Diagnostic Efficacy Study Comparing Tzanakis Scoring System With Alvarado Scoring System in Effective Diagnosis of Acute Appendicitis

TL;DR

This study compares two scoring systems for diagnosing acute appendicitis, finding that the Tzanakis system may be more sensitive but needs more research to confirm its superiority.

Contribution

The study provides a direct comparison of the diagnostic efficacy of the Tzanakis and Alvarado scoring systems for acute appendicitis using histopathological confirmation.

Findings

The Tzanakis scoring system showed higher sensitivity (87%) compared to the Alvarado system (54%) for diagnosing acute appendicitis.

The area under the ROC curve was higher for the Tzanakis system (0.670) than for the Alvarado system (0.598), though the difference was not statistically significant.

Ultrasonography had a sensitivity of 89% and specificity of 50% in diagnosing acute appendicitis.

Abstract

Objective

Among the common causes of abdominal emergencies, acute appendicitis ranks at the top, particularly in the young population. While negative appendectomy is not uncommon, the risk of appendicular perforation is substantial if the diagnosis is missed or delayed. This study evaluated the diagnostic efficacy of the Tzanakis scoring system for acute appendicitis, comparing it with the Alvarado scoring system, considering the histopathological finding as the gold standard.

Materials and methods

This prospective observational study, conducted in the General Surgery department in a tertiary care hospital in India, included clinically diagnosed acute appendicitis cases posted for open or laparoscopic appendicectomy.

Results

The mean age for the 60 participants included in the study was 30.97±13.44, and the median was 24.5 yrs. The sensitivity of ultrasonography (USG) in diagnosing histopathological positive acute appendicitis was 89%, and the specificity was 50%. The sensitivity, specificity, positive, and negative predictive values of the Tzanakis score were 87%, 50%, 96%, and 22%, respectively, and those of the Alvarado score were 54%, 75%, 96%, and 10%, respectively.

Conclusion

The receiver operator characteristic (ROC) curve for the Alvarado and Tzanakis scores showed that the area under the curve (AUC) was greater for the Tzanakis scoring system (0.670) than for the Alvarado scoring system (0.598). Differences between the AUCs were not statistically significant. Although the Tzanakis scoring system is more sensitive than the Alvarado scoring system in diagnosing acute appendicitis, studies with larger samples are needed to show the superiority of this scoring system over the Alvarado scoring system.

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