{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:12:35Z","timestamp":1788430355107,"version":"build-2803163510"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007797","name":"University of Helsinki","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007797","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The utilization of computed tomography in the early stage of acute appendicitis may result in overdiagnosis and unnecessarily expose patients to ionising radiation. The Adult Appendicitis Score (AAS) can be used to select patients for imaging. Observation and re-scoring in the DIAMOND trial reduced the need for imaging. Now, we wanted to determine if the change in AAS (\u2206AAS) can serve as a diagnostic tool to select patients for imaging even more precisely.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighty-eight patients with early equivocal appendicitis participated in the observation arm of the DIAMOND trial. The data for these patients were reanalysed, and \u2206AAS during the observation was calculated. The baseline AAS, final AAS, and the change in C-reactive protein (\u2206CRP) were selected as reference standards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-three patients with complete data were included in the analysis. The AUROC (Area Under the Receiver Operating Characteristic) values are as follows: \u2206AAS, 0.932 (95% CI 0.868\u20130.996); baseline AAS, 0.629 (95% CI 0.498\u20130.760); final AAS, 0.936 (95% CI 0.886\u20130.987); and \u2206CRP, 0.796 (95% CI 0.696\u20130.897). Using receiver operating characteristic curves, we established the thresholds for low (AAS\u2009\u2264\u2009\u22122), intermediate (AAS \u22121 to 0), and high (AAS\u2009\u2265\u20091) probability of appendicitis. The negative predictive value for the low-probability group and the positive predictive value for the high-probability group concerning acute appendicitis were 97% and 94%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with equivocal signs of appendicitis may benefit from short observation and the calculation of \u2206AAS to reduce overdiagnosis and exposure to excessive imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>The DIAMOND trial was officially registered on ClinicalTrials.gov (NCT02742402) on April 13, 2016.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03326-x","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T09:15:10Z","timestamp":1788426910000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Repeated scoring with the adult appendicitis score improves the sensitivity and the specificity of appendicitis diagnosis in patients with early equivocal signs of appendicitis: a secondary analysis"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3439-7988","authenticated-orcid":false,"given":"Kirsi S.","family":"Lastunen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6228-2619","authenticated-orcid":false,"given":"Ari K.","family":"Lepp\u00e4niemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6516-3797","authenticated-orcid":false,"given":"Panu J.","family":"Mentula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"issue":"2","key":"3326_CR1","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1148\/radiol.10091570","volume":"256","author":"AS Raja","year":"2010","unstructured":"Raja AS, Wright C, Sodickson AD, Zane RD, Schiff GD, Hanson R, et al. Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology. 2010, Aug;256(2):460\u201365. https:\/\/doi.org\/10.1148\/radiol.10091570.","journal-title":"Radiology"},{"issue":"4","key":"3326_CR2","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1001\/jamasurg.2020.6357","volume":"156","author":"KH Lee","year":"2021","unstructured":"Lee KH, Lee S, Park JH, Lee SS, Kim HY, Lee WJ, et al. Risk of hematologic malignant neoplasms from abdominopelvic computed tomographic radiation in patients who underwent appendectomy. JAMA Surg. 2021, Apr, 1;156(4):343\u201351. https:\/\/doi.org\/10.1001\/jamasurg.2020.6357.","journal-title":"JAMA Surg"},{"issue":"6","key":"3326_CR3","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1097\/01.sla.0000256391.05233.aa","volume":"245","author":"EH Livingston","year":"2007","unstructured":"Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis. Ann Surg. 2007, Jun;245(6):886\u201392. https:\/\/doi.org\/10.1097\/01.sla.0000256391.05233.aa.","journal-title":"Ann SurgAnnals Surg"},{"issue":"3","key":"3326_CR4","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1097\/sla.0b013e318166177b","volume":"247","author":"RE