The price of better diagnostic accuracy in suspected appendicitis in Jerusalem.

We studied changes in diagnostic accuracy and in perforation rates in cases of suspected appendicitis at two major Jerusalem hospitals. In females, a major improvement in accuracy was observed over the past decade which was not accompanied by higher perforation rates. In males, on the other hand, the reduction in the rate of negative appendectomies was accomplished at the expense of a large increase in perforations. At the end of the decade of observation, diagnostic accuracy in males was still far better than for females, but the perforation rate in males had become worse than the rate for females. We conclude from our work and that of others that at high baseline negative appendectomy rates much improvement is possible without causing higher perforation rates, whereas at relatively low negative appendectomy rates, further decreases will, perforce, cause more perforations, a poor trade-off in the opinion of most investigators.