Comparison of the reliability of scoring systems in the light of histopathological results in the diagnosis of acute appendicitis

Abstract

Background:Acute appendicitis is a very common surgical emergency. Early and correct diagnosis and early intervention are necessary to prevent complications. It is often diagnosed on clinical signs and a certain ratio of negative appendectomy is acceptable. For early and accurate diagnosis, various scoring systems such as Alvarado, Ohmann, Eskelinen and more recently Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) have been developed.Objective:In this study, we aimed to compare the effectiveness and accuracy of scoring systems.Materials and methods:The patients who attended emergency department and operated with acute appendicitis pre-diagnosis were evaluated retrospectively. Alvarado, Ohmann, Eskelinen, and RIPASA scores were calculated and compared with histopathologic results by reviewing the patient files.Results:A total of 76 patients (44 males and 32 females) were included in the study. The mean age was 33.8 ± 13.2 years. Of which, 59 patients (77.6%) were diagnosed to have acute appendicitis on histopathological examination. The mean leukocyte count was 13.9 ± 3.7 × 103μL. Sensitivity and specificity of Alvarado, Ohmann, Eskelinen, and RIPASA were 36%–82%; 58%–71%; 36%–8%, and 68%–71%, respectively. Cut-off values were 8, 14, 55.63, and 10, respectively. RIPASA had the highest accuracy. The cut-off value of leukocyte counts was 13,900 × 103/μL. Sensitivity and specificity were 64% and 88%, respectively; positive predictive value was 95%. In the receiver operating curve analysis, the area under the curve was found to be 74%.Conclusion:The RIPASA scoring system is a more reliable scoring system than Ohmann, Eskelinen, and Alvarado scoring systems. In cases of suspected acute appendicitis, it may be useful to evaluate patients with RIPASA score in emergency departments by general practitioners, where there is no general surgeon. Thus, patients can be guided in a timely manner to reduce the complications that may arise from delays. The cut-off value of 13,900 × 103/μL is an important marker for the presence of acute appendicitis.