Effect of surgeon's judgement on the diagnosis of acute appendicitis.

ABSTRACT

OBJECTIVE: The accuracy of a surgeon's judgement still remains to be controversial in the diagnosis of acute appendicitis, which is a diagnosis usually based on laboratory data and imaging tests. MATERIAL AND METHODS: Patients with a possible diagnosis of acute appendicitis were reviewed retrospectively with regard to demographic variables, laboratory and imaging results, and treatment modalities. RESULTS: There were 128 patients with a mean age of 31.2±14 years. The mean white blood cell count and the proportion of polymorphonuclear leukocytes were 11403±4669/mm(3) and 75±11%, respectively. Appendectomy was performed on 66 (51.6%) patients. Conservative management was applied to 62 (48.4%) patients. Statistical analysis showed that patients with appendicitis have a higher white blood cell count (p=0.015) and a higher proportion of polymorphonuclear leukocytes (p=0.023). Sensitivity, specificity and accuracy rates were 84.6%, 63.7% and 74.3% for ultrasound and 100%, 86.7% and 92.2% for computed tomography, respectively. CONCLUSION: Diagnosis based on patients' laboratory and imaging data, in combination with, the surgeon's judgement appears to yield the best outcomes in patients with suspicion of acute appendicitis.