Comparison of the reliability of scoring systems in the light of histopathological results in the diagnosis of acute appendicitis

Abstract

Background: Acute appendicitis is a very common surgical emergency. Early and correct diagnosis and early intervention are necessary to prevent complications. It is often diagnosed on clinical signs and a certain ratio of negative appendectomy is acceptable. For early and accurate diagnosis, various scoring systems such as Alvarado, Ohmann, Eskelinen and more recently Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) have been developed. Objective: In this study, we aimed to compare the effectiveness and accuracy of scoring systems. Materials and methods: The patients who attended emergency department and operated with acute appendicitis pre-diagnosis were evaluated retrospectively. Alvarado, Ohmann, Eskelinen, and RIPASA scores were calculated and compared with histopathologic results by reviewing the patient files. Results: A total of 76 patients (44 males and 32 females) were included in the study. The mean age was 33.8 ± 13.2 years. Of which, 59 patients (77.6%) were diagnosed to have acute appendicitis on histopathological examination. The mean leukocyte count was 13.9 ± 3.7 × 103 μL. Sensitivity and specificity of Alvarado, Ohmann, Eskelinen, and RIPASA were 36%–82%; 58%–71%; 36%–8%, and 68%–71%, respectively. Cut-off values were 8, 14, 55.63, and 10, respectively. RIPASA had the highest accuracy. The cut-off value of leukocyte counts was 13,900 × 103/μL. Sensitivity and specificity were 64% and 88%, respectively; positive predictive value was 95%. In the receiver operating curve analysis, the area under the curve was found to be 74%. Conclusion: The RIPASA scoring system is a more reliable scoring system than Ohmann, Eskelinen, and Alvarado scoring systems. In cases of suspected acute appendicitis, it may be useful to evaluate patients with RIPASA score in emergency departments by general practitioners, where there is no general surgeon. Thus, patients can be guided in a timely manner to reduce the complications that may arise from delays. The cut-off value of 13,900 × 103/μL is an important marker for the presence of acute appendicitis.

RIPASA Score in Diagnosis of Acute Appendicitis: To What Extent Is It Accurate?

“…Many studies [14,15,16,17] had documented the sensitivity of RIPASA score taking into consideration a cut-off value of 7.5 and reported a range from 95.5% up to 98.5 % and this is going with the results of the current study which reposted sensitivity of 96.4%. However, this was much higher than Korkut et al [18] and Ozdemir et al [19] , who reported sensitivity of 75% and 68%, respectively. This is assumed to the smaller sample size of their study and the higher cut-off value as they considered 12 and 10, respectively, while 7.5 was the significant cut-off value in the present study.…”

Comparison of the RIPASA and Labeda Scoring Systems to Assess the Morphological Severity of Acute Appendicitis

“…The use of a scoring system can assist in diagnosis and ensure prompt and appropriate therapy [10], [17] This study showed that subjects identified as high probability and undergoing emergency surgery generally had complicated appendicitis (64.4%). [19] and Karapolat [11] showing a significant relationship between RIPASA scores and histopathological findings. The RIPASA score is an inexpensive, simple, noninvasive, and rapid scoring system.…”

Evaluation of the Ohmann Scoring System in the Diagnosis of Acute Appendicitis in Al-Yarmouk Teaching Hospital

“…Zielke A. etal 1999 carried a study in Germany to validate of the Ohmann score concluded that it has sensitivity (63%), specificity (93%), positive predictive value (77%) and negative predictive value (86%) (19) . Unal Ozdemir Z et al, study 2019 in Turkey found that the sensitivity of Ohmann scoring system was 58% and specificity was 71% (20) . Koppad SN et al, 2016 in Indian study indicated Sensitivity of 96%, specificity 66.7%, positive predictive value 82.8% and negative predictive value of 90.9% (21) .…”