Akut Apandisit Tanısında Dört Farklı Skorlama Sisteminin Etkinliğinin Değerlendirilmesi

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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