Derivation and validation of the APPEND score: an acute appendicitis clinical prediction rule

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Appendicitis is a common acute surgical presentation.1 It represents a diagnostic challenge due to the wide range of pathologies which have similar presentations, particularly in women of childbearing age.2 Timely diagnosis is necessary to reduce morbidity and mortality.3 Accurate diagnosis is also important to reduce the rate of negative appendicectomy, an operation not without risk.5 Historically, negative appendicectomy rates (NARs) of 18–23%8 have been widely accepted, with our institution having a rate of 20%. However, with increased availability of radiological imaging, high NARs are no longer acceptable.12
Clinical prediction rules (CPRs) have the potential to improve diagnostic accuracy and enhance patient care.14 A number of CPRs for appendicitis exist.15 These CPRs often perform well in the original paper but less so on external validation, possibly due to differences between the derivation and validation populations.21 No CPRs for appendicitis have been developed in a New Zealand population.
An appropriate CPR would standardize patient care, improve resource allocation and reduce the rate of negative appendicectomy. The aim of this study was to derive and validate a CPR for patients presenting with suspected appendicitis (in the form of right iliac fossa (RIF) pain) in New Zealand.
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