Diagnostic value of clinical and laboratory symptoms in the diagnosis of acute appendicitis in patients with suspected acute appendicitis referring to Imam Reza Hospital in Birjand

Appendicitis is a challenging condition for emergency specialists and surgeons to diagnose. If it is not treated in time, the inflamed tissue of the appendix ruptures, causing peritonitis and shock. This study evaluated the diagnostic value of clinical and laboratory symptoms in the diagnosis of acute appendicitis.

This descriptive cross-sectional study was carried out on a total of 134 patients with suspected appendicitis referring to the Emergency Department of Imam Reza Hospital in Birjand, Iran, within 2013 and 2015 using convenience sampling. The data collection tool was a questionnaire covering patients’ demographics, clinical signs, and laboratory and pathology test results. Sensitivity and specificity, positive predictive value, negative predictive value, likelihood ratio, area under the receiver operating characteristic (ROC) curve (AUC), and cut-off point of each test (i.e., white blood cell, aspartate transaminase, alanine transaminase, C-reactive protein, polymorphonuclear leukocytes, lymphocytes, total and direct bilirubin, iron, and total iron-binding capacity) were analyzed using SPSS software (version 18) and MedCalc software (version 19). A p-value of 0.05 was considered statistically significant.

In this study, 68 and 66 participants were male and female, respectively. The mean age of the patients was 24. (44±11).26 years. Pathological examination showed that six patients underwent a negative appendectomy. A positive appendectomy was noted in 128 subjects. Histopathological results confirmed the perforation of the appendix in 78 patients. Among the laboratory tests, only the accuracy of serum iron was fair in the diagnosis of acute appendicitis (AUC numerical value in the ROC curve=0.787). The accuracy of other tests based on the AUC numerical value in the ROC curve was poor or failed.

Although the accuracy of serum iron based on the numerical value of AUC in the ROC curve was diagnostically fair for acute appendicitis, it is suggested to carry out further studies with larger sample sizes in order to draw definitive conclusions given the small sample size in this study.