Simple appendicitis cannot be distinguished from complicated appendicitis by clinical examination and laboratory findings say Finnish investigators. They looked at data from their randomized prospective trial of antibiotics vs. surgery for treatment of appendicitis and concluded that only CT scans could reliably differentiate the two entities.
The study involved adult patients from 18 to 60 years old; 368 of whom had uncomplicated acute appendicitis and 337 had complicated appendicitis—appendicolith, perforation, or abscess.
Duration of symptoms, C-reactive protein, white blood cell count, and temperature were significantly different between simple and complicated appendicitis patients. However substantial overlap of values meant they were not helpful in predicting the presence of complicated appendicitis.
Receiver operating curves for C-reactive protein and temperature areas under the curve do no exceed 0.77. Combining these parameters did not improve accuracy.
The paper concluded that CT scanning is essential in diagnosing acute appendicitis and identifying simple and complicated cases.
A companion study by many of the same authors looked at 1321 patients who presented with clinical and laboratory findings of possible appendicitis. Since their protocol called for confirmation of the diagnosis, all patients underwent CT scans, and 351 (27%) did not have appendicitis.