Clinical Prediction Score for Ruptured Appendicitis in ED

Background. Ruptured appendicitis has a high morbidity and mortality and requires immediate surgery. &e Alvarado Score is used as a tool to predict the risk of acute appendicitis, but there is no such score for predicting rupture. &is study aimed to develop the prediction score to determine the likelihood of ruptured appendicitis in an Asian population. Methods. &is study was a diagnostic, retrospective cross-sectional study in the Emergency Medicine Department of Ramathibodi Hospital between March 2016 and March 2018. &e inclusion criteria were age >15 years and an available pathology report after appendectomy. Clinical factors included gender, age>60 years, right lower quadrant pain, migratory pain, nausea and/or vomiting, diarrhea, anorexia, fever>37.3°C, rebound tenderness, guarding, white blood cell count, polymorphonuclear white blood cells (PMN) > 75%, and pain duration before presentation. &e predictive model and prediction score for ruptured appendicitis were developed by multivariable logistic regression analysis. Result. During the study period, 480 patients met the inclusion criteria; of these, 77 (16%) had ruptured appendicitis. Five independent factors were predictive of rupture, age>60 years, fever>37.3°C, guarding, PMN>75%, and duration of pain>24 hours to presentation. A score >6 increased the likelihood ratio of ruptured appendicitis by 3.88 times. Conclusion. Using the Ramathibodi Welawat Ruptured Appendicitis Score (RAMA WeRA Score) developed in this study, a score of >6 was associated with ruptured appendicitis.