Signs and Evidence

Making clinical sense of scientific data


Beware of the limitations of this tool


Calculated pretest probability: 1.6 %
Relevant inclusion criteria: Acute abdominal pain 


2Migration of pain

Clinical signs

7Psoas sign
8Rebound tenderness
9Right lower quadrant pain

To further investigations

Sources used:

1.David G. Bundy et al. Does This Child Have Appendicitis? JAMA. 2007 Jul 25; 298(4): 438–451.
2.Wagner JM et al. Does This Patient Have Appendicitis? JAMA. 1996;276(19):1589-1594
3.Hardin M et al. Acute Appendicitis: Review and Update. Am Fam Physician. 1999 Nov 1;60(7):2027-2034
4.Nshuti R et al. Clinical presentation of acute appendicitis in adults at the Chris Hani Baragwanath academic hospital. Int J Emerg Med. 2014; 7: 12
5.Lamture YR et al. The role of rebound tenderness in acute appendicitis and appendicular perforation. Int Surg J. 2017 Feb;4(2):725-727
6.Idris SA et al. The sensitivity and specificity of the conventional symptoms and signs in making adiagnosis of acute appendicitis. Sudan journal of medical sciences. 4. 55-61
7.Al-gaithy Zuhoor K et al. Clinical value of total white blood cells and neutrophil counts in patients with suspected appendicitis: retrospective study. World Journal of Emergency Surgery : WJES. 2012;7:32
8.Al-Ajerami Y et al. Sensitivity and specificity of ultrasound in the diagnosis of acute appendicitis. East Mediterr Health J. 2012 Jan;18(1):66-9
9.Al-Khayal KA et al. Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. A meta-analysis. Saudi Med J. 2007 Feb;28(2):173-80
10.Toorenvliet BR et al. Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis. World J Surg 34(10):2278, October 2010
11.Neufeld D et al. Management of acute appendicitis: an imaging strategy in children. Ped Surg Internat 26(2):167, February 2010
12.Doria AS et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241(1):83, October 2006
13.Saaiq M et al. Diagnostic Accuracy of Leukocytosis in Prediction of Acute Appendicitis. Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (1): 67-69
14.Dahmardehei M et al. Diagnostic Value of Leukocytosis, ESR and CRP in Patients with Suspected Acute Appendicitis. Zahedan J Res Med Sci 2013 Jul; 15(7): 59-63
15.Kamran H et al. Role of total leukocyte count in diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad 2008;20(3)
16.Hastings RS et al. Abdominal pain in the ED: a 35 year retrospective. Am J Emerg Med. 2011 Sep;29(7):711-6
17.Caporale N et al. Acute abdominal pain in the emergency department of a university hospital in Italy. United European Gastroenterology Journal 2016, Vol. 4(2) 297–304