Tzanakis Score vs Alvarado in Acute Appendicitis

INTRODUCTION: Acute appendicitis is a common surgical emergency. Accurate diagnosis and timely intervention reduces mortality and morbidity. This study compared the efficacy of Tzanakis and Alvarado score in diagnosis of acute appendicitis. METHODS: A prospective, non randomized study was conducted in 100 consecutive patients who had undergone emergency appendectomy from May 2008 to October 2008. Tzanakis and Alvarado scores were obtained at the time of admission. Final diagnosis of acute appendicitis was based on histological findings. RESULTS: The sensitivity, specificity and overall diagnostic accuracy of Tzanakis score was 91.48% and 66.66% and 90% respectively. The sensitivity, specificity and overall diagnostic accuracy of Alvarado score was 81.91% and 66.66% and 81% respectively. Negative appendectomy rate was 6%. CONCLUSIONS: Tzanakis score is an effective modality to establish the accurate diagnosis of acute appendicitis. Keywords: acute appendicities, Tzanakis score, Alvarado Score.

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A Comparative Study of Raja Isteri Pengiran Anak Saleha and Alvarado Scores to Diagnose Acute Appendicitis

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v19i1.1435 ◽

2021 ◽

Vol 19 (1) ◽

pp. 111-114

Author(s):

Uttam Pachya ◽

Sita Ram Shrestha ◽

Yagya Raj Pokharel ◽

Ambika Thapa

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Asian Population ◽

Final Diagnosis ◽

Negative Appendectomy ◽

Microsoft Excel ◽

Alvarado Score ◽

Generalized Peritonitis ◽

Sensitivity Specificity

Background: Acute Appendicitis is a clinical diagnosis with atypical presentation in young, elderly, females, genitourinary and gynecological conditions. Delayed appendectomy increases the risk of appendicular perforation, sepsis morbidity and mortality. Literature reports as high as 20-40% negative appendectomy. Raja Isteri Pengiran Anak Saleha score has come with higher sensitivity and diagnostic accuracy than Alvarado score in Asian population. This study aims to compare RIPASA and Alvarado score for diagnostic accuracy.Methods: Appendectomy patients at Patan Hospital from April to September 2014 were compared on raja isteri pengiran anak saleha (cut-off value 7.5 out of 15) and Alvarado score (cut-off value 7 out of 10). Final diagnosis was histopathology based. Microsoft Excel and SPSS 17 were used for analysing sensitivity, specificity and diagnostic accuracy of both scores. The study included patients who underwent appendectomy with histopathology report and excluded those with conservative management, generalized peritonitis, appendicular lump and abscess.Results: There were 88 appendectomy patients with median age 26 (18.25, 35) years, and male 52 (59.1%). Negative appendectomy was 10 (11.36%). Sensitivity and specificity of Raja Isteri Pengiran Anak Saleha 98.71% and 80.00% respectively, and for Alvarado 52.56% and 70%.The Raja Isteri Pengiran Anak Saleha score had statistically significant sensitivity (p=0.000). Positive Predictive value, Negative Predictive Value and diagnostic accuracy were 97.46%, 88.89% and 96.6% for RIPASA and 93.18%, 15.19% and 54.4% for Alvarado respectively.Conclusions: The Raja Isteri Pengiran Anak Saleha score had better diagnostic accuracy compared to Alvarado score for diagnosis of Acute Appendicitis.Keywords: Acute appendicitis; alvarado score; RIPASA score

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Comparison of Tzanakis Score vs Alvarado Score in the Effective Diagnosis of Acute Appendicitis

Kathmandu University Medical Journal ◽

10.3126/kumj.v12i1.13638 ◽

2015 ◽

Vol 12 (1) ◽

pp. 48-50 ◽

Cited By ~ 3

Author(s):

BR Malla ◽

H Batajoo

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Final Diagnosis ◽

Negative Appendectomy ◽

Alvarado Score ◽

Effective Diagnosis ◽

Sensitivity Specificity

Background Acute appendicitis is the most frequent surgical emergency encountered worldwide. This study was conducted to compare the efficacy of Tzanakis score and Alvarado score in diagnosing acute appendicitis.Objectives The aim of this study is to compare the efficacy of Tzanakis scoring system with Alvarado scoring system in diagnosing AA.Methods This was a retrospective and nonrandomized observational study conducted in Dhulikhel hospital. It included 200 clinically diagnosed cases of acute appendicitis who underwent emergency open or laparoscopic appendectomy during the year 2012. Final diagnosis of acute appendicitis was based on histological findings given by pathologist.Results The sensitivity, specificity, positive predictive value and negative predictive value of Tzanakis score was 86.9%, 75.0, 97.5% and 33.3% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of Alvarado score was 76.0%, 75.0%, 97.2% and 21.4% respectively. Negative appendectomy was 8.0%. Conclusion Tzanakis scoring system is an effective scoring system in diagnosing acute appendicitis.Kathmandu University Medical Journal Vol.12(1) 2014: 48-50

