Accuracy of Surgeon’s Clinical Acumen in Diagnosing Severity of Appendicitis in Adults

Assessing Surgeon Accuracy: Diagnosing Adult Appendicitis Severity

Abstract

Objective: To identify the accuracy of surgical clinical acumen in diagnosing severity of appendicitis in adults. Study Design: Observational study (Prospective). Settings: This study was conducted at University of Lahore Teaching Hospital, Lahore (UOLTH); a tertiary Care Hospital, Lahore Pakistan. Duration: November 2021 to April 2022. Methods: After ERB approval (ERC 58/21/09), data collection proforma was administered to general surgeons at UOLTH, who were asked to anticipate the severity of appendicitis preoperatively depending on history, clinical examination, ultrasound findings and laboratory tests reports. Area under the curve (AUC) and the optimal cut-point values for clinical variables were identified by drawing Receiver operating characteristic (ROC) curves for identifying non- complicated appendicitis. Preoperative diagnoses were compared to operative findings using chi-square test. Data was analyzed using SPSS version 24 was used for data analysis and p-value of < 0.05 was accepted as statistically significant. Results: Surgeon’s prediction showed an accuracy of 85.9% with 89.3% positive predictive value and 78% negative predictive value and an error rate of 9.67%. Abdominal ultrasound demonstrated high sensitivity (95.8%) but lower specificity (29.1%) for appendicitis. Clinical variables, such as anorexia, nausea, and elevated temperature, exhibited a substantial diagnostic competence to distinguish complicated and non-complicated appendicitis. Conclusion: Surgeon’s prognostication in appendicitis is more accurate than clinical or imaging alone, yet errors persist. Caution in patient selection for conservative management is vital, aided by integrating clinical judgment with imaging.