Diagnostic performance of Alvarado versus Karaman scoring systems in acute appendicitis: A retrospective comparative study
Abstract
Aims: Acute appendicitis (AA) is the most common cause of acute abdomen requiring surgical intervention. This study aimed to compare the diagnostic accuracy and consistency of the classic Alvarado score, which is widely used worldwide in the diagnosis of AA, with the more recently introduced Karaman score.
Methods: A retrospective analysis was conducted on 101 patients who underwent appendectomy with a preliminary diagnosis of AA in a tertiary hospital between December 2020 and December 2021. Demographic data, clinical findings, laboratory parameters, preoperative Alvarado and Karaman scores, and histopathological results of the patients were analyzed. The diagnostic performance of the scores was evaluated using ROC analysis (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Results: The mean age of the study group was 35.8 ± 13.8 years, with 61.4% males and 38.6% females. Histopathologically, the rate of AA was 92.1%, and the negative appendectomy rate was 7.9%. In the ROC analysis, while the Alvarado score (AUC: 0.657) showed slightly higher discriminative power compared to the Karaman score (AUC: 0.651), both systems demonstrated "moderate" performance. At the Alvarado score threshold, 100% specificity and 100% PPV were achieved; however, sensitivity was found to be 28.0% at this threshold. In logistic regression analysis, both Alvarado (OR: 1.48, p=0.024) and Karaman (OR: 1.18, p=0.031) scores were determined to be independent predictors for predicting AA. A strong positive correlation (r=0.773, p<0.001) was detected between the two scoring systems.
Conclusion: Alvarado and Karaman scoring systems are reliable auxiliary tools that support the surgeon in the diagnosis of AA. The full specificity provided by the Alvarado score at its threshold supports the conclusion that these patients can be directed to surgery without the need for advanced imaging. However, the moderate overall accuracy rates of the scores indicate that an approach based solely on scoring may be insufficient; a comprehensive strategy integrating clinical examination, biochemical markers, and imaging methods (USG/CT) should be implemented for definitive diagnosis.
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Ethical Statement
References
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Details
Primary Language
English
Subjects
Surgery (Other)
Journal Section
Research Article
Authors
Aydın Dincer
0000-0002-0662-512X
Türkiye
Onur İlkay Dinçer
0000-0001-8956-351X
Türkiye
Kemal Eyvaz
0000-0002-7410-107X
Türkiye
Nedim Akgül
0000-0002-7003-7883
Türkiye
Publication Date
September 27, 2026
Submission Date
June 16, 2026
Acceptance Date
September 25, 2026
Published in Issue
Year 2026 Volume: 6 Number: 3