Akut Apandisit Tanısında Alvarado ve RIPASA Skorlama Sistemlerinin Etkinliğinin Retrospektif Değerlendirilmesi

Yıl 2022, Cilt: 5 Sayı: 1, 26 - 30, 09.03.2022

Murat Çetin , Gürkan Altuntaş , Mehmet Altuntaş

https://doi.org/10.54996/anatolianjem.1080597

Öz

Amaç: Bu çalışmanın amacı acil servise başvuran ve akut apandisit tanısı ile apendektomi yapılan hastalarda Alvarado ve RIPASA skorlarının etkinliğini incelemektir.

Gereç ve Yöntemler: Akut apandisit tanısı alan hastaların incelendiği tek merkezli, retrospektif bir çalışma olarak planlandı. Çalışmamızda, hastaların post-operatif histopataolojik tanıları altın standart kabul edilerek, hastalardan başlangıç muayenelerinde bakılan Alvarado ve RIPASA klinik skorlar ile karşılaştırılması planlandı.

Bulgular: Akut apandisit tanısı ile opere edilen 125 hastanın; 81’i erkek (%64,8) 44’ü kadındı (%35,2). Hastaların 95’inde (%76) non-komplike apandisit, 21’inde (%16,8) reaktif lenfoid hiperplazi, 9’unda (%7,2) komplike apandisit tanısı konulmuştur. Alvarado ve RIPASA skorlarının ROC eğrisi ve eğri altında kalan alanı değerlendirildiğinde RIPASA skoru AUC=0.811 iken Alvarado için AUC=0.762 idi. Cut-off değer olarak her iki skorda da en iyi değer ≥7 olarak belirlendi. Alvarado ve RIPASA skorları arasındaki karşılaştırmada istatistiksel olarak anlamlı bir fark bulunmadı.

Sonuç: Akut apandisit kesin tanısı histopatolojik olarak konulabilen bir cerrahi acildir. Hızlı ve doğru teşhisini sağlamak için çeşitli skorlama sistemleri acil hekimleri tarafından daha sık kullanılmalıdır Acil serviste skorlama sistemleri tanı koymada faydalı olup birbirlerine üstünlükleri bulunmamıştır. Hem RIPASA hem de Alvarado skorlama sistemlerinin daha sık kullanılması ile negatif apendektomi oranı azaltılabilir.

Anahtar Kelimeler

Akut apandisit, Alvarado, RIPASA

Retrospective Evaluation of the Effectiveness of Alvarado and RIPASA Scoring Systems in the Diagnosis of Acute Appendicitis

Öz

Aim: The aim of this study is to examine the effectiveness of Alvarado and RIPASA scores in patients who applied to the emergency department and underwent appendectomy with the diagnosis of acute appendicitis.

Material and Methods: This is a single-center, retrospective study examining patients diagnosed with acute appendicitis. In our study, the post-operative histopathological diagnosis of the patients was accepted as the gold standard. The patients were divided into two groups and the clinical scores of Alvarado and RIPASA obtained during the initial examination were compared between the two groups of patients.

Results: Of 125 patients who were operated with the diagnosis of acute appendicitis; 81 (64.8%) were male and 44 (35.2%) were female. Non-complicated appendicitis was diagnosed in 95 (76%) of the patients, reactive lymphoid hyperplasia in 21 (16.8%), and complicated appendicitis in 9 (7.2%). In the comparison between both groups, when the ROC curve and the area under the curve of Alvarado and RIPASA scores were evaluated, the RIPASA score was AUC=0.811, while for Alvarado it was AUC=0.762. As the cut-off value, the best value was determined as ≥7 in both scores. No statistically significant difference was found in the comparison between Alvarado and RIPASA scores.

Conclusion: The definitive diagnosis of acute appendicitis is surgical emergency, which can be made histopathologically. Various scoring systems should be used more frequently by emergency physicians to ensure rapid and accurate diagnosis in the emergency department. With the more frequent use of both RIPASA and Alvarado scoring systems, the negative appendectomy rate can be reduced.

Anahtar Kelimeler

Acut appendicits, Alvarado, RIPASA

Kaynakça

• Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 2004;91:28-37.
• Sengupta A, Bax G, Paterson-Brown S. White cell count and C-reactive protein measurement in patients with possible appendicitis. Ann R Coll Surg Engl. 2009 Mar;91(2):113-5.
• Chisthi MM, Surendran A, Narayanan JT. RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study. Ann Med Surg (Lond). 2020 Sep 24;59:138-142.
• Shuaib A, Shuaib A, Fakhra Z, Marafi B, Alsharaf K, Behbehani A. Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis. World J Emerg Med. 2017;8(4):276-280.
• Khan S, Usama M, Basir Y, Muhammad S, Jawad M, Khan T, et al. Evaluation Of Modified Alvarado, Ripasa And Lintula Scoring System As Diagnostic Tools For Acute Appendicitis. J Ayub Med Coll Abbottabad. 2020 Jan-Mar;32(1):46-50.
• Díaz-Barrientos CZ, Aquino-González A, Heredia-Montaño M, Navarro-Tovar F, Pineda-Espinosa MA, Espinosa de Santillana IA. The RIPASA score for the diagnosis of acute appendicitis: A comparison with the modified Alvarado score. Rev Gastroenterol Mex (Engl Ed). 2018 Apr-Jun;83(2):112-116.
• Yılmaz EM, Kapçı M, Çelik S, Manoğlu B, Avcil M, Karacan E. Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation? Ulus Travma Acil Cerrahi Derg. 2017 Jan;23(1):29-33.
• Mohammed A, Shanbhag V, Ashfaque K, S A P. A Comparative Study of RIPASA Score and ALVARADO Score in the Diagnosis of Acute Appendicitis. J Clin Diagn Res. 2014 Nov;8(11):NC03-5.
• 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. Int J Surg. 2018 Aug;56:307-314.
• Flum DR, McClure TD, Morris A, Koepsell T. Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg 2005;201 (6):933–9.
• Dey S, Mohanta PK, Baruah AK, Kharga B, Bhutia KL, Singh VK. Alvarado scoring in acute appendicitis—a clinico-pathological correlati on. Indian J Surg 2010;72 (4) :290–3.
• Chong CF, Adi MI, Thien A, et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J 2010; 51:220-5.
• Alnjadat I, Abdallah B. Alvarado versus RIPASA score in diagnosing acute appendicitis. Rawal Med J 2013;38(2):147–51.
• Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI. Evaluation of the Alvarado score in acute appendicitis. JR Soc Med. 1992; 85:87–88.
• Singla A, Singla S, Singh M, Singla D. A comparison between modified Alvarado score and RIPASA score in the diagnosis of acute appendicitis. Updates Surg. 2016 Dec;68(4):351-355. doi: 10.1007/s13304-016-0381-0. Epub 2016 Jun 23. PMID: 27338243.
• Chisthi MM, Surendran A, Narayanan JT. RIPASA and air scoring systems are superior to alvarado scoring in acute appendicitis: Diagnostic accuracy study. Ann Med Surg (Lond). 2020 Sep 24;59:138-142. doi: 10.1016/j.amsu.2020.09.029. PMID: 33024555; PMCID: PMC7527659.