Diagnostic Accuracy of Clinical Finding for the Diagnosis of Acute Peritonitis

Abstract

Objective: To evaluate the diagnostic accuracy of clinical findings in identifying acute peritonitis, using computed
tomography (CT) and surgical results as the gold standard, among patients presenting to a surgical emergency
department.
Methodology: Over the course of six months, this prospective cross-sectional research was conducted in the
emergency ward, surgery department, Gujranwala Teaching Hospital. 240 patients presenting with acute abdominal
pain were included. The patients were subjected to either surgical exploration, CT scanning, or ultrasonography. The
gold standard was considered to be CT and surgical findings. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity were used to determine the diagnostic performance of the clinical examination. Independent determinants of diagnostic accuracy were found using binary logistic regression.
Results: Of the 240 patients, 75% were male and the mean age was 38.8 ± 15.6 years. The most frequent presenting
symptom was abdominal pain (100%), followed by abdominal distension (66.3%) and vomiting (51.7%). Compared
with surgical/CT confirmation, clinical diagnosis showed sensitivity 98.8%, specificity 52.5%, PPV 80.6%, and NPV
95.5%. Logistic regression identified fever as the only significant independent predictor of correct diagnosis (p =
0.046). Other symptoms, including vomiting and abdominal distension, were not significant predictors.
Conclusion: In emergency and resource-constrained situations, clinical diagnosis of acute peritonitis is a dependable
tool for initial triage and early decision-making due to its great sensitivity and NPV.
Key words: Acute Abdomen; Clinical Diagnosis; Computed Tomography; Diagnostic Accuracy; Peritonitis; Sensitivity;
Specificity;