Published: 2019-05-28

A comparison of Tzanakis and Alvarado scoring system in the diagnosis of acute appendicitis

R. Anupriya, C. P. Ganesh Babu, K. V. Rajan


Background: Appendicitis is the most common abdominal emergency worldwide. Lifetime risk of acute appendicitis is 8.6% and 6.7% for man and women respectively. Clinical examination is helpful in diagnosis of acute appendicitis in only 70-87% of the cases. To compare Tzanaki and Alvarado scoring system in diagnosing acute appendicitis.

Methods: This was a prospective, comparative, cross-sectional study, which was conducted at the Mahatma Gandhi Medical College and Research Institute Hospital. Patients with acute appendicitis were included in the study. Relevant history, examination and laboratory investigations done. Patients were scored according to both Alvarado scoring system and Tzanakis scoring, and both were documented in the proforma. Sensitivity, specificity, positive predictive value, negative predictive value were assessed and compared for both scoring systems.

Results: 70 patients were included in this study. 54.3% of patients have Tzanakis score more than 8. 35.7% of patients have Alvarado score more than 7. 82.9% of patients had evidence of appendicitis in histopathological examination. Tzanakis score: sensitivity– 65.52%, specificity- 100%, PPV–  100%, NPV– 37.50%, accuracy– 71.43%. Alvarado score: sensitivity– 36.21%, specificity– 66.67%, PPV- 84%, NPV– 17.78%, accuracy– 41.43%.

Conclusions: Tzanakis scoring system is an effective scoring system in diagnosing acute appendicitis.


Acute appendicitis, Alvarado score, Tzanakis score

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Balsano N, Cayten CG. Surgical emergencies of the abdomen. Emerg Med Clin North Am. 1990;8(2):399-410.

Flum DR, Morris A, Koepsell T. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001;286(14):1748-53.

Detmer DE, Nevers LE, Sikes ED. Regional results of acute appendicitis care. JAMA. 1981;246(12):1318-20.

Ellis H, Nathanson LK. Appendix and Appendicectomy. In: Maingots Abdominal Operations. 10th Ed.

Balsano N, Cayten CG. Surgical emergencies of the abdomen. Emerg Med Clin North Am. 1990;8(2):399-410.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.

Tzanakis NE, Efstathiou SP, Danulidis K, Rallis GE, Tsioulos DI, Chatzivasiliou A, Peros G, Nikiteas NI. A new approach to accurate diagnosis of acute appendicitis. World J Surg. 2005;29(9):1151-6.

Suresh BK, Savitha S. A study on acute appendicitis in a tertiary care hospital in Tamil Nadu, India. Intern Surg J. 2017;4(3):929.

Memon ZA, Irfan S, Fatima K, Iqbal MS, Sami W. Acute appendicitis: diagnostic accuracy of Alvarado scoring system. Asian J Surg. 2013;36(4):144-9.

Sigdel GS, Lakhey PJ, Mishra PR. Tzanakis score vs. Alvarado score in acute appendicitis. JNMA J Nepal Med Assoc. 2010;49(178):96-9.

Shashikala V, Hegde H, Victor A. Comparative study of Tzanakis score vs Alvarado score in the effective diagnosis of acute appendicitis. I J Biomed Advance Res. 2016;7(9):418.

Lakshminarasimhaiah A, Nagaraja A, Srinivasaiah M. Evaluation of Tzanakis scoring system in acute appendicitis: a prospective study. I Surg J. 2017;4(10):3338.

Raja A, Wright C, Sodickson A. Negative Appendectomy Rate in the Era of CT: An 18-year Perspective. Radiol. 2010;256(2):460-5.

Joshi MK, Joshi R, Alam SE, Agarwal S, Kumar S. Negative Appendectomy: an Audit of Resident-Performed Surgery. How Can Its Incidence Be Minimized? Indian J Surg. 2014;77(3):913-7.

Hsiao KH, Lin LH, Chen DF. Application of the Mantrels scoring system in the diagnosis of acute appendicitis in children Actapaediatrica Taiwanica. 2005;46(3):128-31.

Rezak A, Abbas HMA. Decreased use of computed tomography with a modified clinical scoring system in diagnosis of pediatric acute appendicitis Archives of surgery (Chicago, Ill: 1960). 2011;146(1):64-7.