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The Fenyo-Lindberg scoring system for appendicitis increases positive predictive value in fertile women - A prospective study in 455 patients randomized to either laparoscopic or open appendectomy

Enochsson, L; Gudbjartsson, T; Hellberg, A; Rudberg, C; Wenner, Jörgen LU ; Ringqvist, I; Sorensen, S and Fenyo, G (2004) In Surgical Endoscopy 18(10). p.1509-1513
Abstract
Background: Suspected appendicitis is one of the most common indications for acute laparotomy or laparoscopy. The negative laparotomy and laparoscopy rates are high, often in the range of 15-30%, and especially high in some groups of patients such as women of child-bearing age and young patients. Different scoring systems have been introduced in order to improve diagnostic accuracy. The aim of the present study was to analyse the outcome of the Fenyo-Lindberg scoring system in a prospectively randomized multicenter trial and to analyze how well the score performed in stratified subgroups. Methods: The variables of the Fenyo-Lindberg scoring system were collected in a prospective study comparing laparoscopic and open surgery in suspected... (More)
Background: Suspected appendicitis is one of the most common indications for acute laparotomy or laparoscopy. The negative laparotomy and laparoscopy rates are high, often in the range of 15-30%, and especially high in some groups of patients such as women of child-bearing age and young patients. Different scoring systems have been introduced in order to improve diagnostic accuracy. The aim of the present study was to analyse the outcome of the Fenyo-Lindberg scoring system in a prospectively randomized multicenter trial and to analyze how well the score performed in stratified subgroups. Methods: The variables of the Fenyo-Lindberg scoring system were collected in a prospective study comparing laparoscopic and open surgery in suspected appendicitis and with four participating centers. None of the hospitals had used the scoring system previously. Since surgeons were unfamiliar with the score, they could not use it as a diagnostic aid. When comparing the score with the clinical outcome, retrospectively, the investigators interpreting the score were blinded regarding the surgical outcome. Results: Positive predictive value (PPV) of the Fenyo-Lindberg score was higher than that of the surgeon's clinical diagnosis in the patient cohort [0.90 vs 0.79 (p < 0.001)]. The score demonstrated an improvement of PPV in women [0.83 vs 0.70 (p < 0.01)]. PPV was increased in women between 15 and 50 years of age. In women aged 15-30 years and 31-50 years PPV increased from 0.69 to 0.82 and 0.68 to 0.86, respectively (p < 0.01). Both the sensitivity (0.77) and the specificity (0.69) of the score were, however, low. Conclusion: The Fenyo-Lindberg score is an inexpensive clinical tool that may improve the diagnostic accuracy for acute appendicitis in women of childbearing age, which is a group of patients where the diagnostic accuracy usually is low and where the arsenal of diagnostic tools such Lis Computed tomography is limited because of radiation. The low specificity of the score in women of childbearing age must, however, be kept in mind. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
appendectomy, PPV, scoring, appendicitis, laparoscopy
in
Surgical Endoscopy
volume
18
issue
10
pages
1509 - 1513
publisher
Springer
external identifiers
  • wos:000224475100020
  • pmid:15791379
  • scopus:4744366952
ISSN
0930-2794
DOI
10.1007/s00464-003-9323-2
language
English
LU publication?
yes
id
ce84cbf3-13e3-4de9-bc4e-de6d7ec421ec (old id 264195)
date added to LUP
2007-10-22 14:40:17
date last changed
2017-04-09 04:23:37
@article{ce84cbf3-13e3-4de9-bc4e-de6d7ec421ec,
  abstract     = {Background: Suspected appendicitis is one of the most common indications for acute laparotomy or laparoscopy. The negative laparotomy and laparoscopy rates are high, often in the range of 15-30%, and especially high in some groups of patients such as women of child-bearing age and young patients. Different scoring systems have been introduced in order to improve diagnostic accuracy. The aim of the present study was to analyse the outcome of the Fenyo-Lindberg scoring system in a prospectively randomized multicenter trial and to analyze how well the score performed in stratified subgroups. Methods: The variables of the Fenyo-Lindberg scoring system were collected in a prospective study comparing laparoscopic and open surgery in suspected appendicitis and with four participating centers. None of the hospitals had used the scoring system previously. Since surgeons were unfamiliar with the score, they could not use it as a diagnostic aid. When comparing the score with the clinical outcome, retrospectively, the investigators interpreting the score were blinded regarding the surgical outcome. Results: Positive predictive value (PPV) of the Fenyo-Lindberg score was higher than that of the surgeon's clinical diagnosis in the patient cohort [0.90 vs 0.79 (p &lt; 0.001)]. The score demonstrated an improvement of PPV in women [0.83 vs 0.70 (p &lt; 0.01)]. PPV was increased in women between 15 and 50 years of age. In women aged 15-30 years and 31-50 years PPV increased from 0.69 to 0.82 and 0.68 to 0.86, respectively (p &lt; 0.01). Both the sensitivity (0.77) and the specificity (0.69) of the score were, however, low. Conclusion: The Fenyo-Lindberg score is an inexpensive clinical tool that may improve the diagnostic accuracy for acute appendicitis in women of childbearing age, which is a group of patients where the diagnostic accuracy usually is low and where the arsenal of diagnostic tools such Lis Computed tomography is limited because of radiation. The low specificity of the score in women of childbearing age must, however, be kept in mind.},
  author       = {Enochsson, L and Gudbjartsson, T and Hellberg, A and Rudberg, C and Wenner, Jörgen and Ringqvist, I and Sorensen, S and Fenyo, G},
  issn         = {0930-2794},
  keyword      = {appendectomy,PPV,scoring,appendicitis,laparoscopy},
  language     = {eng},
  number       = {10},
  pages        = {1509--1513},
  publisher    = {Springer},
  series       = {Surgical Endoscopy},
  title        = {The Fenyo-Lindberg scoring system for appendicitis increases positive predictive value in fertile women - A prospective study in 455 patients randomized to either laparoscopic or open appendectomy},
  url          = {http://dx.doi.org/10.1007/s00464-003-9323-2},
  volume       = {18},
  year         = {2004},
}