temperature prior to admission

(14) rigors

(15) diarrhea

(16) rebound tenderness

(17) abdominal rigidity

(18) tenderness outside of right lower quadrant (RLQ)

(19) rectal tenderness

Parameter	Finding	Points for a Male	Points for a Female
gender		1	-6
temperature	<= 37.4°C	-3	-4
	>= 37.5°C	2	2
WBC count	<= 10,000 per µL	-12	-5
	> 10,000 per µL	8	4
duration of pain	<= 12 hours	5	5
	13 - 48 hours	0	-4
	> 48 hours	-10	-4
migration of pain to RLQ	no	-7	-5
	yes	12	9
onset of pain	sudden	0	-2
	gradual	0	2
intensity of pain	increasing	0	3
	unchanged	-2	-4
	decreasing	0	-7
pain and movement	aggravated	4	0
	not aggravated	-6	0
pain and coughing	aggravated	5	2
	not aggravated	-5	-2
anorexia	no	0	-5
	yes	0	1
nausea	no	-2	-9
	yes	1	2
vomiting	no	-3	-3
	yes	5	5
elevated temperature prior to admission	no	-1	-1
	yes	2	2
rigors	no	-1	-3
	yes	1	4
diarrhea	no	-1	0
	yes	4	0
rebound tenderness	no	-8	-7
	yes	13	11
abdominal rigidity	no	-6	-6
	yes	18	14
tenderness outside RLQ	no	1	3
	yes	-5	-12
rectal tenderness	no	-4	-2
	yes	2	2

total score =

= SUM(points for all 19 parameters)

Interpretation:

• minimum score for male: -71

• maximum score for male: 84

• minimum score for female: -83

• maximum score for female: 65

• A score >= 12 was considered positive for acute appendicitis. A score >= 51 was positive for appendicitis in 98%.

• A score <= -17 was 99.3% against the diagnosis of acute appendicitis.

• False negative results on initial evaluation are usually in the 1 to 11 range. These usually become positive during observation.

Performance:

• The sensitivity was 90% and specificity 91%.

• The positive predictive value was 83% and the negative predictive value was 95%.

• False negative rates are higher in women > 50 years of age and in men < 50 years.

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