[Negative appendectomies can be decreased by improved clinical assessment alone].

We had a 20% rate of negative appendectomies in our patients presenting with suspected appendicitis. We suggested that an improved clinical examination would reduce this rate. 84 consecutive patients presenting with suspected acute appendicitis were prospectively studied. 10 clinical features were used to calculate a score which should distinguish appendicitis and non-specific abdominal pain. 53 appendectomies with 6 (11.3%) perforations, 41 (77.4%) acute inflammations and 6 (11.3%) normal appendixes have been performed. 26 patients suffered from non-specific abdominal pain, 5 had an other surgical disease. In the appendectomized patients the score was 4.2 +/- 1.2 with perforation, 4.4 +/- 1.1 with acute inflammation and 3.8 +/- 1.3 with a normal appendix (p = ns). The score for non-specific abdominal pain in patients without operation was significantly lower (2.0 +/- 1.1; p less than 0.01). Patients with other surgical disease had a score of 2.8 +/- 1.5 with no significant difference to patients which had undergone appendectomy. Negative appendectomies were reduced by improved clinical examination from 20.3% to 11.3% without change in the rate of perforation. The remaining patients with negative appendectomies could not be identified by improved clinical examination even by means of the score. But the use of the score improved the performance of the clinicians.