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A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective

Journal of Lumbini Medical College ◽

10.22502/jlmc.v6i2.264 ◽

2018 ◽

Vol 6 (2) ◽

Author(s):

Suman Baral ◽

Neeraj Thapa ◽

Raj Kumar Chhetri ◽

Rupesh Sharma

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Sensitivity Specificity

Introduction: Various diagnostic criteria have been described for acute appendicitis. For decades the most commonly used one has been Alvarado score. RIPASA scoring system has also been developed for Asian population which has shown highest sensitivity and diagnostic accuracy. This study aimed to compare these two diagnostic criteria in Nepalese population attending a tertiary center. Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination was taken as the gold standard for diagnosis. Statistical analysis was done using McNemar's test as applicable. Results: Ninety nine (90 %) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 94.5%, 27.27 %, 92.16 %, 37.5 %, 88.18% and 7.84% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 71.72%, 72.73 %, 95.95 %, 22.22%, 71.82 %, and 4.05 % respectively. 94.5% of patients were correctly stratified by RIPASA under higher probability group while only 71.8 % were classified by Alvarado (p value= 0.0001). Conclusion: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, this method can be applied in Nepalese setting for the diagnosis of acute appendicitis.

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Diagnosis and management of acute appendicitis by Alvarado scoring with ultrasonography as supportive tool

International Surgery Journal ◽

10.18203/2349-2902.isj20173423 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2806 ◽

Cited By ~ 1

Author(s):

Chenna Krishna Reddy Chada ◽

Srikrishna Malepati ◽

Jithendra Kandati ◽

Sreeram Satish

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Open Appendectomy ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Predictive Values ◽

Female Ratio ◽

Male Predominance ◽

Sensitivity Specificity

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Delay in management results in complications and misdiagnosis results in negative appendectomy. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. Alvarado score for diagnosis of acute appendicitis is an easy, affordable and diagnostic which has been evaluated early with variable reports. In cases with equivocal score, additional tools like sonography may provide a reliable result in accurate diagnosis of acute appendicitis. Objective of the study was to determine the diagnostic accuracy of Alvarado score and ultrasonography in diagnosis of acute appendicitis. To determine the sensitivity, specificity and predictive values of ultrasonography in cases operated with histopathological correlation.Methods: A prospective observational study was conducted at our hospital by department of general surgery for a period of six months. All suspected cases of appendicitis were scored by Alvarado score and cases with>5 were performed additional USG for further evaluation. All the cases of appendicitis that underwent surgery were further confirmed by histopathological correlation with USG and clinical Alvarado score.Results: A total of 200 cases were enrolled with male predominance (57.5%) and mean age of study group was 34.26±8.64 years and male to female ratio of 1.3:1.69% of cases presented with Alvarado score of 7 and above, while 21% of cases with 5-6. Migratory pain in RIF was the commonest symptom and tenderness RIF was the most common sign.160 cases (80%) were operated totally with 75% cases lap appendectomy and 25% cases by open appendectomy. USG was performed on 160 cases and 146 were positive and 14 were negative whereas histopathologically 142 cases were confirmed as Acute appendicitis. The sensitivity, specificity, PPV and NPV of USG is 97.18%, 55.56%, 94.52% and 71.43%. The accuracy of USG is 92.5.Conclusions: Acute appendicitis is first and foremost a clinical diagnosis with scoring systems and imaging being necessary adjuncts in equivocal cases. USG is an easily available tool in diagnosis of acute appendicitis. Application of USG as adjunct tool to Alvarado scoring improves the diagnostic accuracy.

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A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20195099 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3937

Author(s):

Waleed Yusif El Sherpiny

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Negative Appendectomy ◽

Alvarado Score ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Various diagnostic criteria have been described for diagnosing acute appendicitis. Of these, Alvarado score has been the most commonly used. The RIPASA score is a new diagnostic scoring system developed for the diagnosis of acute appendicitis and showed higher sensitivity, specificity and diagnostic accuracy as compared to Alvarado score. we want to compare prospectively Alvarado and RIPASA score by applying them to patients attending emergency department complaining of right iliac fossa pain that could probably be acute appendicitis.Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination of the removed appendix was taken as the gold standard for diagnosis of acute appendicitis.Results: Among (90%) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy were 88.2%, 14.5%, 73.1%, 32%,and 68% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 51.2%, 80 %, 91 %, 29%, and 57%, respectively. 87.5% of patients were correctly stratified by RIPASA under higher probability group while only 45% were classified by Alvarado as high probability.Conclusions: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, it can be applied for the diagnosis of acute appendicitis.

