TU7.9 Validation and comparison of new scoring clinical systems to predict uncomplicated versus complicated appendicitis

Abstract

Abstract Aims Methods This was a retrospective review of a sample of patients whom underwent appendicectomy between 2018 and 2021 in a tertiary university teaching hospital. Inclusion criteria consisted of CT imaging prior to surgery to confirm diagnosis, along with clinical and laboratory data needed to analyse the two scoring systems. Final histological diagnosis of complicated versus uncomplicated appendicitis was employed as the gold standard. Positive predictive (PPV) and negative predictive values (NPV) were calculated for CT, Atema and APSI scoring systems. Results In total, 92 patients were included in the study, whereby 55 patients (59.8%) presented with uncomplicated and 37 patients (40.2%) with complicated appendicitis. With regards to predicting complicated appendicitis: Atema score had a PPV of 47.5% and a NPV of 73%. APSI had a PPV of 43.9% and a NPV of 62.7%. CT had a PPV of 50% and NPV of 65.5%. Conclusion The accurate diagnosis of uncomplicated versus complicated appendicitis may aid in selection of patients to conservative versus surgical management of acute appendicitis. Our study has shown that radiological findings alone have low positive and negative predictive values. The use of the new Atema scoring system was found to have a higher NPV when compared to radiology findings and the APSI scoring system. This may improve accuracy in discriminating uncomplicated versus complicated appendicitis when selecting treatment pathway.