Accuracy of Alvarado, Eskelinen, Ohmann, RIPASA and Tzanakis Scores in Diagnosis of Acute Appendicitis; a Cross-sectional Study
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: Many scoring systems have been developed to assist in diagnosis of acute appendicitis (AA). This study aimed to compare the screening performance characteristics of Alvarado, Eskelinen, Ohmann, Raja Isteri Pengiran Anak Saleha (RIPASA), and Tzanakis scores in predicting the need for appendectomy in AA patients.
Methods: Our study prospectively evaluated AA patients that were treated in a tertiary hospitalâ€™s emergency department. The obtained data were used to calculate Alvarado, Tzanakis, RIPASA, Eskelinen and Ohmann scores. Patients were categorized into two groups according to their histopathological results: positive (PA) and negative appendectomy (NA). The accuracy of different scoring systems in diagnosing AA was investigated.
Results: 74 patients suspected to AA with the mean age of 36.68 Â± 11.97 years were studied (56.8% male). The diagnosis was histopathologically confirmed in 65 cases (87.8%). Median Alvarado, Tzanakis, RIPASA, Eskelinen and Ohmann scores were significantly higher in patients with positive appendectomy. The area under the curve (AUC), sensitivity, and specificity of Tzanakis score in the cut-off value of 8 were 0.965, 84.4%, and 100%, respectively. For Ohmann and Alvarado scores, these measures were 0.941; 71.9%, 89.9% and 0.938, 60.9%, 89.9%, respectively. Tzanakis scoring system had the best screening performance in detection of cases with AA.Â
Conclusion: Tzanakis score is more sensitive and specific than Alvarado, RIPASA, Eskelinen and Ohmann scores in identifying AA patients needing appendectomy.
- Emergency Medicine
- Sensitivity and Specificity
- Raja Isteri Pengiran Anak Saleha Appendicitis
How to Cite
Karaman K, Ercan M, Demir H, YalkÄ±n Ã–, UzunoÄŸlu Y, GÃ¼ndoÄŸdu K, et al. The Karaman score: A new diagnostic score for acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2018;24(6):545-51.
Dal F, Ã‡iÃ§ek Y, Pekmezci S, Kocazeybek B, Tokman HB, KonukoÄŸlu D, et al. Role of Alvarado score and biological indicators of C-reactive protein, procalicitonin and neopterin in diagnosis of acute appendicitis. Ulus Travma Acil Cerrahi Derg. 2019;25(3):229-37.
Ã‡alÄ±ÅŸkan YK. Original Alvarado scoring system in the diagnosis of acute appendicitis: A cohort study. Journal of Surgery and Medicine. 2017;1(2):28-31.
Bakula B, Biljak VR, Bakula M, RaÅ¡iÄ‡ F, Å imundiÄ‡ A-M. Retrospective Evaluation of the Diagnostic Accuracy of the Modified Alvarado Scoring System (MASS) in a Croatian Hospital. Acta medica academica. 2019;48(2).
Karimi E, Aminianfar M, Zarafshani K, Safaie A. The accuracy of emergency physicians in ultrasonographic screening of acute appendicitis; a cross sectional study. Emergency. 2017;5(1).
Jain S, Gehlot A, Songra M. Modified alvarado score in diagnosis of acute appendicitis: a clinicopathological study. International Surgery Journal. 2018;5(3):878-82.
Pasumarthi V, Madhu C. A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis. International Surgery Journal. 2018;5(3):796-801.
Lakshminarasimhaiah AKS, Nagaraja A, Srinivasaiah M. Evaluation of Tzanakis scoring system in acute appendicitis: a prospective study. International Surgery Journal. 2017;4(10):3338-43.
Benabbas R, Hanna M, Shah J, Sinert R. Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Pointâ€ofâ€care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Metaâ€analysis. Academic Emergency Medicine. 2017;24(5):523-51.
