Maaret Eskelinen1, Jannica Meklin1, Kari Syrjänen2,3, Matti Eskelinen4. 1. Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland. 2. Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil. 3. SMW Consultants, Ltd., Kaarina, Finland. 4. Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland; matti.eskelinen@kuh.fi.
Abstract
BACKGROUND/AIM: Although acute appendicitis (AA) in elderly patients is different from AA in younger patients, the accuracy of diagnostic scores (DSs) in detecting AA is rarely considered. PATIENTS AND METHODS: A cohort of 470 AAP (acute abdominal pain) patients older than 50 years, including 224 women (53.7%) and 193 men (46.3%), were included in the study. The most significant diagnostic predictors were used to construct DS formulas for AA diagnosis with (Tax+) and without body temperature (Tax-). Meta-analytical techniques were used to calculate the summary Se and Sp estimates for each data sets (history-taking, findings, and DS formulas). RESULTS: In SROC analysis, the AUC values for i) symptoms ii) signs and tests iii) DSTax- and iv) DSTax+ were as follows: i) AUC=0.658 (95%CI=0.601-0.709); ii) AUC=0.751 (95%CI=0.701-0.800), iii) AUC=0.977 (95%CI=0.942-1.000), and for iv) AUC=0.980 (95%CI=0.956-1.000). Using roccomp analysis for these AUC values, the differences were significant as follows: between i) and ii) p=0.0358; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.682. CONCLUSION: Similar to younger AA patients, the DS formula was superior to both the clinical history-taking and findings, and therefore, the use of DS should be an important part of the diagnostic decision tree of AA also in the elderly patients presenting with AAP.
BACKGROUND/AIM: Although acute appendicitis (AA) in elderly patients is different from AA in younger patients, the accuracy of diagnostic scores (DSs) in detecting AA is rarely considered. PATIENTS AND METHODS: A cohort of 470 AAP (acute abdominal pain) patients older than 50 years, including 224 women (53.7%) and 193 men (46.3%), were included in the study. The most significant diagnostic predictors were used to construct DS formulas for AA diagnosis with (Tax+) and without body temperature (Tax-). Meta-analytical techniques were used to calculate the summary Se and Sp estimates for each data sets (history-taking, findings, and DS formulas). RESULTS: In SROC analysis, the AUC values for i) symptoms ii) signs and tests iii) DSTax- and iv) DSTax+ were as follows: i) AUC=0.658 (95%CI=0.601-0.709); ii) AUC=0.751 (95%CI=0.701-0.800), iii) AUC=0.977 (95%CI=0.942-1.000), and for iv) AUC=0.980 (95%CI=0.956-1.000). Using roccomp analysis for these AUC values, the differences were significant as follows: between i) and ii) p=0.0358; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.682. CONCLUSION: Similar to younger AA patients, the DS formula was superior to both the clinical history-taking and findings, and therefore, the use of DS should be an important part of the diagnostic decision tree of AA also in the elderly patients presenting with AAP.