Shabir Ahmad Mir, Mumtaz Din Wani

Department of Surgery, Government Medical College Srinagar, Kashmir, India


Objective: Complicated appendicitis needs an aggressive and urgent management, hence there is need of an efficient scoring system for predicting complicated appendicitis. With this in mind, the author developed the present scoring system for predicting complicated acute appendicitis. The study aimed to assess the suitability of this novel (Shabir’s SMART-LAB) score for predicting diagnosis of complicated appendicitis.

Material and Methods: In this prospective study, a novel score designated as “SMART-LAB” SCORE, proposed by the author (Shabir) based on his previous observations was calculated in all patients. This score includes sonography (S), migratory right iliac fossa pain (M), anorexia (A), rebound tenderness (R), tenderness (T), leukocytosis (L), Acute phase protein-CRP (A), and serum bilirubin (B).

Results: Of a total of 150 patients included in this study, 52 cases turned out to be perforated and/or gangrenous appendicitis on intraoperative/histopathologic examination. The most commonly affected age group was 10-19 years. SMART-LAB score of >9 was present in significantly higher number of patients in complicated (perforated and gangrenous) appendicitis than uncomplicated appendicitis (p value<0.001 i.e., highly significant). Hence, high likelihood of complicated appendicitis is reflected by a score >9 (with a sensitivity= 80.7%, specificity= 92.9%, PPV= 85.7%, NPV= 90.1%, and accuracy= 88.7%), while a score 7-9 needs further confirmation to reach a conclusion, and for a score of <7, there is low likelihood of complicated appendicitis.

Conclusion: It seems that this novel score (Shabir’s SMART-LAB score) is a reasonably good tool to predict the diagnosis of complicated appendicitis. Early diagnosis of appendiceal perforation is important to limit the associated abdominal sepsis.

Keywords: Gangrenous/perforated appendicitis, SMART-LAB score, bilirubin, leukocyte count, ultrasonography

Cite this article as: Mir SA, Wani MD. Shabir’s “SMART-LAB” score for predicting complicated appendicitis-a prospective study. Turk J Surg 2022; 38 (2): 140-148.


Ethics Committee Approval

This study was approved Government Medical College Ethical Committee (Decision no: 125/ETH/GMC/ICM, Date: 10.01.2014).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept - S.A.M; Design - S.A.M; Supervision - S.A.M; Materials - S.A.M; Data Collection and/or Processing - S.A.M; Analysis and/or Interpretation - S.A.M; Literature Search - S.A.M., M.D.W.; Writing Manuscript - S.A.M; Critical Reviews -S.A.M, M.D.W.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.


We thank Zahoor Ahmad (PG department of statistics, University of Kashmir) for guiding in statistical part.