caa a22 4500 475802918 CHVBK 20180406123742.0 cr unu---uuuuu 170329e20000401xx s 000 0 eng 10.1007/s002689910076 doi (NATIONALLICENCE)springer-10.1007/s002689910076 Repeated Clinical and Laboratory Examinations in Patients with an Equivocal Diagnosis of Appendicitis [Elektronische Daten] [Roland E. Andersson, Anders Hugander, Hans Ravn, Karsten Offenbartl, Sam H. Ghazi, Per Olof Nyström, Gunnar Olaison] Abstract.: In-hospital observation with repeated clinical examinations is commonly used in patients with an equivocal diagnosis of appendicitis. It is not known if repeated measurements of temperature and laboratory examinations have any diagnostic importance in this situation. The importance of repeated measurements of the body temperature, white blood cell (WBC) and differential cell counts, C-reactive protein concentration (CRP) and of the surgeon's repeated assessments was prospectively analyzed in 420 patients with an equivocal diagnosis of appendicitis at admission who were reexamined after a median of 6 hours of observation. The final diagnosis was appendicitis in 137 patients. After observation the inflammatory response was increasing among patients with appendicitis and decreasing among patients without appendicitis. The variables discriminating power for appendicitis consequently increased, from an area under the receiver operating characteristic (ROC) curve of 0.56 to 0.77 at admission, to 0.75 to 0.85 after observation. The ROC area of the surgeons' clinical assessment increased from 0.69 to 0.89. The WBC and differential cell counts were the best discriminators at the repeat examination. The change in the variables between the observations had weak discriminating power and had no additional importance in addition to the actual level at the repeat examination. To conclude, the diagnostic information of the temperature and laboratory examinations increased after observation. Repeated controls of the body temperature and laboratory examinations are therefore useful in the management of patients with equivocal signs of appendicitis, but the result of the examinations must be integrated with the clinical assessment. Société Internationale de Chirurgie, 2000 Andersson Roland E. Department of Surgery, Ryhov Hospital, S-551 85 Jönköping, Sweden, SE aut Hugander Anders Department of Surgery, Ryhov Hospital, S-551 85 Jönköping, Sweden, SE aut Ravn Hans Department of Surgery, Highlands Hospital, Eksjö, Sweden, SE aut Offenbartl Karsten Department of Surgery, Highlands Hospital, Eksjö, Sweden, SE aut Ghazi Sam H. Department of Pathology, Ryhov Hospital, S-551 85 Jönköping, Sweden, SE aut Nyström Per Olof Department of Surgery, University Hospital, Linköping, Sweden, SE aut Olaison Gunnar Department of Surgery, University Hospital, Linköping, Sweden, SE aut World Journal of Surgery Springer-Verlag 24/4(2000-04-01), 479-485 0364-2313 24:4<479 2000 24 268 https://doi.org/10.1007/s002689910076 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689910076 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Andersson Roland E. Department of Surgery, Ryhov Hospital, S-551 85 Jönköping, Sweden, SE aut NATIONALLICENCE 700 1- Hugander Anders Department of Surgery, Ryhov Hospital, S-551 85 Jönköping, Sweden, SE aut NATIONALLICENCE 700 1- Ravn Hans Department of Surgery, Highlands Hospital, Eksjö, Sweden, SE aut NATIONALLICENCE 700 1- Offenbartl Karsten Department of Surgery, Highlands Hospital, Eksjö, Sweden, SE aut NATIONALLICENCE 700 1- Ghazi Sam H. Department of Pathology, Ryhov Hospital, S-551 85 Jönköping, Sweden, SE aut NATIONALLICENCE 700 1- Nyström Per Olof Department of Surgery, University Hospital, Linköping, Sweden, SE aut NATIONALLICENCE 700 1- Olaison Gunnar Department of Surgery, University Hospital, Linköping, Sweden, SE aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/4(2000-04-01), 479-485 0364-2313 24:4<479 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer