Predictive value of scoring systems for the diagnosis of acute appendicitis in emergency department patients: Is there an accurate one?

• Published in: Hong Kong journal of emergency medicine Vol. 27; no. 5; pp. 262 - 269
• Main Authors: Ak, Rohat, Doğanay, Fatih, Unal Akoğlu, Ebru, Akoğlu, Haldun, Uçar, Aslı Bahar, Kurt, Erdem, Arslan Turan, Cansu, Onur, Ozge
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-09-2020; Sage Publications Ltd
• Subjects: abdominal pain; Acute Inflammatory Response; Alvarado; Appendicitis; Care; Clinical medicine; Diagnosis; Emergency medical care; Evaluation; Examinations; Medical care; Medical diagnosis; Pain; Patients; Raja Isteri Pengiran Anak Saleha Appendicitis; Surgery; Acute Inflammatory Response; abdominal pain; Raja Isteri Pengiran Anak Saleha Appendicitis; Appendicitis; Alvarado
• ISSN: 1024-9079; 2309-5407
• DOI: 10.1177/1024907919840175

Background: Acute appendicitis is one of the challenging surgical conditions presented in the emergency departments. Clinical scoring systems were developed to reduce the negative appendectomy rate and also to avoid unnecessary diagnostic evaluation.
Objectives: The primary aim was to compare the clinical adequacy of the Alvarado, Acute Inflammatory Response, and the Raja Isteri Pengiran Anak Saleha Appendicitis scores in patients with right lower quadrant pain for the diagnosis of acute appendicitis.
Methods: This was a prospective and observational study. All patients over the age of 18 years who presented with a complaint of right lower quadrant pain were enrolled. The Alvarado, Acute Inflammatory Response, and Raja Isteri Pengiran Anak Saleha Appendicitis scoring systems were compared. The patients were either admitted or followed-up as out-patient. Face-to-face or telephone follow-up visits were arranged for the patients who did not have surgery and who were not admitted.
Results: 232 patients were included and 14 patients were excluded from the study. Of the 218 patients, 114 patients underwent surgery. Of the 114 patients, 107 patients were pathologically diagnosed with acute appendicitis. It was determined that Raja Isteri Pengiran Anak Saleha Appendicitis score was the most valuable score with 0.88 accuracy, followed by Acute Inflammatory Response (area under the curve = 0.79) and Alvarado (area under the curve = 0.71) scores.