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A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20180430 ◽

2018 ◽

Vol 5 (3) ◽

pp. 796

Author(s):

Vamsavardhan Pasumarthi ◽

C. P. Madhu

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Roc Curve ◽

Predictive Value ◽

Scoring System ◽

Alvarado Score ◽

Predictive Values ◽

Sensitivity Specificity ◽

Ripasa Score

Background: The RIPASA Score is a new diagnostic scoring system developed for the diagnosis of Acute Appendicitis which showed higher sensitivity, specificity and diagnostic accuracy compared to ALVARADO Score, particularly when applied to Asian population. Not many studies have been conducted to compare RIPASA and ALVARADO scoring systems. Hence, author want to compare prospectively Alvarado and RIPASA score by applying them to the patients attending the hospital with right iliac fossa pain that could probably be acute appendicitis.Methods: A prospective analysis of 116 cases admitted with RIF pain during a 2 years period was performed. Patients between 15-60 years were scored as per Alvarado and RIPASA scoring system. Histopathological reports of the cases were collected and compared with the scores. ROC curve area analysis was performed to examine diagnostic accuracy of RIPASA and ALVARADO scores.Results: The sensitivity of ALVARADO score is estimated to be 52.08 for a cut off of 6. The specificity is 80%, positive predictive value is 92.59, negative predictive value is 25.81. The Diagnostic accuracy of ALVARADO scoring is found to be 56.9. The sensitivity, specificity, positive predictive value and negative predictive values of RIPASA scoring system are 75%, 65%, 91.14%, 35.14%. The diagnostic accuracy of RIPASA score is 73.28.Conclusions: The difference in the diagnostic accuracy between ALVARADO and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.

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COMPARISON OF ALVARADO SCORE AND RIPASA SCORE IN THE ACCURATE DIAGNOSIS OF ACUTE APPENDICITIS IN COMBINED MILITARY HOSPITAL RAWALPINDI

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i5.3596 ◽

2021 ◽

Vol 71 (5) ◽

pp. 1519-23

Author(s):

Muhammad Majid ◽

Rasikh Maqsood ◽

Muhammad Ali ◽

Muhammad Ayub Ashraf Malhi ◽

Zaki Hussain ◽

...

Keyword(s):

Emergency Department ◽

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Military Hospital ◽

Alvarado Score ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

Sensitivity Specificity ◽

Ripasa Score

Objective: To determine the diagnostic accuracy of Alvarado score and the RIPASA score for acute appendicitis using histopathology as a gold standard. Study Design: Cross sectional validation study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2018. Methodology: A total number of 270 patients were included in the study presenting with pain right iliac fossa to the Accident and Emergency department. Surgeons and Seniors Residents in Surgery on call in the Accident and Emergency Department. Combined Military Hospital, Rawalpindi, scored the patients with suspicion of acute appendicitis with Alvarado Score and RIPASA score simultaneously. After appendectomy of these patients, the removed appendix was sent for histopathology to confirm whether it was normal or inflamed. A 2x2 table was used for calculating sensitivity, specificity and diagnostic accuracy of the RIPASA score and Alvarado Score. The two scoring systems were then compared for diagnostic accuracy. Results: In our study, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of RIPASA score and Alvarado score for diagnosing acute appendicitis were 92.1%, 62.1%, 95.2%, 48.6%, 88.9% and 72.6%, 68.9%, 95.1%, 23.2%, 72.2% respectively. Conclusion: The diagnostic accuracy of RIPASA score was more than that of Alvarado score in diagnosing acute appendicitis.

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A Comparison between the Diagnostic Accuracy of Alvarado and Tzanaki Scoring Systems in Acute Appendicitis

10.53350/pjmhs2115123175 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3175-3177

Author(s):

Anum Iftikhar ◽

Muhammad Arsalan ◽

Sheeza Azaz ◽

S H Waqar ◽

Sajid Ali Shah ◽

...