Ferlengez E, Ferlengez AG, Akbulut H, Kadioglu H. Evaluation of four different scoring systems in the management of acute appendicitis; a prospective clinical study/Akut Apandisit Degerlendirilmesinde Dort Farkli Skorlama Sisteminin Degerlendirilmesi; ileri Donuk Klinik Calisma. The Medical Bulletin of Haseki. 2013;51(1):15-8.
YÄ±lmaz EM, KapÃ§Ä± M, Ã‡elik S, ManoÄŸlu B, Avcil M, Karacan E. Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation? Turkish Journal of Trauma and Emergency Surgery. 2017;23(1):29-33.
Lintula H, Pesonen E, Kokki H, Vanamo K, Eskelinen M. A diagnostic score for children with suspected appendicitis. Langenbeck's archives of surgery. 2005;390(2):164-70.
Kiyak G, KorukluoÄŸlu B, OzgÃ¼n Y, Devay AO, KuÅŸdemir A. Evaluation of Ohmann and Eskelinen scores, leukocyte count and ultrasonography findings for diagnosis of appendicitis. Ulusal travma ve acil cerrahi dergisi= Turkish journal of trauma & emergency surgery: TJTES. 2009;15(1):77-81.
Butt MQ, Chatha SS, Ghumman AQ, Farooq M. RIPASA score: a new diagnostic score for diagnosis of acute appendicitis. J Coll Physicians Surg Pak. 2014;24(12):894-7.
KollÃ¡r D, McCartan D, Bourke M, Cross K, Dowdall J. Predicting acute appendicitis? A comparison of the Alvarado score, the Appendicitis Inflammatory Response Score and clinical assessment. World journal of surgery. 2015;39(1):104-9.
Jalil A, Shah SA, Saaiq M, Zubair M, Riaz U, Habib Y. Alvarado scoring system in prediction of acute appendicitis. J Coll Physicians Surg Pak. 2011;21(12):753-55.
Subramani B, Kalaichelvan L, Selvam G, Madhavan L. Comparison between RIPASA and alvarado scoring in diagnosing acute appendicitis. J Evid Based Med Health. 2017;4(11):624-7.
Elhosseiny MM, Eltokhy E, Elekiabi OA, Elaidy MM. Tamer Mohamed El shahidy, et al. Comparative Study between Alvarado Score& Ripasa Score in Diagnosis of Acute Appendicitis J Surgery. 2018;6(2):5.
Khan I, ur Rehman A. Application of Alvarado scoring system in diagnosis of acute appendicitis. Journal of Ayub Medical College Abbottabad. 2005;17(3).
Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. International Journal of Surgery. 2018;56:307-14.
Chong CF, Thien A, Mackie AJA, Tin AS, Tripathi S, Ahmad M, et al. Evaluation of the RIPASA Score: a new scoring system for the diagnosis of acute appendicitis. Brueni Int Med J. 2010;6:17-26.
Ahn S, Lee H, Choi W, Ahn R, Hong J-S, Sohn CH, et al. Clinical importance of the heel drop test and a new clinical score for adult appendicitis. PloS one. 2016;11(10).
Zielke A, Sitter H, Rampp T, Bohrer T, Rothmund M. Clinical decision-making, ultrasonography, and scores for evaluation of suspected acute appendicitis. World journal of surgery. 2001;25(5):578-84.
Erdem H, Ã‡etinkÃ¼nar S, DaÅŸ K, Reyhan E, DeÄŸer C, Aziret M, et al. Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha appendicitis scores for diagnosis of acute appendicitis. World Journal of Gastroenterology: WJG. 2013;19(47):9057.
Malla B, Batajoo H. Comparison of Tzanakis score vs alvarado score in the effective diagnosis of acute appendicitis. Kathmandu University medical journal. 2014;12(1):48-50.
Sigdel G, Lakhey P, Misra P. Tzanakis Score vs Alvarado in Acute Appendicitis. Journal of Nepal Medical Association. 2010;49(178).
Umar MM, Abubakar IU, Agbo SP. Comparative study of alvarado score and its modifications in the preoperative diagnosis of acute appendicitis at a tertiary center in Sokoto, Nigeria. Nigerian Journal of Surgery. 2020;26(1):16.
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