{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:02:19Z","timestamp":1792083739512,"version":"4.4.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2015,5,12]],"date-time":"2015-05-12T00:00:00Z","timestamp":1431388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100001826","name":"Netherlands Organisation for Health Research and Development","doi-asserted-by":"publisher","award":["171001005"],"award-info":[{"award-number":["171001005"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"Netherlands Organisation for Health Research and Development","doi-asserted-by":"publisher","award":["94504308"],"award-info":[{"award-number":["94504308"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,6,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Non-operative management may be an alternative for uncomplicated appendicitis, but preoperative distinction between uncomplicated and complicated disease is challenging. This study aimed to develop a scoring system based on clinical and imaging features to distinguish uncomplicated from complicated appendicitis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with suspected acute appendicitis based on clinical evaluation and imaging were selected from two prospective multicentre diagnostic accuracy studies (OPTIMA and OPTIMAP). Features associated with complicated appendicitis were included in multivariable logistic regression analyses. Separate models were developed for CT and ultrasound imaging, internally validated and transformed into scoring systems.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 395 patients with suspected acute appendicitis based on clinical evaluation and imaging were identified, of whom 110 (27\u00b78 per cent) had complicated appendicitis, 239 (60\u00b75 per cent) had uncomplicated appendicitis and 46 (11\u00b76 per cent) had an alternative disease. CT was positive for appendicitis in 284 patients, and ultrasound imaging in 312. Based on clinical and CT features, a model was created including age, body temperature, duration of symptoms, white blood cell count, C-reactive protein level, and presence of extraluminal free air, periappendiceal fluid and appendicolith. A scoring system was constructed, with a maximum possible score of 22 points. Of the 284 patients, 150 had a score of 6 points or less, of whom eight (5\u00b73 per cent) had complicated appendicitis, giving a negative predictive value (NPV) of 94\u00b77 per cent. The model based on ultrasound imaging included the same predictors except for extraluminal free air. The ultrasound score (maximum 19 points) was calculated for 312 patients; 105 had a score of 5 or less, of whom three (2\u00b79 per cent) had complicated appendicitis, giving a NPV of 97\u00b71 per cent.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>With use of novel scoring systems combining clinical and imaging features, 95 per cent of the patients deemed to have uncomplicated appendicitis were correctly identified as such. The score can aid in selection for non-operative management in clinical trials.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.9835","type":"journal-article","created":{"date-parts":[[2015,5,12]],"date-time":"2015-05-12T08:43:14Z","timestamp":1431420194000},"page":"979-990","source":"Crossref","is-referenced-by-count":183,"title":["Scoring system to distinguish uncomplicated from complicated acute appendicitis"],"prefix":"10.1093","volume":"102","author":[{"given":"J J","family":"Atema","sequence":"first","affiliation":[{"name":"Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C C","family":"van Rossem","sequence":"additional","affiliation":[{"name":"Department of Surgery, Tergooi Hospital, Hilversum, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M M","family":"Leeuwenburgh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Stoker","sequence":"additional","affiliation":[{"name":"Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M A","family":"Boermeester","sequence":"additional","affiliation":[{"name":"Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,5,12]]},"reference":[{"key":"2021021717574984700_bjs9835-bib-0001","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1007\/s00268-006-0056-y","article-title":"The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis","volume":"31","author":"Andersson","year":"2007","journal-title":"World J Surg"},{"key":"2021021717574984700_bjs9835-bib-0002","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1097\/01.sla.0000256391.05233.aa","article-title":"Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management","volume":"245","author":"Livingston","year":"2007","journal-title":"Ann Surg"},{"key":"2021021717574984700_bjs9835-bib-0003","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1136\/bmj.308.6921.107","article-title":"Indications for operation in suspected appendicitis and incidence of perforation","volume":"308","author":"Andersson","year":"1994","journal-title":"BMJ"},{"key":"2021021717574984700_bjs9835-bib-0004","doi-asserted-by":"crossref","first-page":"e2156","DOI":"10.1136\/bmj.e2156","article-title":"Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials","volume":"344","author":"Varadhan","year":"2012","journal-title":"BMJ"},{"key":"2021021717574984700_bjs9835-bib-0005","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1097\/SLA.0b013e31826a9602","article-title":"Progress in the diagnosis of appendicitis: a report from Washington State's Surgical Care and Outcomes Assessment Program","volume":"256","author":"Drake","year":"2012","journal-title":"Ann Surg"},{"key":"2021021717574984700_bjs9835-bib-0006","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1148\/radiol.2411050913","article-title":"US or CT for diagnosis of appendicitis in children and adults? 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