Comparison of physical examination, laboratory and radiologic findings in the diagnosis of acute appendicitis.

Abstract

Objective: The aim of the present study was to compare the diagnostic performance of physical examination, routinely used laboratory markers, and radiological imaging modalities in adult patients with suspected acute appendicitis (AA), and to evaluate the relative contribution of each diagnostic tool under real-world clinical conditions.

Methods: This prospective observational study included 665 consecutive adult patients who underwent appendectomy for AA. Preoperative laboratory parameters, including white blood cell count, C-reactive protein, neutrophil count, neutrophil percentage, total bilirubin, and indirect bilirubin, were recorded. Radiological findings from computed tomography and ultrasonography were documented. Physical examinations were independently performed without access to laboratory or imaging results by both a general surgery resident and a specialist general surgeon. Physical examination findings were categorized as compatible, suspicious, or incompatible with AA. Histopathological examination of all specimens served as the reference standard.

Results: Of the 665 patients, 242 (36.4%) were women, and 423 (63.6%) were men, with a mean age of 34.9±14.2 years. The negative appendectomy rate was 5.8%. Resident physical examination demonstrated the highest sensitivity (95.2%) and overall diagnostic accuracy (88.9%). Among laboratory markers, neutrophil count showed high sensitivity (87.9%), while total and indirect bilirubin demonstrated the highest specificity (89.7% and 94.7%, respectively). Computed tomography achieved a sensitivity of 85.7%, whereas ultrasonography showed lower diagnostic performance, particularly in specificity.

Conclusion: Physical examination remains a highly effective diagnostic tool for AA when performed systematically and should be integrated with laboratory and selective imaging rather than replaced by them.