A Comparative Analysis of the Diagnostic Accuracy of Appendicitis Scoring Systems Using Histopathology as the Gold Standard

Unaiza Erum, Rabia Feroz, Aisha Gul, Erum Kazim, Imrana Zulfikar, Omer Bin Khalid

Abstract

Objective

To compare the diagnostic accuracy of Alvarado, Eskelinen, Ohmann, RIPASA and Tzanakis scores for the diagnosis of acute appendicitis by taking histopathology as gold standard.

Study design

Cross sectional analytic study.

Place & Duration of study

Department of General Surgery, Dr Ruth Km Pfau Civil Hospital, Dow University of Health Sciences Karachi, from October 2023 to May 2024.

Methods

Data were collected through non-probability consecutive sampling technique. The sample size was calculated as 107.  Patients suspected of having acute appendicitis and meeting the inclusion criteria were enrolled. A detailed history and physical examination were performed. All patients had ultrasound scan and abdominal computed tomography (CT) scan. 

Results

The mean age of the patients was 32.5±8.2 years. Gender distribution revealed a predominance of females (n=60 - 56.1%). The RIPASA score demonstrated the highest sensitivity of 90% and specificity of 80% with positive predictive value (PPV) of 95%. The Alvarado score showed a sensitivity of 80% and specificity of 70% with PPV of 85%.

Conclusion

The diagnostic accuracy of Alvarado, Eskelinen, Ohmann, RIPASA, and Tzanakis scores varied significantly in patients suspected of having acute appendicitis. Among these scores, RIPASA, Ohmann, and Alvarado scores in descending order, demonstrated higher sensitivity and specificity.

Key words

Appendicitis, Diagnostic accuracy, Abdominal pain, Eskelinen score, RIPSASA score, Alvarado score, Ohmann score.