Clinical Scoring Systems to Diagnose Complicated Acute Appendicitis in a Rural Hospital: Are They Good Enough?

Autor:	Balakrishnan P; Pathology, Sri Lakshmi Narayana Institute of Medical Sciences and Hospital, Pondicherry, IND., Munisamy P; General Surgery, Sri Lakshmi Narayana Institute of Medical Sciences and Hospital, Pondicherry, IND., Vijayakumar S; Pathology, Sri Lakshmi Narayana Institute of Medical Sciences and Hospital, Pondicherry, IND., Sinha P; Pathology, Sri Lakshmi Narayana Institute of Medical Sciences and Hospital, Pondicherry, IND.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Jul 19; Vol. 16 (7), pp. e64927. Date of Electronic Publication: 2024 Jul 19 (Print Publication: 2024).
DOI:	10.7759/cureus.64927
Abstrakt:	Introduction Acute appendicitis (AA) is the most common surgical emergency in developed countries, whose incidence peaks in the second and third decades. The risk of mortality in uncomplicated AA is very low. There are many scoring systems to predict AA. Prediction scores are used less frequently to predict complicated AA. Rural hospitals are often constrained by a lack of round-the-clock imaging or special laboratory services, which may enable accurate diagnosis. Materials and methods This study aimed to determine whether prediction scores without imaging or C-reactive protein (CRP) levels could predict complicated AA in a rural setting. All cases of AA for the previous 13 months were recruited for the study. Demographic data, clinical signs and symptoms, complete blood counts, intraoperative findings, and the corresponding histopathological results were collated. The scoring systems (Alvarado, RIPASA, Tzanakis, and Ohmann) were calculated from the clinical and laboratory data. Demographic variables, clinical features, and histopathological findings are described as frequencies/proportions. Chi-squared and Student's t-tests were used to analyze differences between patients with complicated and uncomplicated AA. A receiver operating curve (ROC) analysis was performed to calculate the area under the curve (AUC) and determine whether appendicitis scores could predict complicated AA. Results There were 76 patients with a mean age of 29.1±13.0 years. Serositis was observed in 65% of the patients; mucosal ulceration was the most common microscopic finding, with a pathological diagnosis of AA in 58 (76.3%) patients. Rovsing's sign and the presence of phlegmon and granuloma were significantly different between those with and without complicated AA. The clinical prediction scores were not significantly different between the two groups. The Tzanakis and Ohmann scores were significant (cutoff: 6.5 and 7.25, p=0.001 and 0.01, respectively) in diagnosing AA (sensitivity/specificity of 98.3/66.7 and 98.3/94.4, respectively). With a cutoff of 5.75, the RIPASA score, with an AUC of 0.663 (p=0.09), showed the highest sensitivity (90.7) and specificity (76.6) for diagnosing complicated AA. Conclusion Diagnosing AA based solely on clinical presentation remains a challenge. This study showed that clinical scores such as those of Alvarado, RIPASA, Tzanakis, and Ohmann could not accurately predict complicated AA. Scoring systems without imaging and intraoperative diagnoses are not infallible; therefore, histopathological examination of the resected appendix is mandatory. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee (Human Studies) issued approval IEC/C-P/19/2024. This is to certify that the project titled "Clinical scoring system to diagnose complicated acute appendicitis in a rural hospital: are they good enough?" submitted by "Principal Investigator, Dr. V Saravanakumari, Associate Professor, Dept of Pathology" has been approved by the IEC at this meeting held on 08/02/2024. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Balakrishnan et al.)
Databáze:	MEDLINE
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