Diagnostic value of dry lips in patients with suspected acute appendicitis: A prospective cohort study: Dry lips in acute appendicitis diagnosis

Yahia Akeely; Nouf  Alblowi; Wael Alanazi; Shabana Begum Patel; Nader Bokhari; Razan Alshaheen; Ali  Afaifi

doi:10.28982/josam.8648

Authors

Yahia Akeely SFH, RIYADH, SAUDI ARABIA https://orcid.org/0000-0002-5130-0658
Nouf Alblowi Security Forces Hospital Program, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia https://orcid.org/0000-0003-0682-0125
Wael Alanazi Security Forces Hospital Program, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia https://orcid.org/0009-0007-6965-9371
Shabana Begum Patel Security Forces Hospital Program, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia https://orcid.org/0009-0005-0885-4873
Nader Bokhari Security Forces Hospital Program, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia https://orcid.org/0009-0009-8576-0853
Razan Alshaheen Security Forces Hospital Program, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia https://orcid.org/0009-0000-4733-7274
Ali Afaifi Security Forces Hospital Program, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia https://orcid.org/0009-0008-6626-8022

DOI:

https://doi.org/10.28982/josam.8648

Keywords:

Appendicitis, Physical examination, Dry lips, Sensitivity and Specificity, Dehydration

Abstract

Background/Aim: Acute appendicitis is a common surgical emergency, but accurate diagnosis remains challenging. Simple bedside findings may complement established diagnostic strategies. This study aimed to evaluate the diagnostic accuracy of dry lips as a bedside clinical sign in adults presenting with suspected acute appendicitis.

Methods: This prospective observational cohort study was conducted in the emergency department of a tertiary care hospital from June 2024 to May 2025. Consecutive adults presenting with suspected acute appendicitis were enrolled. Dry lips were assessed during the initial examination before intravenous fluid administration, laboratory testing, or imaging. Histopathological examination confirmed appendicitis in operated patients, whereas non-operated patients were classified as not having appendicitis based on negative computed tomography findings and/or an uneventful 30-day clinical follow-up. Sensitivity, specificity, predictive values, likelihood ratios, and 95% confidence intervals (CIs) were calculated.

Results: Of 115 patients screened, 96 met the eligibility criteria and were included. Acute appendicitis was confirmed in 44 patients (45.8%), and dry lips were present in 36 (37.5%). Dry lips had a sensitivity of 54.6% (95% CI, 38.8-69.6%) and a specificity of 76.9% (95% CI, 63.2-87.5%). The positive likelihood ratio was 2.36 (95% CI, 1.34-4.16), and the negative likelihood ratio was 0.59 (95% CI, 0.41-0.84). Combining dry lips with a C-reactive protein level of at least 10 mg/L increased specificity to 93.9% (95% CI, 84.4-98.0%) and the positive likelihood ratio to 6.61 (95% CI, 2.24-22.49).

Conclusion: Dry lips showed moderate specificity but limited sensitivity for diagnosing acute appendicitis. This finding is not sufficiently accurate for use as a standalone test but may provide a rapid, cost-free adjunct to bedside assessment when interpreted with inflammatory markers and other clinical findings. Larger multicenter studies are needed to validate these results.

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