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J Med Syst (2012) 36:14911502 DOI 10.1007/s10916-010-9610-0
ORIGINAL PAPER
An Approach to Model Right Iliac Fossa Pain Using Pain-Only-Parameters for Screening Acute Appendicitis
Subhagata Chattopadhyay & Fethi Rabhi &
U. Rajendra Acharya & Rohan Joshi &
Rudhram Gajendran
Received: 1 September 2010 /Accepted: 6 October 2010 /Published online: 15 October 2010 # Springer Science+Business Media, LLC 2010
Abstract Acute appendicitis (AA) is one of the commonest of multiple possible pathologies at the backdrop of Right Iliac Fossa (RIF) pain. RIFis the most common acute surgical condition of the abdomen. Even though AA is a recognized disease entity since decades, its diagnosis still lacks clinical confidence and mandates laboratory tests. Given the issue, this paper proposes a mathematical model using Pain-Only-Parameters (POP) obtained from available literature to screen AA. Weights have been assigned for each POP to create a training data matrix (N=51) and used to calculate the cumulative effect or weighted sum, which is termed as the Pain Confidence Score (PCS). Based on PCS, a group of real-world patients (N=40; AA and NA=20 each) are classified as cases of AA or non-appendicitis (NA) with satisfactory results (sensitivity 85%, specificity 75%, precision 77%, and accuracy 80%). Most rural health centers (RHC) in developing nations lack specialist services
and related infrastructure. Hence, such a tool could be useful in RHC to assist general physicians in screening AA and their timely referral to higher centers.
Keywords Right iliac fossa (RIF) pain . Acute appendicitis (AA) . Non appendicitis (NA) . Pain-only-parameters (POP) . Pain confidence score (PCS)
AbbreviationsAA Acute AppendicitisCT Computed TomographyCRP C-reactive proteinNA Non AppendicitisPCS Pain Confidence ScorePOP Pain-only-parametersRIF Right iliac fossaRHC Rural health centersSPSS Statistical Package for the Social Sciences USG Ultrasonography
Introduction
Abdominal pain is the primary complaint present in a patient with acute appendicitis (AA). It is a common surgical condition that is usually managed with early surgery and is associated with low morbidity or mortality if diagnosed and treated at an appropriate time. Even though it has been more than 100 years since the establishment of appendicitis as a disease entity, problems related to its clinical diagnosis are evident by the significantly high negative laparotomy rate of 2025% even today, when medical diagnoses are largely supported by the use of technology [1]. Since...