Determining the Likelihood of Appendicitis: Clinical Scoring Systems vs. Gestalt

Neither clinical scoring systems nor physician gestalt, alone or in combination, adequately risk stratified patients with appendicitis.

Several scoring systems have been developed to risk stratify patients with suspected appendicitis. To determine how they compare with physician's estimates of risk, researchers conducted a prospective observational study of 287 patients older than 11 years (mean age, 31) undergoing computed tomography (CT) for suspected appendicitis at a single academic medical center during a 2-year period.

The prevalence of CT-confirmed appendicitis was 33%. The positive likelihood ratios for accurately predicting the case incidence of appendicitis were as follows:

Physician-determined alone: 1.3
Alvarado score: 2.2 alone; 3.7 combined with gestalt
Modified Alvarado score: 2.4 alone; 3.9 combined
Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score: 1.…

Reviewing Author

Jennifer L. Wiler, MD, MBA, FACEP

Disclosures

Leadership Positions in Professional SocietiesColorado Medical Society (Member, Board of Directors)

Jennifer L. Wiler, MD, MBA, FACEP

Disclosures

Leadership Positions in Professional SocietiesColorado Medical Society (Member, Board of Directors)

Determining the Likelihood of Appendicitis: Clinical Scoring Systems vs. Gestalt

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Reviewing Author