Results
Among the 201 patients in the retrospective study, there were 15 signs and symptoms that significantly divided patients with acute appendicitis from those without (Table 1). Tenderness in the right fossa was found to have the greatest impact on the decision to perform appendectomy with an odds ratio (OR) of 76, followed by raised CRP (OR 47), pain in the right fossa (OR 29), increasing CRP (OR 23), indirect tenderness (OR 19), pain migration (OR 18) and image diagnostics (OR 4) i.e., these items differed the most between patients with appendicitis and those without. These data were used to construct a new questionnaire in which the surgeon could choose between 25 items comprising all 15 with a significant odds ratio plus a few items that are commonly described in the literature on the diagnosis of acute appendicitis.
Altogether 117 patients were included in the prospective study (66 women, 51 men). Mean age was 37 ± 16 years (± SD). The patients were operated at the Departement of Suregery at Södersjukhuset and at Karolinska University Hospital. The outcome of the prospective investigation regarding symptoms, signs and diagnostic measures recorded prior to surgery is presented in Table 2.
In the prospective study the most frequent symptoms present at the time of decision to operate were pain in the right fossa (94 %), pain migration (56 %) and vomiting (56 %). The most frequent signs were tenderness in the right fossa (91 %), raised CRP (76 %) and image diagnostics (67 %).
Signs, symptoms, and diagnostic measures with greatest impact on treatment decision, according to the surgeon performing the appendectomy and recorded after the outcome of surgery was known (3 per patient), were tenderness in the right fossa (76 %), image diagnostics (90 %) and pain migration (50 %).