Does scoring system help us in the diagnosis of acute appendicitis? A prospective clinical trial

Abstract

It is very important to make accurate and early diagnosis to reduce both the rate of negative laparotomy and the morbidity and mortality associated with acute appendicitis. Numerous scoring systems have been described in the diagnosis of acute appendicitis. We aimed to determine the accuracy rates of these scoring systems in the diagnosis of acute appendicitis by applying Alvarado, Eskelinen, and Ohmann clinical scoring systems to patients who underwent appendectomy. This study was performed on patients who underwent appendectomy for acute appendicitis at Baskent University Alanya Hospital and Alanya Alaaddin Keykubat University Education and Research Hospital between September 2017 and December 2018. The sensitivity and specificity of Alvarado, Eskelinen, and Ohmann scoring systems as well as the compatibility analysis of scoring systems with pathology results were investigated. A total of 554 patients undergoing appendectomy were included in the study. The sensitivity of Eskelinen scoring method was found to be 53.4%, the specificity was 68.1%; the sensitivity of Alvarado scoring method 41.6%, the specificity 79.7%; and the sensitivity of Ohmann scoring system 94.0%, the specificity was 8.7%. In conclusion, Ohmann scoring system has the highest sensitivity; it could be more efficient in exclusion of the appendicitis diagnosis due to its low specificity. It is also concluded that some clinical parameters that are scored in Eskelinen and Alvarado scoring systems may decrease the sensitivity and specificity of these methods depending on the patient population and atypical clinical presentations.