The Simple Clinical Diagnostic Triad in Acute Appendicitis: Re-examined
Introduction: The numerous clinical and radiologic scoring systems available are a testament to the challenges of diagnosing acute appendicitis. As the name implies, the simple acute appendicitis clinical diagnostic triad is simple and userfriendly. Its reproducibility remains to be demonstrated....
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Pvt. Ltd.
2021-01-01
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| Series: | International Journal of Anatomy Radiology and Surgery |
| Subjects: | |
| Online Access: | http://www.ijars.net/articles/PDF/2601/43164_CE[Ra1]_F(SHU)_PF1(ShG_SHU)_PFA(SHU_ShG)_PN(SHU).pdf |
| _version_ | 1818580925329440768 |
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| author | Alexander Achile Aikoye Pradeep S Basnyat Gandrasupalli Harinath Nipin Bagla Kassem Alubaidi |
| author_facet | Alexander Achile Aikoye Pradeep S Basnyat Gandrasupalli Harinath Nipin Bagla Kassem Alubaidi |
| author_sort | Alexander Achile Aikoye |
| collection | DOAJ |
| description | Introduction: The numerous clinical and radiologic scoring
systems available are a testament to the challenges of
diagnosing acute appendicitis. As the name implies, the simple
acute appendicitis clinical diagnostic triad is simple and userfriendly. Its reproducibility remains to be demonstrated.
Aim: To validate the simple clinical diagnostic triad of right
lower quadrant abdominal tenderness, anorexia and migratory
abdominal pain for the diagnosis of acute appendicitis in a
District General Hospital.
Materials and Methods: This was a retrospective review
of consecutive appendicectomies undertaken over a
4-month period, for patients who were 18 years and older.
Acute appendicitis was proven histologically. The patients’
preoperative symptoms, signs and biochemical parameters
were analysed. Sensitivity, specificity, Positive Predictive Value
(PPV) and Negative Predictive Value (NPV) were calculated.
Outcomes were compared using Fisher’s exact test.
Results: A total of 92 appendicectomies were undertaken
during the study period. The histological diagnoses included
acute appendicitis (75), normal appendix (14), carcinoid (1),
lymphoid hyperplasia (1) and spirochete (1). Of the 75 patients
with acute appendicitis, right lower quadrant tenderness
was present in 73, anorexia in 66 and migratory pain in
57 patients. The simple clinical triad (all three parameters)
showed a sensitivity of 69.3%, 64.7% specificity, 89.7% PPV
and 32.4% NPV.
Conclusion: The triad of right lower quadrant tenderness,
anorexia and migratory abdominal pain shows consistently high
PPV in the diagnosis of acute appendicitis. |
| first_indexed | 2024-12-16T07:25:20Z |
| format | Article |
| id | doaj.art-e02457eafdc946d3a42bee1fddfd9855 |
| institution | Directory Open Access Journal |
| issn | 2277-8543 2455-6874 |
| language | English |
| last_indexed | 2024-12-16T07:25:20Z |
| publishDate | 2021-01-01 |
| publisher | JCDR Research and Publications Pvt. Ltd. |
| record_format | Article |
| series | International Journal of Anatomy Radiology and Surgery |
| spelling | doaj.art-e02457eafdc946d3a42bee1fddfd98552022-12-21T22:39:31ZengJCDR Research and Publications Pvt. Ltd.International Journal of Anatomy Radiology and Surgery2277-85432455-68742021-01-01101SO09SO1110.7860/IJARS/2021/43164:2601The Simple Clinical Diagnostic Triad in Acute Appendicitis: Re-examinedAlexander Achile Aikoye0 Pradeep S Basnyat1Gandrasupalli Harinath2Nipin Bagla3Kassem Alubaidi4Consultant, Department of General Surgery, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, United Kingdom.Consultant, Department of General Surgery, William Harvey Hospital, East Kent Hospitals NHS Foundation Trust, Ashford, Kent, United Kingdom.Consultant, Department of General Surgery, William Harvey Hospital, East Kent Hospitals NHS Foundation Trust, Ashford, Kent, United Kingdom.Consultant, Department of Pathology, William Harvey Hospital, East Kent Hospitals NHS Foundation Trust, Ashford, Kent, United Kingdom.Consultant, Department of General Surgery, William Harvey Hospital, East Kent Hospitals NHS Foundation Trust, Ashford, Kent, United Kingdom.Introduction: The numerous clinical and radiologic scoring systems available are a testament to the challenges of diagnosing acute appendicitis. As the name implies, the simple acute appendicitis clinical diagnostic triad is simple and userfriendly. Its reproducibility remains to be demonstrated. Aim: To validate the simple clinical diagnostic triad of right lower quadrant abdominal tenderness, anorexia and migratory abdominal pain for the diagnosis of acute appendicitis in a District General Hospital. Materials and Methods: This was a retrospective review of consecutive appendicectomies undertaken over a 4-month period, for patients who were 18 years and older. Acute appendicitis was proven histologically. The patients’ preoperative symptoms, signs and biochemical parameters were analysed. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated. Outcomes were compared using Fisher’s exact test. Results: A total of 92 appendicectomies were undertaken during the study period. The histological diagnoses included acute appendicitis (75), normal appendix (14), carcinoid (1), lymphoid hyperplasia (1) and spirochete (1). Of the 75 patients with acute appendicitis, right lower quadrant tenderness was present in 73, anorexia in 66 and migratory pain in 57 patients. The simple clinical triad (all three parameters) showed a sensitivity of 69.3%, 64.7% specificity, 89.7% PPV and 32.4% NPV. Conclusion: The triad of right lower quadrant tenderness, anorexia and migratory abdominal pain shows consistently high PPV in the diagnosis of acute appendicitis.http://www.ijars.net/articles/PDF/2601/43164_CE[Ra1]_F(SHU)_PF1(ShG_SHU)_PFA(SHU_ShG)_PN(SHU).pdfabdominal painanorexiapredictive valuetenderness |
| spellingShingle | Alexander Achile Aikoye Pradeep S Basnyat Gandrasupalli Harinath Nipin Bagla Kassem Alubaidi The Simple Clinical Diagnostic Triad in Acute Appendicitis: Re-examined International Journal of Anatomy Radiology and Surgery abdominal pain anorexia predictive value tenderness |
| title | The Simple Clinical Diagnostic Triad in Acute Appendicitis: Re-examined |
| title_full | The Simple Clinical Diagnostic Triad in Acute Appendicitis: Re-examined |
| title_fullStr | The Simple Clinical Diagnostic Triad in Acute Appendicitis: Re-examined |
| title_full_unstemmed | The Simple Clinical Diagnostic Triad in Acute Appendicitis: Re-examined |
| title_short | The Simple Clinical Diagnostic Triad in Acute Appendicitis: Re-examined |
| title_sort | simple clinical diagnostic triad in acute appendicitis re examined |
| topic | abdominal pain anorexia predictive value tenderness |
| url | http://www.ijars.net/articles/PDF/2601/43164_CE[Ra1]_F(SHU)_PF1(ShG_SHU)_PFA(SHU_ShG)_PN(SHU).pdf |
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