Can clinical scoring systems improve the diagnostic accuracy in patients with suspected adult appendicitis and equivocal preoperative computed tomography findings?

Chae, Min Seok; Hong, Chong Kun; Ha, Young Rock; Chae, Minjung Kathy; Kim, Young Sik; Shin, Tae Yong; Ahn, Jung Hwan

doi:10.15441/ceem.16.168

Cited by 11 publications

(11 citation statements)

References 19 publications

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“…It has been reported in previous studies that scoring systems reduce NARs or increase diagnostic accuracy. These scoring systems include Alvarado [10,24] RIPASA, [25] Ohmann, [14] Eskelinen, [26] Lintula [27] and Adult Appendicitis Score. [28] However, the number of studies in which these systems were evaluated on a large scale and with imaging methods was quite limited.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasonography and Scoring Systems: The Effect on the Negative Appendectomy Rate and Gender

Şenocak

Kaymak

2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Despite the development of clinical, laboratory, and imaging methods, the diagnosis of acute appendicitis is not always easy, and negative appendectomy rates are still high. This study aims to reveal the effects of different scoring systems on the diagnostic accuracy of acute appendicitis and negative appendectomy rates, alone or when evaluated together with ultrasonography. METHODS: In this study, 202 consecutive patients who underwent emergency appendectomy for acute appendicitis were included. Clinical scores of all patients were preoperatively calculated using Ohmann, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), Lintula, Eskelinen, and Alvarado scoring systems. Abdominal ultrasonography (USG) was performed randomly in all cases. The sensitivity and specificity of scoring systems were calculated according to the threshold values. The area under the curve (AUC) was calculated using ROC analysis. In the regression model, histological diagnosis of appendicitis was used as the dependent variable, while scoring systems and USG were preferred as independent variables. RESULTS: The negative appendectomy rate was 15.8%. In the diagnosis of acute appendicitis, Ohmann was the most predictive for both genders (DOR=24.2, 95% CI 6.98-84.44). Similarly, the lowest negative appendectomy rates were obtained with the Ohmann score as 6.9% in females and 3.4% in males. When the scores were combined with USG, the rate of diagnostic accuracy for acute appendicitis was not increased. However, when Ohmann and USG were combined, negative appendectomy rates were further reduced for women from 6.9% to 4%. CONCLUSION: In addition to being a good diagnostic predictor of acute appendicitis in male and female patients, Ohmann score provides the best negative appendectomy rates. The combination of USG and scoring systems does not increase the diagnostic accuracy of acute appendicitis. However, negative appendectomy rates are significantly reduced when the USG and Ohmann scale are used together in females, while this reduction is minimal in men.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasonography and Scoring Systems: The Effect on the Negative Appendectomy Rate and Gender

Şenocak

Kaymak

2020

Ulus Travma Acil Cerrahi Derg

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“…[3,9–11,13] Unfortunately, the diagnostic power of the previous clinical scoring systems were less accurate (0.5 < AUC ≤ 0.7, Alvardo score; 0.698, AIR; 0.668, RIPASA; 0.653) to moderately accurate (0.7 < AUC ≤ 0.9, Eskelinen; 0.710, AAS; 0.726) clinically. [19] Furthermore, 74.1% to 94.1% of patients with suspected AA were categorized under an intermediate probability group and therefore, the scoring systems were of limited use in establishing accurate diagnosis. [19] However, under the new model, the results provided diagnostic and treatment decisions (surgery or discharge) in 59 (24.2%) out of 244 patients.…”

Section: Discussionmentioning

confidence: 99%

“…The scoring systems were selected based on their performance in predicting AA in patients with equivocal CT findings in a previous study. [19] The parameters used to calculate the Alvarado score, Eskelinen score, and AAS were obtained from patient medical records and laboratory report systems. Patient demographics, history, and urinalysis results were also collected.…”

Section: Methodsmentioning

confidence: 99%

“…In the study that evaluated the diagnostic power of these scoring systems on equivocal AA, the scores were found to be less accurate than other studies. [5,14–16,18,19] Therefore, if patients with suspected AA and equivocal CT findings are classified as a third group, the previous scoring systems may not be accurate for AA diagnosis. Therefore, a new scoring system or method is needed.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the diagnostic performance of a decision tree model in suspected acute appendicitis with equivocal preoperative computed tomography findings compared with Alvarado, Eskelinen, and adult appendicitis scores

