Akut Apandisit Tanısında Dört Farklı Skorlama Sisteminin Etkinliğinin Değerlendirilmesi

Abstract

Amaç: Bu çalışmada akut apandisit nedeniyle opere edilecek hastalarda dört ayrı skorlama sisteminin (Alvarado, Lintula, RIPASA, Tzanakis) akut apandisit tanısında etkinliğini araştırmayı hedefledik. Materyal ve Metod: Skorlama sistemlerinin sonuçları ve etkinliği histopatolojik olarak akut apandisit net tanısı alan hastaların sonuçları ile karşılaştırıldı. Bulgular: 115 hasta ameliyat edildi. 62’si erkek, 53’ü kadındı. Alvarado, Lintula, RİPASA ve Tzanakis skorlama sistemleri için sensitivite sırasıyla %93,6, %91,4, %93,6, %55,3, spesifite sırasıyla %71,4, %90,4, %81, %76, Pozitif Prediktif Değer (PPD) sırasıyla %93,6, %97,7, %95,7 %91,2, Negatif Prediktif Değer (NPD) sırasıyla %71,4, %70,3, %74, %27,6 bulundu. Sonuç: Skorlama sistemleri içerisinde Alvarado, Lintula ve RIPASA skorlama sistemlerinin akut apandisit tanısı koymada daha etkili olduğu ve Tzanakis skorlama sistemi için ise tanı koyma etkinliğinin düşük olduğunu saptadık. Ultrasonografi bulgularının skorlamada etkisi yüksek olduğu için deneyimli bir radyoloji kliniği ile beraber çalışıldığında Tzanakis skorlama sisteminin de tanı aşamasında güçlü bir skorlama sistemi olabileceği düşünülmektedir. Akut apandisit tanısında %100 tahmin etme görüsü olan herhangi bir yöntem olmadığı ve tüm skorlama sistemlerinin eksiklerinin olduğu görülmektedir. Yine de en önemli kriterlerin hastanın kliniği, muayene bulguları ve klinisyenin deneyimi olduğunu ve ek tanısal yöntemlerin tanıyı destekleyici ve klinisyeni yönlendirici araçlar olduğunu düşünmekteyiz.

Keywords

• Akut apandisit
• Skorlama sistemleri
• Alvarado
• Lintula
• Ripasa
• Tzanakis

Evaluation of the Efficiency of Four Different Scoring Systems in the Diagnosis of Acute Appendicitis

Abstract

Objective: The aim of this study was to investigate the effectiveness of four commonly used scoring systems (Alvarado, Lintula, RIPASA, Tzanakis) in the diagnosis of acute appendicitis in patients to be operated for acute appendicitis. Materials and Methods: We compared the results and efficacy of the scoring systems with the results of patients with an accurate histopathologic diagnosis of acute appendicitis. Results: A total number of 115 patients were included in the study (62 male and 53 female). For Alvarado, Lintula, RIPASA and Tzanakis scoring systems, sensitivity was 93.6%, 91.4%, 93.6%, 55.3%, specificity was 71.4%, 90.4%, 81%, 76%, Positive Predictive Value (PPV) was 93.6%, 97.7%, 95.7%, 91.2%, Negative Predictive Value (NPV) was 71.4%, 70.3%, 74%, 27.6%, respectively. Conclusion: Our findings show that among the four scoring systems, Alvarado, Lintula and RIPASA scoring systems are more effective scoring systems in diagnosing acute appendicitis whereas Tzanakis scoring system had a low diagnostic efficiency. Since ultrasonography findings have a high impact on Tzanakis scoring system, by working with an experienced radiology clinic, Tzanakis scoring system could be also a powerful scoring system at the diagnostic stage. None of the four scoring systems has 100% predictive accuracy in the diagnosis of acute appendicitis and all scoring systems have some shortcomings. Nevertheless, we believe that the most important criteria in the diagnostic process are the clinic where the patients are admitted, the examination findings and the experience of the clinician. Scoring systems seem to support the diagnosis and guide the clinician.

