Assessing the Diagnostic Effectiveness of Appendicitis Scoring Systems: A Comparative Analysis with Histopathology as the Reference Standard

Abstract

Background: The most common reason for acute severe abdominal pain that requires surgery is acute appendicitis, which may be challenging to diagnose because of unusual symptoms, especially in young patients, the elderly, and fertile women. Although imaging techniques such as CT and ultrasound enhance diagnostic accuracy, they are not universally available, particularly in settings where resources are less, and may lead to delays or unnecessary operations. In aiding early diagnosis from clinical and laboratory findings, some clinical scoring systems have been devised in response, such as the Alvarado, Ohmann, RIPASA, Tzanakis, and Eskelinen scores. In a bid to enhance diagnostic efficacy and reduce morbidity, the current study compares various scoring systems to identify which is best adapted for use during emergency cases. Objective: To compare various scoring systems such as RIPASA, Alvarado, Tzanakis, Ohmann, and Eskelinen for identifying which is best adapted to use during emergency cases. Duration and place of study: This study was conducted in Suleman Roshan Medical College Hospital Tando Adam Pakistan from January 2023 to December 2023 Methodology: 120 ASA I–II status patients with presumed acute appendicitis aged between 20 and 60 years are selected for this comparative study. Patients were recruited after taking informed consent and ethical clearance. Patients were subjected to imaging, laboratory assessment, clinical assessment, and the use of five scoring diagnostic grading systems. All underwent surgery that was histopathologically confirmed. Standard statistical tests were employed while analyzing the data in SPSS Version 23 for assessing the diagnostic accuracy of each scoring system. Results: There were a total of 120 patients involved in this study. All the people who were a part of this study were aged from 20 years to 60 years. The mean age calculated was 32.5 years. The females included in this study were representing 55.8% of the total population. The remaining 44.2% were males. The highest sensitivity as well as specificity was shown in the RIPASA score. Moreover, the highest positive predictive value and highest accuracy was also shown in the RIPASA score. The positive appendectomy group had 78 cases while the negative appendectomy group had 42 cases. There was no significant difference seen in gender distribution (p=0.422). Conclusion: This research highlights the RIPASA and Ohmann scores as the most accurate diagnostic tools for acute appendicitis, with the highest sensitivity and specificity of the score systems evaluated.