Estimating the probability of acute appendicitis using clinical criteria of a structured record sheet: the physician against the computer

Eur J Surg. 1997 Jun;163(6):427-32.


Objective: To evaluate physicians' probability estimates of acute appendicitis based on structured collection of clinical data.

Design: Open prospective study.

Setting: District hospital, Norway.

Subjects: 304 patients admitted with suspected acute appendicitis.

Interventions: Initial diagnostic accuracy of physicians was compared with corresponding results from a computer model.

Main outcome measures: The estimated probabilities of appendicitis in different testing groups were analysed using receiver operating characteristic (ROC) curves.

Results: Physicians' estimates had a mean area under ROC-curve of 0.81 (95% CI 0.79 to 0.82), not significantly different from the computer model. Both correlated well with the actual rate of appendicitis, but the physicians tended to overestimate the probability by 10%.

Conclusion: Physicians' probability estimates perform rather well. Further attempts to implement a probabilistic approach in the diagnostic process of acute appendicitis therefore seem justified.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Appendicitis / diagnosis*
  • Child
  • Child, Preschool
  • Decision Support Techniques
  • Diagnosis, Computer-Assisted*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Prospective Studies
  • ROC Curve