The diagnostic accuracy of three scoring systems in the diagnosis of acute appendicitis in the Egyptian population
Abdel-ltif Ahmed Abdel-ltif
Background: Acute appendicitis is a common but elusive surgical condition and remains a diagnostic dilemma. It may simulate other conditions and diagnosis is usually made on clinical grounds, leading to the evolution of scoring systems for more accurate diagnosis. The Alvarado, RIPASA, and Lintula scoring systems are three important scoring systems, for diagnosis of acute appendicitis. Patients and Methods: A prospective study on 320 patients presented with right lower abdominal pain. The diagnostic accuracy of Alvarado, RIPASA, and Lintula scores in diagnosing acute appendicitis was compared. A score of 7 is the optimal cut off threshold for Alvarado, 7.5 for RIPASA, and 21 for Lintula scoring system. Sensitivity, specificity, accuracy, positive predictive and negative values were done. Results: The sensitivity, specificity, and accuracy of Alvarado score were 90.3%, 47%, and 83.4%, respectively. The sensitivity, specificity, and accuracy of RIPASA score were 95.9%, 33.3%, and 85.9%, respectively. The sensitivity, specificity, and accuracy of Lintula score were 97.8%, 84.3%, and 95.6%, respectively. The positive predictive value for Alvarado was 90% and negative predictive value was 48%. The positive predictive value of RIPASA was 88.4% and negative predictive value 39.3%. The positive predictive value for Lintula was 97% and negative predictive value was 87.8%. Lintula score correctly classified 95.6% of all patients confirmed with histological acute appendicitis to the high probability group (Lintula score greater than 21), compared with 85.9% with RIPASA score (RIPASA score greater than 7.5), and with 83.4% with Alvarado score (Alvarado score greater than 7.0; p-value is 0.001). Conclusion: Lintula scoring system is the most convenient, accurate and specific scoring system for Egyptian population suffering from acute appendicitis followed by RIPASA scoring system and lastly Alvarado scoring system.