Fascial Involvement Score on CT Imaging: A Guide for Managing Patients with Acute Appendicitis

Purpose To assess the potential value of the fascial involvement score in guiding the selection of surgical treatment for patients with acute appendicitis. Methods Between January 1, 2017, and July 31, 2024, data from 711 patients (median age: 59 years; range: 12–88 years) with clinically confirmed acute appendicitis who underwent CT imaging at our hospital were analyzed. Patients were treated either conservatively (427 cases) or surgically (284 cases). The fascial involvement score was evaluated in conjunction with other CT findings and clinical data. Univariate and multivariate logistic regression analyses were performed to identify potential predictors for surgical management. Results Univariate analysis identified the CRP level (P = 0.008), fascial involvement score (P < 0.001), appendiceal diameter (P = 0.001), the presence of extraluminal air (P < 0.001), and intraluminal appendicolith (P = 0.001) as significant factors associated with the need for surgery. Multivariate analysis demonstrated that the fascial involvement score (odds ratio [OR], 2.476; P < 0.001), the presence of extraluminal air (OR, 24.046; P < 0.001), and intraluminal appendicolith (OR, 1.757; P = 0.012) were independent predictors of surgical treatment. The fascial involvement score exhibited an area under the receiver operating characteristic curve (AUC) of 0.866, with an optimal cutoff value of 2.5. Among the 427 patients managed conservatively, 68 (15.9%) experienced recurrence, with 56 (82.4%) of these having appendiceal fecaliths located at the base of the appendix. Conclusion The fascial involvement score independently predicts the need for surgical intervention in patients with acute appendicitis.