Keywords

• Acute appendicitis
• Scoring systems
• Alvarado
• Lintula
• Ripasa
• Tzanakis

References

1. Referanslar 1. Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Catena F, et al. Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases. Annals of translational medicine. 2016;4(19).
2. 2. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. 1990;132(5):910-25.
3. 3. Shelton T, McKinlay R, Schwartz RW. Acute appendicitis: current diagnosis and treatment. Current surgery. 2003;5(60):502-5.
4. 4. Van Way 3rd C, Murphy J, Dunn E, Elerding S. A feasibility study of computer aided diagnosis in appendicitis. Surgery, gynecology & obstetrics. 1982;155(5):685-8.
5. 5. Pouget-Baudry Y, Mucci S, Eyssartier E, Guesdon-Portes A, Lada P, Casa C, et al. The use of the Alvarado score in the management of right lower quadrant abdominal pain in the adult. Journal of Visceral Surgery. 2010;147(2):e40-e4.
6. 6. 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.
7. 7. Chong C, Adi M, Thien A, Suyoi A, Mackie A, Tin A, et al. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore medical journal. 2010;51(3):220.
8. 8. Sigdel G, Lakhey P, Misra P. Tzanakis Score vs alvarado in acute appendicitis. Journal of Nepal Medical Association. 2010;49(178).

9. 9. Andersson R, Hugander A, Thulin A. Diagnostic accuracy and perforation rate in appendicitis: association with age and sex of the patient and with appendicectomy rate. The European journal of surgery= Acta chirurgica. 1992;158(1):37-41.
10. 10. Blind P, Dahlgren S. The continuing challenge of the negative appendix. Acta chirurgica scandinavica. 1986;152:623-7.
11. 11. Jones PF. Active observation in management of acute abdominal pain in childhood. Br Med J. 1976;2(6035):551-3.
12. 12. Velanovich V, Satava R. Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. The American surgeon. 1992;58(4):264-9.
13. 13. Jose T, Rajesh PS. Appendicitis Inflammatory Response Score in Comparison to Alvarado Score in Acute Appendicitis. Surgery journal (New York, NY). 2021;7(3):e127-e31.
14. 14. Farooqui W, Pommergaard HC, Burcharth J, Eriksen JR. The diagnostic value of a panel of serological markers in acute appendicitis. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2015;104(2):72-8.
15. 15. Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong medical journal = Xianggang yi xue za zhi. 2010;16(1):12-7.
16. 16. Awayshih MMA, Nofal MN, Yousef AJ. Evaluation of Alvarado score in diagnosing acute appendicitis. The Pan African medical journal. 2019;34:15.
17. 17. Yoldas O, Karaca T, Tez M. External validation of Lintula score in Turkish acute appendicitis patients. International Journal of Surgery. 2012;10(1):25-7.
18. 18. Şenocak R, Kaymak Ş. Diagnostic accuracy of ultrasonography and scoring systems: The effects on the negative appendectomy rate and gender. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2020;26(2):306-13.
19. 19. Kundiona I, Chihaka O, Muguti G. Negative appendicectomy: evaluation of ultrasonography and Alvarado score. Central African Journal of Medicine. 2015;61(9-12):66-73.
20. 20. Bouali M, El Berni Y, Moufakkir A, El Bakouri A, El Hattabi K, Bensardi F, et al. Value of Alvarado scoring system in diagnosis of acute appendicitis. Annals of medicine and surgery (2012). 2022;77:103642.
21. 21. Noor S, Wahab A, Afridi G, Ullah K. Comparing Ripasa Score And Alvarado Score In An Accurate Diagnosis Of Acute Appendicitis. Journal of Ayub Medical College, Abbottabad : JAMC. 2020;32(1):38-41.
22. 22. Yoldas O, Karaca T, Tez M. External validation of Lintula score in Turkish acute appendicitis patients. International journal of surgery (London, England). 2012;10(1):25-7. 423. Konan A, Hayran M, Kılıç YA, Karakoç D, Kaynaroğlu V. Scoring systems in the diagnosis of acute appendicitis in the elderly. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES. 2011;17(5):396-400.
23. 24. 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. Journal of Ayub Medical College, Abbottabad : JAMC. 2020;32(1):46-50.
24. 25. Nanjundaiah N, Mohammed A, Shanbhag V, Ashfaque K, Priya S. A comparative study of RIPASA score and ALVARADO score in the diagnosis of acute appendicitis. Journal of clinical and diagnostic research: JCDR. 2014;8(11):NC03.
25. 26. Tzanakis NE, Efstathiou SP, Danulidis K, Rallis GE, Tsioulos DI, Chatzivasiliou A, et al. A new approach to accurate diagnosis of acute appendicitis. World journal of surgery. 2005;29(9):1151-6.
26. 27. Korkut M, Bedel C, Karancı Y, Avcı A, Duyan M. Accuracy of Alvarado, Eskelinen, Ohmann, RIPASA and Tzanakis scores in diagnosis of acute appendicitis; a cross-sectional study. Archives of academic emergency medicine. 2020;8(1).