RAMA-WeRA Risk Score in Predicting the Ruptured Appendicitis in Emergency Department; a Multicenter Study for External Validation
Archives of Academic Emergency Medicine,
Vol. 12 No. 1 (2024),
1 January 2024
,
Page e44
https://doi.org/10.22037/aaem.v12i1.2237
Abstract
Introduction: Distinguishing between ruptured and non-ruptured acute appendicitis presents a significant challenge. This study aimed to validate the accuracy of RAMA-WeRA Risk Score in predicting ruptured appendicitis (RA) in emergency department.
Methods: This study was a multicenter diagnostic accuracy study conducted across six hospitals in Thailand from February 1, 2022, to January 20, 2023. The eligibility criteria included individuals aged >15 years suspected of acute appendicitis, presenting to the ED, and having an available pathology report following appendectomy or intraoperative diagnosis by the surgeon. We assessed the screening performance characteristics of RAMA-WeRA Risk Score, in detecting the ruptured appendicitis (RA) cases.
Results: 860 patients met the study criteria. 168 (19.38%) had RA and 692 (80.62%) patients had non-RA. The area under the receiver operating characteristic curve (AuROC) of RAMA-WeRA Risk Score was 75.11% (95% CI: 71.10, 79.11). The RAMA-WeRA Risk Score > 6 points (high-risk group) demonstrated a positive likelihood ratio (LR) of 3.22 in detecting the ruptured cases. The sensitivity and specificity of score in > 6 cutoff point was 43.8% (95%CI: 36.2, 51.6) and 86.4% (95%CI: 83.6, 88.9), respectively.
Conclusions: The RAMA-WeRA Risk Score can predict rupture in patients presenting with suspected acute appendicitis in the emergency department with total accuracy of 75% for high-risk cases.
- appendicitis
- acute
- rupture
- validate
- predict
- Abdomen
- Clinical decision rules
- Validation study
How to Cite
References
Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27.
Talan DA, Di Saverio S. Treatment of Acute Uncomplicated Appendicitis. N Engl J Med. 2021;385(12):1116-23.
Al-Tarakji M, Zarour A, Singh R, Ghali MS. The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population. Cureus. 2022;14(7):e26902.
Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139.
Dey S, Mohanta PK, Baruah AK, Kharga B, Bhutia KL, Singh VK. Alvarado scoring in acute appendicitis-a clinicopathological correlation. Indian J Surg. 2010 Aug;72(4):290-3.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.
Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg. 2002;137(7):799-804; discussion
Kang CB, Li XW, Hou SY, Chi XQ, Shan HF, Zhang QJ, et al. Preoperatively predicting the pathological types of acute appendicitis using machine learning based on peripheral blood biomarkers and clinical features: a retrospective study. Ann Transl Med. 2021;9(10):835.
Khan MS, Siddiqui MTH, Shahzad N, Haider A, Chaudhry MBH, Alvi R. Factors Associated with Complicated Appendicitis: View from a Low-middle Income Country. Cureus. 2019;11(5):e4765.
Patel SV, Nanji S, Brogly SB, Lajkosz K, Groome PA, Merchant S. High complication rate among patients undergoing appendectomy in Ontario: a population-based retrospective cohort study. Can J Surg. 2018;61(6):412-7.
Potey K, Kandi A, Jadhav S, Gowda V. Study of outcomes of perforated appendicitis in adults: a prospective cohort study. Ann Med Surg (Lond). 2023;85(4):694-700.
Rait JS, Ajzajian J, McGillicuddy J, Sharma A, Andrews B. Acute appendicitis and the role of pre-operative imaging: A cohort study. Ann Med Surg (Lond). 2020;59:258-63.
Depetris MA, Martínez Chamorro E, Ibáñez Sanz L, Albillos Merino JC, Rodríguez Cuellar E, Borruel Nacenta S. The usefulness and positive predictive value of ultrasonography and computed tomography in the diagnosis of acute appendicitis in adults: A retrospective study. Radiologia (Engl Ed). 2022;64(6):506-15.
Sirikurnpiboon S, Amornpornchareon S. Factors Associated with Perforated Appendicitis in Elderly Patients in a Tertiary Care Hospital. Surg Res Pract. 2015;2015:847681.
Prachanukool T, Yuksen C, Tienpratarn W, Savatmongkorngul S, Tangkulpanich P, Jenpanitpong C, et al. Clinical Prediction Score for Ruptured Appendicitis in ED. Emerg Med Int. 2021;2021:6947952.
Al Amri FS, Fihrah RS, Al Jabbar I, Alqahtani R, Alnujaymi B, Alshehri RM, et al. Accuracy of Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Acute Appendicitis: A Single-Center Retrospective Study. Cureus. 2023;15(9):e45923.
Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis. Am J Surg. 2020;219(1):154-63.
Ahmad KA, Ideris N, Aziz S. A Cross-Sectional Study of Neutrophil-to-Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka. Malays J Med Sci. 2019;26(6):55-66.
Kim TH, Cho BS, Jung JH, Lee MS, Jang JH, Kim CN. Predictive Factors to Distinguish Between Patients With Noncomplicated Appendicitis and Those With Complicated Appendicitis. Ann Coloproctol. 2015;31(5):192-7.
Atema JJ, van Rossem CC, Leeuwenburgh MM, Stoker J, Boermeester MA. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102(8):979-90.
Kang CB, Li WQ, Zheng JW, Li XW, Lin DP, Chen XF, et al. Preoperative assessment of complicated appendicitis through stress reaction and clinical manifestations. Medicine (Baltimore). 2019;98(23):e15768.
Bröker ME, van Lieshout EM, van der Elst M, Stassen LP, Schepers T. Discriminating between simple and perforated appendicitis. J Surg Res. 2012;176(1):79-83.
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