New diagnostic score (SDN) of acute appendicitis in the elderly and clinical implementation algorithm

Abstract

The diagnostic difficulties of acute appendicitis in the elderly created premises for the standardization of diagnosis and the creation of a score that would correspond to current requirements. The aim of this work was to improve the diagnosis of acute appendicitis in the elderly by creating a new clinical-ultrasound score. It is a prospective study, targeting 224 elderly patients with diagnosed AA, treated at IMSP IMU and IMSP SCM “St. Arch. Mihail” between 2013-2018. Distribution by age: 60 - 92 years. The mean age was 76 ± 16 years. Men 88(39%), women 136(61%). Clinical, ultrasonographic and laboratory signs of acute appendicitis (AA) were analyzed. The diagnostic criteria that were included in the score are: Kocher’s symptom (positive) – (1 point), vomiting / nausea (present) – (1 point), Blumberg’s symptom in the right iliac region (positive) – (2 points), Bartomie-Michelson symptom (positive) – (1 point); Laboratory signs: Leukocytosis (>10*109/l) – (1 point); USG signs: unchanged AV and / or other pathology (determined) ((minus) - 3 points), increase in AV diameter > 7mm (determined) – (2 point), thickening of periappendiceal tissue (determined) – (1 point), AV incompressibility (determined) – (1 point), coprolite in the AV lumen (determined) – (1 point); Total – Maximum +10 points, minimum -3 (minus 3) points. In conclusion we can say that diagnostic scores and their algorithms are scientific standards for the diagnosis of AA, which need to be developed and evaluated in comparison in different population groups, especially in elderly patients. The new SD AA and its application algorithm in elderly people, aimed at the diagnosis of AA, developed in accordance with the proposed unified methodological requirements for the creation of the SD AA.