Evaluation of the efficiency of four different scoring systems in the diagnosis of acute appendicitis

YILMAZ M., Evaluation of the Efficiency of Four Different Scoring Systems in the Diagnosis of Acute Appendicitis, Recidency Thesis, Gaziantep University Faculty of Medicine, Department of General Surgery, Gaziantep, 2022. After the approval of the ethics committee on 06.04.2022, preoperational anamnesis, physical examination findings, laboratory results and imaging methods of 115 patients who were operated with the preliminary diagnosis of acute appendicitis (AA) between April 2022 and June 2022 were recorded prospectively. Based on these collected data, the efficacy of four scoring systems (Alvarado, Lintula, RIPASA and Tzanakis), laboratory values of WBC and CRP, and imaging methods of USG and CT alone were evaluated and compared in the diagnosis of acute appendicitis. The obtained data were analyzed using the SSPS for Windows version 24.0 statistical program. Of the patients, 62 (53.9%) were male and 53 (46.1%) were female. The mean age of 115 patients included in the study was 32.68 years (18-77).Postoperative pathology results diagnosed 94 (81.7%) patients with acute appendicitis. The appendix was normal in 21 (18.2%) patients (negative appendectomy). Increased WBC values was found to be the most precise and valuable test in the diagnosis of AA among all other laboratory tests, imaging methods and scoring methods. In all of the complicated cases and 97% of other cases diagnosed with AA, one or both of WBC and CRP were found to be significantly elevated. USG was performed in 61 patients. CT with IV contrast was performed for patients whose appendix could not be visualized on USG and for patients who were clinically suspicious, complicated or required differential diagnosis. CT had an accuracy rate of 80%. For diagnosing AA, Alvarado, RIPASA, Lintulascorings were all similar in terms of sensitivity, specificity, PPV and NPV, which consistent with the literature. Conversely Tzanakis scoring system were less accurate which was attributed to the low sensitivity of the USG parameters and dependence on the physician who performing it. According to these results, it was concluded that scoring systems other than the Tzanakis, can be used in the diagnosis of AA in our population. The Tzanakis scoring system was thought to be a successful if the USG measurements was performed by an experienced radiologist. While physical examination and laboratory findings have an important place in the diagnosis of AA, they are not superior to imaging methods. USG is useful in cases where the diagnosis cannot be made based on scoring systems. CT can be helpful in differential diagnosis and in cases where USG is not sufficient. Instead of wasting time with CT and USG in places where these modalities cannot be performed, the operation decision should be taken based on the physical examination and laboratory findings, relying on the surgeon's experience. Keywords: Acute Appendicitis, Alvarado Score, Lintula Score, RIPASA Score, Tzanaksi Score.