Fascial involvement score on unenhanced CT potentially helps predict complicated appendicitis

Abstract

Objectives: To assess the accuracy of diagnosing complicated appendicitis by examining changes in the involved fasciae on CT imaging.

Methods: From January 1, 2020, to December 31, 2023, 273 patients (median age 50 years; range 14-80 years) with surgically and pathologically confirmed appendicitis were analyzed. Of these, 96 had complicated appendicitis and 177 had uncomplicated appendicitis. Fascial involvement score was assessed along with other CT findings and clinical data. Univariate and multivariate logistic regression analyses were conducted to identify potential predictors of complicated appendicitis.

Results: Univariate analysis identified several features significantly associated with complicated appendicitis: age (P < 0.001), gender (P = 0.006), time from symptom onset to diagnosis (P = 0.015), CRP level (P < 0.001), fascial involvement score (P < 0.001), appendiceal diameter (P < 0.001), and the presence of extraluminal air (P < 0.001). Multivariate analysis revealed that the fascial involvement score (odds ratio 2.252; P < 0.001) and appendiceal diameter (odds ratio 1.263; P < 0.001) were independent risk factors for complicated appendicitis. The fascial involvement score demonstrated an area under the receiver operating characteristic curve of 0.896, with a cutoff value of 2.5.

Conclusion: Both the fascial involvement score and an appendiceal diameter of 14.5 mm or greater are independent predictors of complicated appendicitis.

Keywords: Acute appendicitis; Fascial involvement; Tomography; X-ray computed.