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Cross Sectional

Aim: To find out how accurate the Alvarado and Tzanaki scoring systems are in diagnosing acute appendicitis taking histopathology as gold standard. Methods: A cross-sectional prospective study was conducted from August 2019 to July 2020 at Department of General Surgery, Pakistan Institute of Medical Sciences Islamabad. Sixty patients were included, all of whom had appendectomies after a clinical diagnosis of acute appendicitis. Samples were submitted for histopathology, which was used as the gold standard for the definitive diagnosis of acute appendicitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and negative appendectomy rate of Alvarado and Tzanaki scoring systems was calculated using SPSS version 23. Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Alvarado score at optimal cut-off threshold of ≥7.0, were calculated as 74%, 55%, 90%, 27% and 71.66% respectively. The cut-off threshold point of Tzanaki score was set at more than 8, which yielded a 94.11% sensitivity and an 88.88% specificity. The positive predictive value was 99.95% and the negative predictive value was 72.72%. The Alvarado and Tzanaki scoring systems had negative appendectomy rates of 9.5% and 2.04%, respectively. Conclusion: The Tzanaki scoring system has a better diagnostic accuracy for acute appendicitis as compared to the Alvarado score. Keywords: Acute appendicitis, Alvarado score, Tzanaki score

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Comparison of the Modified Alvarado Score and Ultrasonography for Diagnosing Acute Appendicitis

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i59b34367 ◽

2021 ◽

pp. 171-177

Author(s):

S. Keerthana ◽

. Vignaradj

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Care Center ◽

Age Groups ◽

Alvarado Score ◽

Health Care Center ◽

Modified Alvarado Score ◽

Sensitivity Specificity

Background: Acute appendicitis can be diagnosed much accurately by using Modified Alvarado score and Ultrasound together in the clinical setting. Objectives: Comparison of the diagnostic accuracy of Modified Alvarado score and Ultrasonographic findings in acute appendicitis. Materials and Methods: A total of 200 patients of age group ranging from 4-65 years, both male and female, who visited the tertiary health care center with clinical features suggestive of acute appendicitis were randomly selected. Data from the patients regarding their Modified Alvarado score, ultrasonographic findings and histopathological reports were collected for the study. Statistical analysis was performed for the results of both Modified Alvarado score and Ultrasonographic findings in contrast to the pathology reports. Results: The study included 200 patients, with maximum incidence of acute appendicitis seen in males (70.5%) and among 21-30 age groups (40.5%). The sensitivity, specificity of Modified Alvarado Score was 89.47% and 73.33%, with Positive Predictive Value, Negative Predictive Value and diagnostic accuracy being 40%, 73.33% and 45% respectively. Ultrasonography revealed 89.58% sensitivity, 15.62 % specificity, Positive predictive value and NPV were 75.88% and 50%, and diagnostic accuracy was 72%. The negative appendectomies rates accounted to 15%. Conclusion: It is advised that both Modified Alvarado score and Ultrasound can be used to together to diagnose acute appendicitis. This can be useful in decreasing the negative appendectomies and hence reduce the morbidity and mortality.

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Diagnostic Role of C- Reactive protein in Acute Appendicitis

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i4.31107 ◽

2020 ◽

Vol 16 (4) ◽

pp. 246-251

Author(s):

Ashis Pun ◽

Amit Dhungana ◽

Ramjee Bastola

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

White Blood Count ◽

Negative Appendectomy ◽

C Reactive Protein ◽

Accuracy Rate ◽

Reactive Protein ◽

Diagnostic Role ◽

Sensitivity Specificity

Introduction: Acute appendicitis is the common surgical disease however, accurate diagnosis and exclusion of acute appendicitis always remains challenge to the surgeons. Although diagnoses rely mostly on clinical examination but C- reactive protein (CRP) can be of valuable armamentarium. Hence, this study was conducted to find the diagnostic role of C-reactive protein in Acute Appendicitis Methods: A retrospective cross sectional study was conducted among 100 respondents in the Department of Surgery, Bharatpur Hospital from September 2019 to August 2020. Ethical approval was taken from the Institutional Review Committee (IRC) Bharatpur Hospital. Statistical analysis was done by using SPSS version 16 using descriptive statistics. Results: Total of 100 patients was included in study with mean age 31 years old.Out of which 60% were male and 40% were female. CRP value was raised (>6) in 87 (87%) cases and normal in 13(13%) cases. Among those with raised CRP, three patients had normal appendix histopathologically and 57 had uncomplicated appendicitis and 27 had complicated appendicitis histopathologically with sensitivity, specificity, positive predictive value and diagnostic accuracy rate of 95.45 %, 75 %, 96.55 % and 93% respectively. When white blood count (WBC) and CRP level were combined with HPE findings, its sensitivity, specificity and diagnostic accuracy rate were 100%, 80% and 93.83 % respectively. Conclusions: CRP improves the diagnostic accuracy of Acute appendicitis. The adjunct use of CRP and leucocyte count can effectively reduce the negative appendectomy rate.

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