Score of Ramirez and Deus for Evaluating a Patient for Appendicitis

 

Parameters:

(1) gender

(2) location of initial pain

(3) diarrhea

(4) white blood cell (WBC) count per µL

(5) percent neutrophils in peripheral blood differential

(6) guarding in right lower quadrant (RLQ)

(7) rebound tenderness

 

Parameter	Finding	Points
gender	male	6
	female	-5
location of initial pain	epigastric	5
	other	-6
diarrhea	absent	1
	present	-9
WBC count	>= 10,500 per µL	6
	< 10,500 per µL	-14
percent neutrophils	>= 75%	6
	< 75%	-19
guarding in RLQ	yes	8
	no	-7
rebound tenderness	yes	5
	no	-21

 

total score =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum score: - 81

• maximum score: 37

• The higher the score the greater the likelihood of acute appendicits.

• The authors used the apex of ROC curve (>= 10) to determine the cutoff for surgery.

• No one with a score < -15 had appendicitis (>= -15 100% sensitive), so these patients were discharged.

• A patient with a score from -15 to 9 was observed.

 

Performance:

• Everyone with a score >= 15 had appendicitis (100% specific) according to Table 3. According to Figure 2 100% specificity was seen at 25.

• The maximum Youden index was >= -10 (sensitivity 96%, specificity 69%) in Table 3 but a score of -10 in Figure 2 would not perform well.

• At the cutoff (>= 10) the sensitivity was 77% and specificity 87%) in Table 3.