Appendicitis is a place for clinical judgement

BACKGROUND: Acute appendicitis remains a clinical entity. Reports of negative appendectomies range from 9% to 40%. The goal of this study is to evaluate clinical performance and factors associated with complicated appendicitis. METHODS: Records of patients with a preoperative or postoperative diagnosis of appendicitis between January 1994 and December 1997 were reviewed. Demographic, clinical, and paraclinical data were collected. Multivariate analysis was carried out by logistical regression. RESULTS: TWO hundred and thirty-seven consecutive cases were reviewed (male 132, female 105). The mean age was 31.4 +/- 16.8. Twenty-three cases had other surgical conditions. In the remaining cases (n = 214), 127 (59.4%) had noncomplicated appendicitis, 69 (32.2%) had complicated appendicitis, and 18 (8.4%) had negative exploration. Delays occurring before first medical consultation were significantly longer in patients with complicated appendicitis (3.30 days) and negative exploration (3.00 days) compared to patients with noncomplicated appendicitis (1.24 days) (P < 0.001). CONCLUSIONS: Acceptable rates of negative appendix and complicated appendicitis can be obtained from clinical data. The presence of complicated appendicitis is primarily associated with a longer delay before first medical consultation. (C) 1999 by Excerpta Medica, Inc.