Relevance of scoring systems in acute appendicitis
DOI:
https://doi.org/10.18203/2349-2902.isj20192977Keywords:
Acute appendicitis, Clinical scoring systems, Izbicki, TeicherAbstract
Background: Acute appendicitis continues to be a clinical dilemma, despite the addition of myriad diagnostic modalities to the surgeon’s arsenal. A reliable scoring system would help streamline diagnosis as well as avoid unnecessary surgeries, in a limited resource setting.
Methods: Retrospective observational study evaluating 2 clinical scoring systems for acute appendicitis.
Results: For Teicher and Izbicki scores, a sensitivity of 49.5% and 55.71%, specificity of 63.41% and 51.22%, positive predictive value of 92.22% and 90.90%, negative predictive value of 12.56% and 11.67%, negative appendicectomy rate of 8.82% and 10% were found respectively.
Conclusions: Acute appendicitis is one of the most common cases presenting to the general surgeon and its diagnosis continues to be clinical enigma, owing to a variety of presentations, degrees of severity and differential diagnoses. Our study shows that Teicher and Izbicki scoring systems can be of value in decision making in acute appendicitis and in reducing the number of negative laparotomies, particularly in limited resource settings where access to advanced diagnostic modalities is limited and expensive. Amongst the two scoring systems, the Teicher score appears to be superior in reducing the negative appendicectomy rate.
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References
Chan MY, Tan C, Chiu MT, Ng YY. Alvarado score: an admission criterion in patients with right iliac fossa pain. Surgeon. 2003;1(1):39-41.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25.
Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study. Ann Surg. 1995;221(3):278-81.
Field S, Marrison L. Acute Abdomen. In: Sutton D. Textbook of Radiology and Imaging. 7th ed. Chruchill Livingston; 2003:685.
Khan MN, Davie E, Irshad K. The role of white cell count and C-reactive protein in the diagnosis of acute appendicitis. J Ayub Med Coll Abbottabad. 2004;16(3):17-9.
Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg. 2002;137(7):799-804.
Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg. 1995;161(4):273-81.
Ohmann C, Franke C, Yang Q. Clinical benefit of a diagnostic score for appendicitis: results of a prospective interventional study. German Study Group of Acute Abdominal Pain. Arch Surg. 1999;134(9):993-6.
Lindberg G, Fenyo G. Algorithmic diagnosis of appendicitis using Bayes’ theorem and logistic regression. In: Bernardo JM, DeGront MH, Lindley DV, Smith AF, editors. Bayesian statistics. 3rd ed, Oxford University Press; 1988: 665-668.
Teicher I, Landa B, Cohen M, Kabnick LS, Wise L. Scoring system to aid in diagnoses of appendicitis. Ann Surg. 1983;198(6):753-9.
Izbicki JR, Wilker DK, Mandelkow HK, Müller K, Siebeck M, Geissler K, et al. Retro- and prospective studies on the value of clinical and laboratory chemical data in acute appendicitis. Chirurg. 1990;61(12):887-93.
Christian F, Christian GP. A simple scoring system to reduce the negative appendicectomy rate. Ann R Coll Surg Engl. 1992;74(4):281-5.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.
Dhall JC, Marwah S, Soni S, Marwah N. Simple scoring system for reduction of negative appendicectomy rate. The Ind Pract. 1998;51:854-6.
Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI. Evaluation of the Alvarado score in acute appendicitis. J R Soc Med. 1992;85(2):87-8.
Ohle R, Oreilly F, Obrien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: A systematic review. BMC Medicine. 2011;9(1).
Bond GR, Tully SB, Chan LS, Bradley RL. Use of The MANTRELS score in childhood appendicitis: a Prospective study of 187 children with abdominal Pain Annals Emerg Med. 1990;19(9):1014-8.
Hsiao KH, Lin LH, Chen DF. Application of the mantrels scoring system in the diagnosis of acute appendicitis in children. Acta paediatrica Taiwan. 2005;46(3):128-31.
Chan MY, Teo BS, Ng BL. The Alvarado score and acute appendicitis. Ann Acad Med Singapore. 2001;30:510-2.
Owen TD, William H, Stiff G, Jenkinson LR, Recs BI. Evaluation of Alvarado score in acute appendicitis. J R Soc Med. 1992;85:87-9.
Reza F. Saidi, Mitra Ghasemi. Role of Alvarado Scoring in diagnosis and treatment of suspected acute appendicitis. Am J Emerg Med. 2000;18:230-1.
Subramaniyan P, Iyer SP. Evaluation of accuracy of four clinical scores and comparison with ultrasonography for diagnosis of acute appendicitis. Int Surg J. 2017;4:1940-4.
Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl. 1994;76(6):418-9.
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