Kang

Kim

et al. 2019

Medicine

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This study evaluated the diagnostic performance of a new clinical approach based on decision tree (DT) analysis in adult patients with equivocal computed tomography (CT) findings of acute appendicitis (AA) compared with previous scoring systems.This retrospective study of 244 adult patients with equivocal CT findings included appendicitis (AG, n = 80) and non-appendicitis (NAG, n = 164) groups. The chi-squared automatic interaction detection algorithm was for AA prediction. A receiver operating characteristic curve analysis and area under the curve (AUC) were used to compare the DT analysis with Alvarado, Eskelinen score, and adult appendicitis scores (AAS).The following factors were selected for AA prediction: rebound tenderness severity, migration, urinalysis, symptom duration, leukocytosis, neutrophil count, and C-reactive protein levels. The DT comprised 11 final nodes with the following AA probabilities: node 1, 100% (16/16); node 2, 90% (9/10); node 3, 80% (8/10); node 4, 60.9% (14/23); node 5, 50% (3/6); node 6, 43.8% (7/16); node 7, 22.6% (12/53); node 8, 13% (10/77); node 9, 5.6% (1/18); node 10, 0% (0/12); and node 11, 0% (0/3). The AUC of the DT was higher (0.850 [95% confidence interval {CI}; 0.799–0.893]) than the Alvarado score (0.695 [95% CI; 0.633–0.752]), AAS (0.749 [95% CI; 0.690–0.802]), and the Eskelinen score (0.715 [95% CI; 0.654–0.770]). The results were statistically significant when compared with the AUCs of the Alvarado score, Eskelinen score, and AAS (P < .001, P < .001, P = .003, respectively).The DT-based approach facilitated AA diagnosis and determination of clinical status in patients with equivocal preoperative CT findings and ambiguous results.

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“…Many of the studies have documented utilization AS, and compared its scoring with CT and surgical outcomes. [23][24][25] Better clinical assessment and higher scores may help to avoid unnecessary CT examinations. 25 However, this may not be true in difficult cases and further imaging may be warranted to establish a diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of CT Scan in Diagnosing Acute Appendicitis in Patients with Low Alvarado Scores

Waheed¹,

Shah²,

Alshehri³

et al. 2019

jemds

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BACKGROUND Alvarado score has been routinely used in clinical practice for assessing the probability of acute appendicitis in patients presenting with right lower quadrant abdominal pain. Computed tomography can be used for equivocal or difficult cases. We wanted to evaluate role of computed tomography (CT) in patients with low or equivocal Alvarado scores. METHODS This is a retrospective, observational study conducted in the Department of Radiology at our Hospital in Dhahran from October 2017 to October 2018. 138 patients with equivocal Alvarado scores (AS, 4-6) and negative (non-conclusive or limited) ultrasounds, were retrospectively reviewed. Pregnant, postoperative (bowel surgery) cases and chronic appendicitis cases were excluded. Diagnosis of acute appendicitis on CT was based on a thickened or fluid dilated appendix (diameter > 6mm, wall enhancement) with at least one of the associated findings (like appendicolith, peri-appendiceal fat stranding, free fluid, extra-luminal air foci, caecal base thickening and mesenteric lymph nodes). Imaging findings were reviewed by two radiologists and consensus reporting was made. Findings on CT were categorized as AA (Acute Appendicitis), OD (Other Diagnosis) and NOR (Normal). Surgical candidates were confirmed on histopathology, while nonsurgical cases were followed up on either imaging or clinical grounds. Chi-square test was used to determine association. The main outcome measure was diagnosis on CT and histopathology. RESULTS 29.7% (41 patients) were found to have acute appendicitis on CT imaging. Majority of patients with AS of 5 were having OD, while most of AA cases were having AS of 6. All patients with AS of 4 were having normal CT scans. CONCLUSIONS Computed tomography helps to diagnose acute appendicitis or establish an alternate diagnosis in patients with equivocal Alvarado scores.

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Can clinical scoring systems improve the diagnostic accuracy in patients with suspected adult appendicitis and equivocal preoperative computed tomography findings?

Cited by 11 publications

References 19 publications

Diagnostic Accuracy of Ultrasonography and Scoring Systems: The Effect on the Negative Appendectomy Rate and Gender

Diagnostic Accuracy of Ultrasonography and Scoring Systems: The Effect on the Negative Appendectomy Rate and Gender

Evaluation of the diagnostic performance of a decision tree model in suspected acute appendicitis with equivocal preoperative computed tomography findings compared with Alvarado, Eskelinen, and adult appendicitis scores

Usefulness of CT Scan in Diagnosing Acute Appendicitis in Patients with Low Alvarado Scores

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