Diagnostic Performance of the François Score for Suspected Acute Appendicitis: A Prospective Study in a North African Tertiary Center

Acute appendicitis is the most common surgical emergency. Due to its variable clinical presentation, diagnosis can be challenging, often leading to unnecessary imaging or surgery. The François score, a simple clinico-biological tool, aims to stratify patients by diagnostic probability. Objective: To evaluate the diagnostic accuracy of the François score in patients presenting with suspected acute appendicitis at the General Surgery Department of Habib Bougatfa Hospital, Bizerte, Tunisia. Methods: A prospective co-hort study evaluating diagnostic performance was conducted from October 2021 to April 2022. Patients aged over 15 years admitted for suspected acute appendicitis were included. The François score was calculated using predefined clinical and laboratory variables. Final diagnoses were based on histopathology or imaging. Diagnostic per-formance (sensitivity, specificity, predictive values, ROC curves) was analyzed. Re-sults: A total of 139 patients were included. The mean François score was 0.58±4.31. Appendicitis was confirmed in 128 patients (92.1%). A score ≥2 was significantly asso-ciated with acute appendicitis (OR = 8.29; p = 0.024). A score ≤ -6 was inversely corre-lated with appendicitis (OR = 0.004; p < 0.001). The score demonstrated an Area Under the Curve (AUC) of 0.90. At a cut-off of -6, the score yielded a sensitivity of 99.2% and a negative predictive value of 87.5%. The score stratified patients effectively, reducing unnecessary imaging and surgery. Conclusion: The François score is a reliable, low-cost diagnostic tool for evaluating suspected acute appendicitis. It can aid clini-cians in triaging patients and optimizing the use of imaging or surgical exploration.