{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:03:55Z","timestamp":1792782235202,"version":"4.5.0"},"reference-count":73,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2004,1,1]],"date-time":"2004-01-01T00:00:00Z","timestamp":1072915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Scientific Committee, J\u00f6nk\u00f6ping County, Sweden"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2004,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The importance of specific elements in the clinical diagnosis of appendicitis is controversial. This review analyses the diagnostic value of elements of disease history, clinical findings and laboratory test results in suspected appendicitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic Medline search was made of all published studies on the clinical and laboratory diagnosis of appendicitis in patients admitted to hospital with suspected disease. Meta-analyses of receiver\u2013operator characteristic (ROC) areas, and positive and negative likelihood ratios, of 28 diagnostic variables described in 24 studies are presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Inflammatory response variables (granulocyte count, proportion of polymorphonuclear blood cells, white blood cell count and C-reactive protein concentration), descriptors of peritoneal irritation (rebound and percussion tenderness, guarding and rigidity) and migration of pain were the strongest discriminators, with ROC areas of 0\u00b778 to 0\u00b768. The discriminatory power of the inflammatory variables was particularly strong for perforated appendicitis, with ROC areas of 0\u00b785 to 0\u00b787. Appendicitis was likely when two or more inflammatory variables were increased and unlikely when all were normal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although all clinical and laboratory variables are weak discriminators individually, they achieve a high discriminatory power when combined. Laboratory examination of the inflammatory response, clinical descriptors of peritoneal irritation, and a history of migration of pain yield the most important diagnostic information and should be included in any diagnostic assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bjs.4464","type":"journal-article","created":{"date-parts":[[2004,1,6]],"date-time":"2004-01-06T03:00:38Z","timestamp":1073358038000},"page":"28-37","source":"Crossref","is-referenced-by-count":413,"title":["Meta-analysis of the clinical and laboratory diagnosis of appendicitis"],"prefix":"10.1093","volume":"91","author":[{"given":"R E B","family":"Andersson","sequence":"first","affiliation":[{"name":"Department of Surgery, County Hospital Ryhov , SE-551 85 J\u00f6nk\u00f6ping,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2004,1,1]]},"reference":[{"key":"2024093006394204800_bib1","first-page":"37","article-title":"Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate","volume":"158","author":"Andersson","year":"1992","journal-title":"Eur J Surg"},{"key":"2024093006394204800_bib2","first-page":"372","article-title":"Assessment of the reliability of the symptoms and signs of acute appendicitis","volume":"36","author":"Rasmussen","year":"1991","journal-title":"J R Coll Surg Edinb"},{"key":"2024093006394204800_bib3","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1001\/jama.1996.03540190061030","article-title":"Does this patient have appendicitis?","volume":"276","author":"Wagner","year":"1996","journal-title":"JAMA"},{"key":"2024093006394204800_bib4","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1046\/j.0007-1323.2001.01910.x","article-title":"Suspected acute appendicitis: trends in management over 30 years","volume":"88","author":"Jones","year":"2001","journal-title":"Br J Surg"},{"key":"2024093006394204800_bib5","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1002\/bjs.1800760803","article-title":"Aids in the diagnosis of acute appendicitis","volume":"76","author":"Hoffmann","year":"1989","journal-title":"Br J Surg"},{"key":"2024093006394204800_bib6","first-page":"483","article-title":"Influence of white cell count on surgical decision making in patients with abdominal pain in the right lower quadrant","volume":"161","author":"Vermeulen","year":"1995","journal-title":"Eur J Surg"},{"key":"2024093006394204800_bib7","first-page":"475","article-title":"Acute appendicitis: are any investigations cost effective?","volume":"75","author":"Feeley","year":"1982","journal-title":"Ir Med J"},{"key":"2024093006394204800_bib8","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1136\/emj.19.5.429","article-title":"Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. 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