Andersson","year":"2008","unstructured":"Andersson RE. Resolving appendicitis is common: further evidence - reply. Ann SurgAnnals Surg. 2008;247(3):553\u2013553. https:\/\/doi.org\/10.1097\/sla.0b013e318166177b.","journal-title":"Ann SurgAnnals Surg"},{"issue":"4","key":"3326_CR5","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/s002689910076","volume":"24","author":"RE Andersson","year":"2000","unstructured":"Andersson RE, Hugander A, Ravn H, Offenbartl K, Ghazi SH, Nystr\u00f6m PO, et al. Repeated clinical and laboratory examinations in patients with an equivocal diagnosis of appendicitis. World J Surg. 2000;24(4):479\u201385. https:\/\/doi.org\/10.1007\/s002689910076 PubMed PMID: 10706923.","journal-title":"World J Surg"},{"issue":"1","key":"3326_CR6","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/bjs.11440","volume":"107","author":"A Bhangu","year":"2020","unstructured":"Bhangu A. Collaborative RSG on behalf of the WMR. Evaluation of appendicitis risk prediction models in adults with suspected appendicitis. Br J Surg. 2020, Jan, 1;107(1):73\u201386. https:\/\/doi.org\/10.1002\/bjs.11440.","journal-title":"Br J Surg"},{"issue":"1","key":"3326_CR7","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1186\/1471-230x-14-114","volume":"14","author":"HE Sammalkorpi","year":"2014","unstructured":"Sammalkorpi HE, Mentula P, Lepp\u00e4niemi A. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis - a prospective study. BMC Gastroenterol. 2014, Jun, 26;14(1):910. https:\/\/doi.org\/10.1186\/1471-230x-14-114.","journal-title":"BMC Gastroenterol"},{"issue":"7","key":"3326_CR8","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1093\/bjs\/znac120","volume":"109","author":"KS Lastunen","year":"2022","unstructured":"Lastunen KS, Lepp\u00e4niemi AK, Mentula PJ. Diagnostic iMaging or observation in early equivocal appeNdicitis (DIAMOND): open-label, randomized clinical trial. Br J Surg. 2022;109(7):588\u201394. https:\/\/doi.org\/10.1093\/bjs\/znac120 PubMed PMID: 35482016.","journal-title":"Br J Surg"},{"key":"3326_CR9","doi-asserted-by":"publisher","unstructured":"Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015;351:h5527. https:\/\/doi.org\/10.1136\/bmj.h5527 PubMed PMID: 26511519; PubMed Central PMCID: PMC4623764.","DOI":"10.1136\/bmj.h5527"},{"issue":"10412","key":"3326_CR10","doi-asserted-by":"publisher","first-page":"1552","DOI":"10.1016\/s0140-6736(23)01311-9","volume":"402","author":"K Jalava","year":"2023","unstructured":"Jalava K, Sallinen V, Lampela H, Malmi H, Steinholt I, Augestad KM, et al. Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial. Lancet. 2023;402(10412):1552\u201361. https:\/\/doi.org\/10.1016\/s0140-6736(23)01311-9 PubMed PMID: 37717589.","journal-title":"Lancet"},{"issue":"3","key":"3326_CR11","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1177\/1457496916683099","volume":"106","author":"HE Sammalkorpi","year":"2017","unstructured":"Sammalkorpi HE, Mentula P, Savolainen H, Lepp\u00e4niemi A. The introduction of adult appendicitis score reduced negative appendectomy rate. Scand J Surg. 2017, Sep;106(3):196\u2013201. https:\/\/doi.org\/10.1177\/1457496916683099.","journal-title":"Scand J Surg"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03326-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-026-03326-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03326-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T09:15:11Z","timestamp":1788426911000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-026-03326-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3326"],"URL":"https:\/\/doi.org\/10.1007\/s00068-026-03326-x","relation":{},"ISSN":["1863-9941"],"issn-type":[{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"assertion":[{"value":"14 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was carried out under the Code of Ethics of the World Medical Association (Declaration of Helsinki). Approval was granted by the Ethics Committee of Helsinki University Hospital (reference number 27\/13\/03\/02\/2016). According to Finnish legislation, this approval also covered this secondary analysis.","order":1,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Individual written consents were obtained from all participants during the original DIAMOND trial. According to Finnish legislation, there was no need to renew these, as no new interventions or data gathering were conducted for this secondary analysis.","order":2,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"282"}}