Clinical Utility of the François Score in Predicting Acute Appendicitis: A Prospective Study in a Tertiary Care Center.

Background Acute appendicitis is the most common abdominal surgical emergency. Its variable clinical presentation makes diagnosis challenging and may lead to unnecessary imaging or surgery. The François score is a simple clinico-biological tool designed to stratify patients according to the probability of appendicitis. Objective To evaluate the diagnostic accuracy and clinical utility of the François score in patients presenting with suspected acute appendicitis. Methods We conducted a prospective diagnostic accuracy study from October 2021 to April 2022 at a tertiary care center in Tunisia. Consecutive patients aged ≥15 years with suspected acute appendicitis were included. The François score was calculated at admission. The reference standard was histopathology for operated patients and imaging with 30-day clinical follow-up for non-operated patients. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and receiver operating characteristic (ROC) curve analysis. Results A total of 139 patients were included, of whom 128 (92.1%) had confirmed appendicitis. The mean François score was 0.58 ± 4.31 (range −17 to +13). A score ≥ +2 was significantly associated with appendicitis (OR = 8.29; p = 0.024), whereas a score ≤ −6 was strongly associated with absence of disease (OR = 0.004; p < 0.001). At a cut-off > −6, sensitivity was 99.2% and specificity 63.6%. At a cut-off ≥ +2, specificity reached 90.9%. The area under the ROC curve was 0.90 (95% CI: 0.76–1.00), indicating excellent discriminative ability. Conclusion The François score demonstrated good diagnostic accuracy and effective risk stratification in patients with suspected acute appendicitis. It may serve as a practical decision-support tool to optimize clinical management and with potential to reduce unnecessary imaging. Further multicenter validation is warranted.