Development and Internal Validation of a New Predictive Score for Complicated Acute Appendicitis in a Tunisian Population

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Published Sep 13, 2026
https://doi.org/10.62438/tunismed.v104i08.7033
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Vol. 104 No. 08 (2026): Tunis Med Aug 2026

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Amina Chaka
General Surgery Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
Houda Ben Ayed
Department of Preventive and Hospital Hygiene, Hedi Cheker Hospital, Sfax, Tunisia
Nizar Kardoun
General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia
https://orcid.org/0000-0003-0288-8800
Amine Zouari
General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia
https://orcid.org/0000-0001-8340-0488
Amine Chaabouni
General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia
Hamza Houssein Abidi
General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia
Fatma Kolsi
Neuro-Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia
Salah Boujelben
General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia

Abstract

Background: Distinguishing uncomplicated acute appendicitis (UAA) from complicated acute appendicitis (CAA) remains a major diagnostic challenge even after performing cross-sectional imaging with direct therapeutic implications. This study aimed to develop and validate a predictive score for CAA in a Tunisian clinical setting.
Methods: A retrospective study was conducted on 326 patients who underwent surgery for acute appendicitis. Clinical, biological, and radiological data collected at admission were analyzed using univariate and multivariate logistic regression to identify independent predictive factors for CAA. A predictive score was then constructed and its diagnostic performance assessed using the ROC curve.
Results: The prevalence of CAA was 43.6% (N = 142). Six independent predictive factors were identified: age ≥ 40 years (AOR = 3.1; p = 0.002), fever ≥ 38.5°C (AOR = 2.3; p = 0.02), leukocyte count ≥ 15,000/mm³ (AOR = 3.2; p = 0.002), CRP ≥ 100 mg/L (AOR = 7.4; p < 0.001), free fluid in the right iliac fossa or pelvis (AOR = 2.1; p = 0.039), and a collection in the right iliac fossa on imaging (AOR = 7.5; p < 0.001). The score ranged from 0 to 20, with a median of 4 (IQR 2–12). At the optimal cut-off of ≥ 6, it yielded a sensitivity of 80%, specificity of 90%, positive and negative predictive values of 85% each, and an overall accuracy of 84.9% (AUROC = 0.90).
Conclusion: This new predictive score, incorporating six clinical, biological, and radiological parameters available at admission, provides a ....(abstract truncated at 250 words).


 


 

Keywords:

Appendicitis, Risk factors, Predictive score, Therapeutic decision, Tunisia

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Author Biographies

Houda Ben Ayed, Department of Preventive and Hospital Hygiene, Hedi Cheker Hospital, Sfax, Tunisia

²Department of Preventive and Hospital Hygiene, Hedi Cheker Hospital, Sfax, Tunisia

 

Nizar Kardoun, General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia

General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia

Amine Zouari, General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia

General Surgery Department, Habib Bourguiba Hospital, Sfax, Tunisia

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