Clinico sonological and laboratory co-relation with histopathology of acute appendicitis to develop new diagnostic scoring system (Yash scoring system)

Abstract

Background: Of the many scoring systems currently available, the modified Alvarado scoring system (MASS) is the most widely employed, because of its ability to reduce negative appendectomy rate (NAR). Unfortunately, this system is more accurate in western population. In spite of the advances in the diagnostic and imaging techniques NAR have not decreased much. This clearly indicates the need of development of new diagnostic scoring system so we have developed new diagnostic scoring system (Yash Score). The objective of this study was to develop and study diagnostic accuracy of new diagnostic scoring system (Yash scoring system) for acute appendicitis.Methods: A prospective comparison YSS and MASS was done on 418 patients. Depending on clinical judgement appendicectomy was done. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for YSS and MASS were calculated using SPSS 17.0 statistical software for statistical analysis and compared using Chi-square test.Results: The sensitivity and specificity of YSS was found to be 99.48 per cent and 92.86 percent respectively. The sensitivity and specify of MASS was 52.05 per cent and 100 per cent respectively. The positive predictive value and negative predictive value of YSS was 99.48 per cent and 92.86 per cent respectively. Negative and positive predictive values of MASS were 13.02% and 100% respectively.Conclusions: Comparison in between YSS and MASS in the present study shows significant statistical difference.

Yash Scoring System in the Diagnosis of Acute Appendicitis

“…The most common incision used in open appendectomy was Mc Burney's in about 83% of cases followed by the right Para median which was used in 17% of cases. Similarly, in the study done by Lamture YR et al [12] the most common incision used was Mc Burney's in 94.74% of patients followed by right Para median in 5.26% of cases. In our present study, 35 out of 50 patients (70%) had inflamed appendix intra-operatively.…”

“…The present study was undertaken in the department of surgery, Jawaharlal Nehru Medical College, Wardha in collaboration with Datta Meghe Medical College Hingana, Nagpur, Datta Meghe Institute of medical science (DMIMS), Sawangi, Meghe, Wardha, Maharashtra India. • White blood cell count > 10,000 mg/dl =2 points • C-reactive protein (> 15mg/dl) = 3 points • Ultrasonography = 4 points A score of 7 or more is suggestive of acute appendicitis requiring surgery [12].…”

“…The study done by Lamture YR et al [12] in India on the Yash scoring system reveals a sensitivity of 99.48%, a specificity of 92.86%, PPV of 99.48%, and NPV of 92.86%.Though the validity of the Yash scoring system is promising for the Indian population, its only disadvantage was in the mode of a single study.…”

Tzanakis Scoring System in Acute Appendicitis Concern to Indian Population

“…The clinical evaluation is reliable in 50% to 80% of cases. The evaluation is more complex in the extremes of age and women of reproductive age group due to atypical presentations [12,13].…”

Sherren`s triangle hyperaesthesia a tool to rule out complicated appendicitis

“…It was described by the English surgeon James Sherren. 5 Hyperesthesia in Sherren's triangle was the first parameter included to broaden the diagnostic kit by Yash et al 6 This sign was having good sensitivity (47.69%) and PPV (92.08%). They offered score of 1 in Yash scoring system as per its probability and odd`s ratio, in their study positive and negative predictive value of modified Alvarado score (mass) were 13.02% and 100% respectively.…”