Komplike Olmayan Apandisit Ayırımında Kullanılan Bir Puanlama Sisteminin Geçerliliği ve Etkinliği

Öz

Amaç: Komplike-komplike olmayan apandisit vakalarını ayırt etmek için çeşitli parametreler kullanılmakta ve hatta bu parametrelerin birlikte kullanıldığı skorlama sistemleri oluşturulmaktadır. Bu çalışmanın amacı, bu puanlama sistemlerinden birinin etkinliğini dış doğrulama ile değerlendirmektir.

Yöntemler: Ocak 2018-Ocak 2021 tarihleri arasında apendektomi yapılan hastaların klinik, radyolojik ve laboratuvar bulguları retrospektif olarak değerlendirildi. Görüntüleme sonucunda akut apandisit düşünülen her hasta için daha önce tanımlanan skorlama sistemleri kullanılarak skorlama yapıldı. Klinik ve patolojik değerlendirme sonuçlarına göre komplike apandisit ve komplike olmayan apandisit gruplarına ayrıldılar.

Bulgular: 425 hasta değerlendirilirken hastaların %48'inde ultrasonografi, %52'sinde tomografi kullanıldı. Tomografi kullanan grupta ≤6 puanın anlamlı etkinliği gözlendi (p<0,001, EAA: 0.838, Duyarlılık %83,3, pozitif öngörü değeri %50,8, özgüllük %84,3, negatif öngörü değeri %96,3). Ultrasonografi grubunda ≤5 skorunun anlamlı etkinliği gözlendi (p<0,001, EAA: 0.790, Duyarlılık %85,7, pozitif prediktif değer %39,0, spesifisite %72,2, negatif prediktif değer %96,1).

Sonuç: Komplike olmayan apandisit vakalarının seçimi için oluşturulan puanlama sisteminin etkili olduğu gösterilmiştir ve harici olarak doğrulanmıştır. Skorlama sisteminde kullanılan parametrelerin her biri bağımsız etkinliğinden daha yüksek verimliliğe sahip olduğundan; klinik, radyolojik ve laboratuvar değişkenlerini bir arada değerlendiren skorlama sistemleri klinik uygulamada daha iyi sonuçlar vermektedir.

Anahtar Kelimeler

• Akut apandisit
• Komplike apandisit
• Komplike olmayan apandisit
• Skorlama sistemi
• Ultrasonografi
• Tomografi

Validation and Efficiency of a Scoring System Used in the Differentiation of Uncomplicated Appendicitis

Öz

Aim: Various parameters are used to differentiate between complicated-uncomplicated appendicitis cases and even scoring systems are created where these parameters are used together. The aim of this study is to evaluate the effectiveness of one of these scoring systems by external validation.

Method: Retrospective evaluation was performed on the clinical, radiological and laboratory findings of patients who underwent appendectomy between January 2018 and January 2021. Scoring was performed using the previously described scoring systems for each patient considered to have acute appendicitis as a result of imaging. They were divided into complicated appendicitis and uncomplicated appendicitis groups according to clinical and pathological evaluation results.

Results: While evaluating 425 patients, ultrasonography was used in 48% and tomography in 52% of the patients. Significant effectiveness of the score of ≤6 was observed in the group using tomography (p<0.001, AUC: 0.838, Sensitivity 83.3%, positive predictive value 50.8%, specificity 84.3%, negative predictive value 96.3%). Significant effectiveness of the score of ≤5 was observed in the ultrasonography group (p<0.001, AUC: 0.790, Sensitivity 85.7%, positive predictive value 39.0%, specificity 72.2%, negative predictive value 96.1%).

Conclusion: The scoring system created for the selection of uncomplicated appendicitis cases has been shown to be effective and has been externally validated. Since each of the parameters used in the scoring system has higher efficiency than its independent effectiveness, scoring systems that evaluate clinical, radiological and laboratory variables together give better results in clinical practice.

Anahtar Kelimeler

• Acute appendicitis
• Complicated appendicitis
• Uncomplicated appendicitis
• Scoring system
• Ultrasonography
• Tomography

Kaynakça

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