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

Abstract

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.

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

“…Specificity of RIPASA score in the current study was 75% which matched with the results of Odzemeir et al [19] and Akbar et al [15] . However, it was much higher than those reported by Dezfuli et al [20] and Şenocak et al [21] who reported 46.5% and 37.5 %, respectively, and this is assumed to be due to large number of false negative cases reported in their study also it was less than what reported by Korkut et al 18] , who reported 99.7 % specificity and this can be explained by higher cut-off value in their study which was 12.…”

Diagnostic Markers in Acute Appendicitis: A Systematic Review

“…Despite the relatively high incidence of needless appendectomies, ranging from 20% to 30%, such occurrences are deemed tolerable given the substantial reliability of beneficial outcomes. 8,9 The current study unveiled the presence of diagnostic markers in acute appendicitis.…”

Imaging of Appendicitis: A Systematic Review

“…Due to the reliability of positive values, needless appendectomies (20-30%) are permissible. [5][6][7] Delaying diagnosis and treatment can result in gangrene perforation and diffuse peritonitis. This makes radiological examinations easy to carry out with good sensitivity and specificity.…”