A Simplified Appendicitis Score in the Diagnosis of Acute Appendicitis

Introduction Scoring systems such as the Modified Alvarado Score (MAS) can help in the early diagnosis of acute appendicitis (AA) but is cumbersome to use and has not found widespread popularity. A more robust, user‐friendly Simplified Appendicitis Score (SAS) was investigated. Methods Patients presenting with suspected AA were prospectively enrolled. The performance of the SAS (using only 5 variables – migratory pain, right lower quadrant tenderness, rebound pain, fever >37.3 degrees Celsius and leucocytosis >12,000/uL) was analysed and compared to the MAS. Results Out of 238 patients enrolled over four months, 95 (39.9%) patients underwent appendectomy, of which 81 patients had histologically proven AA. A MAS of ≥8 was 92.4% specific for ruling in AA, while a score of <5 was 91.4% sensitive in ruling out AA. A SAS of ≥6 was 91.7% specific for ruling in AA, while a score of <4 was 90.1% sensitive in ruling out AA. Conclusions The performance of the MAS can be maintained by omitting the two subjective variables – “anorexia” and “nausea/vomiting”, and increasing the leucocytosis cut‐off level. A SAS using only 5 variables performed as well as the original MAS.