Diagnostic effectiveness study to determine which scoring system is more accurate, reliable and useful by comparing Tzanakis, RIPASA and Alvarado scoring systems used in the diagnosis

Introduction and purpose: Acute appendicitis (AA) is one of the most common abdominal pathologies requiring emergency surgery. Delay in diagnosis increases the risk of perforation and morbidity, while early diagnosis may reduce negative appendectomy rates. Various clinical scoring systems have been developed in this regard. The aim of this study is to compare the diagnostic success of Tzanakis, RIPASA and Alvarado scoring systems in patients who applied to the Emergency Department of Van Yuzuncu Yil University Dursun Odabas Medical Center and were diagnosed with acute appendicitis. Materials and Methods: The study is prospective, descriptive and comparative in nature and was conducted on the data of 56 patients who applied to the emergency department with a diagnosis of AA between 16.09.2024 and 16.04.2025. Demographic information, clinical symptoms, laboratory values, imaging results and pathology reports of all patients were evaluated. Statistical information of the patients was presented; Tzanakis, RIPASA and Alvarado scores were calculated separately for each patient and the compatibility of each system with the pathology results was analyzed. MS Excel and SPSS programs were used for the analyses. Results: The pathology results of all patients are compatible with AA. The AA diagnostic score limit for Tzanakis is 8 and above, for RIPASA 7.5 and above, and for Alvarado 7 and above. The minimum score for Tzanakis is 4, the maximum score is 15, and the average score is 10.6. The minimum for RIPASA is 5, the maximum is 15, and the average score is 10.5. The minimum for Alvarado score is 2, the maximum is 10, and the average is 7. When the diagnostic success of the algorithms is examined, Tzanakis has 76.79% (N=43), RIPASA has 91.07% (N=51), and Alvarado has 67.86% (N=38). Accordingly, the highest success rate belongs to RIPASA, while the lowest success rate belongs to Alvarado. Conclusion: The highest diagnostic success was achieved with the RIPASA scoring system (91.07%), followed by Tzanakis (76.79%) and Alvarado (67.86%). It was observed that right lower quadrant pain, tenderness and rebound findings were present in 100% of the patients diagnosed with AA by all algorithms simultaneously. This shows that these findings are core symptoms with high diagnostic value. Only one case was found that all three algorithms evaluated as "not AA" at the same time. This supports that the scoring systems generally exhibit similar diagnostic approaches. Opinions on the usability of the scoring systems and suggestions for future studies are presented.