Skip to main content
SpringerLink
Log in

Does Scoring System Help Us in the Diagnosis of Acute Appendicitis? A Prospective Clinical Trial

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

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 Başkent 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Addiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the united states. Am J Epidemiol 132(5):910–925

    Article  CAS  Google Scholar 

  2. Ozsoy Z, Yenidoğan E (2017) Evaluation of the Alvarado scoring system in the management of acute appendicitis. Turk J Surg 33:200–204. https://doi.org/10.5152/turkjsurg.2017.3539

    Article  PubMed  PubMed Central  Google Scholar 

  3. Andersson RE (2004) Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 91:28–37. https://doi.org/10.1002/bjs.4464

    Article  CAS  PubMed  Google Scholar 

  4. Lintula H, Pesonen E, Kokki H, Vanamo K, Eskelinen M (2005) A diagnostic score for children with suspected appendicitis. Langenbeck's Arch Surg 390:164–170. https://doi.org/10.1007/s00423-005-0545-8

    Article  Google Scholar 

  5. Eskelinen M, Ikonen J, Lipponen P (1992) A computer-based diagnostic score to aid in diagnosis of acute appendicitis. A prospective study of 1333 patients with acute abdominal pain. Theor Surg 7:86–90

    Google Scholar 

  6. Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564

    Article  CAS  Google Scholar 

  7. Ohmann C, Franke C, Yang Q and the German Study Group of Acute Abdominal Pain(1995) Clinical benefit of a diagnostic scores for acute appendicitis. Eur J Surg 161: 273–281

  8. Zielke A, Sitter H, Rampp T, Bohrer T, Rothmund M (2001) Clinical decision making, ultrasonography, and scores for evaluation of suspected acute appendicitis world. J Dermatol Surg 25:578–584. https://doi.org/10.1007/s002680020078

    Article  CAS  Google Scholar 

  9. Sammalkorpi HE, Mentula P, Leppäniemi A (2014) A new adult appendicitis score improves diagnostic accuracy of acute appendicitis a prospective study. BMC Gastroenterol 26(14):114. https://doi.org/10.1186/1471-230X-14-114

    Article  Google Scholar 

  10. Enochsson L, Gudbjartsson T, Hellberg A, Rudberg C, Wenner J, Ringqvist I, Sörensen S, Fenyö G (2004) The FenyöLindberg scoring system for appendicitis increases positive predictive value in fertile women a prospective study in 455 patients randomized to either laparoscopic or open appendectomy. Surg Endosc 18(10):1509–1513. https://doi.org/10.1007/s00464-003-9323-2

    Article  CAS  PubMed  Google Scholar 

  11. Gunes Tatar I, Yilmaz KB, Sahin A, Aydin H, Akinci M, Hekimoglu B (2016) Evaluation of clinical Alvarado scoring system and CT criteria inthe diagnosis of acute appendicitis. Radiol Res Pract 2016:9739385. https://doi.org/10.1155/2016/9739385

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sitter H, Hoffmann S, Hassan I Zielke (2004)(2004) A diagnostic score in appendicitis. Validation of a diagnostic score (Eskelinen score) in patients in whom acute appendicitis is suspected. Langenbeck's Arch Surg 389(3):213–218. https://doi.org/10.1007/s00423-003-0436-9

    Article  CAS  Google Scholar 

  13. Park JS, Jeong JH, Lee JI, Lee JH, Park JK, Moon HJ (2013) Accuracies of diagnostic methods for acute appendicitis. Am Surg 79:101–106

    PubMed  Google Scholar 

  14. Linam LE, Munden M (2012) Sonography as the first line of evaluation in children with suspected acute appendicitis. J Ultrasound Med 31:1153–1157

    Article  Google Scholar 

  15. Erdem H, Çetinkünar S, Daş K, Reyhan E, Değer C, Aziret M et al (2013) Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha appendicitis scores for diagnosis of acute appendicitis. World J Gastroenterol 21;19(47):9057–9062. https://doi.org/10.3748/wjg.v19.i47.9057

    Article  Google Scholar 

  16. Chae MS, Hong CK, Ha YR, Chae MK, Kim YS, Shin TY et al (2017) Can clinical scoring systems improve the diagnostic accuracy in patients with suspected adult appendicitis and equivocal preoperative computed tomography findings? Clin Exp Emerg Med 20;4(4):214–221. https://doi.org/10.15441/ceem.16.168

    Article  Google Scholar 

  17. Dumlu EG, Tokaç M, Bozkurt B, Yildirim MB, Ergin M, Yalçin A, Kiliç M (2014) Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis. Clinics (Sao Paulo) 69:677–682. https://doi.org/10.6061/clinics/2014(10)05

    Article  Google Scholar 

  18. Kıyak G, Korukluoğlu B, Özgün Y, Devay AÖ, Kuşdemir A (2009) Evaluation of Ohmann and Eskelinen scores, leukocyte count and ultrasonography findings for diagnosis of appendicitis. Ulus Travma Acil Cerrahi Derg 15:77–81

    PubMed  Google Scholar 

  19. Yılmaz EM, Kapçı M, Çelik S, Manoğlu B, Avcil M, Karacan E (2017) Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation? Ulus Travma Acil Cerrahi Derg 23(1):29–33. https://doi.org/10.5505/tjtes.2016.89894

    Article  PubMed  Google Scholar 

  20. Zielke A, Sitter H, Rampp TA, Schäfer E, Hasse C, Lorenz W et al (1999) Validation of a diagnostic scoring system (Ohmann score) in acute appendicitis. [Article in German] Chirurg 70:777–784 [Abstract]

    Article  CAS  Google Scholar 

  21. McKay R, Shepherd J (2007) The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med 25:489–493. https://doi.org/10.1016/j.ajem.2006.08.020

    Article  PubMed  Google Scholar 

  22. Ohle R, O’Reilly F, O’Brien KK, Fahey B, Dimitrov BD (2011) The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med 28(9):139. https://doi.org/10.1186/1741-7015-9-139

    Article  Google Scholar 

  23. Lindeberg G, Feny G (1988) Algorithmic diagnosis of appendicitis using Bayes’ theorem and logistic regression. In Bayesian statistics 3. Edited by: Bernardo JM, DeGroot MH, Lindley DV, smith AF. Oxford, UK: Oxford University press 665-669

  24. Fenyo G (1987) Routine use of a scoring system for decision-making in suspected acute appendicitis in adults. Acta Chir Scand 153:545–551

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank all our patients who participated to this study.

Author information

Authors and Affiliations

  1. Department of General Surgery, Alanya Alaaddin Keykubat University Medical Faculty Training and Research Hospital, 07400, Alanya, Antalya, Turkey

    Yilmaz Guler, Serkan Sengul, Hasan Calis & Zulfikar Karabulut

  2. Department of General Surgery, Alanya Baskent University Medical Faculty, Alanya, Turkey

    Pasa Dogan

Authors
  1. Yilmaz Guler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pasa Dogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Serkan Sengul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hasan Calis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zulfikar Karabulut
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yilmaz Guler.

Ethics declarations

This study was approved by the Ethics Committee of Alanya Alaaddin Keykubat University of Medical Sciences, and all of the subjects’ parents were informed regarding the details of the study, and they signed a consent form.

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guler, Y., Dogan, P., Sengul, S. et al. Does Scoring System Help Us in the Diagnosis of Acute Appendicitis? A Prospective Clinical Trial. Indian J Surg 82, 507–513 (2020). https://doi.org/10.1007/s12262-019-02043-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-019-02043-7

Keywords

Search

Navigation