Evaluation of the Diagnostic Accuracy of Eight Reported Clinical Scoring Systems in the Diagnosis of Acute Appendicitis

The diagnosis of acute appendicitis is mainly clinical. Clinical scores like Alvarado, Modified Alvarado, Lintula, Tzanakis, AIRS (Appendicitis Inflammatory Response Score), Ohmann, Fenyo-Lindberg, and RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) score have been developed to improve diagnostic ability and reduce negative appendicectomy rate. This study was undertaken to compare the diagnostic accuracy of these eight reported scoring systems. This was a prospective study on patients suspected to have acute appendicitis undergoing emergency appendicectomy. All the above eight scores were applied in all these patients and their diagnostic accuracy compared. The mean age of 70 patients was 32.13 SD 9.53 years, with equal male:female ratio. Most common symptom right lower abdominal pain, while most common sign was right iliac fossa tenderness. The highest sensitivity was seen with RIPASA score. Modified Alvarado, Ohmann, and AIR scores shared the highest specificity. The highest PPV was seen with Ohmann score. The highest NPV was seen with RIPASA score. Positive likelihood ratio (LR) was highest for Ohmann score. Negative LR was highest for AIR score. RIPASA score showed the highest diagnostic accuracy. Maximum area under the ROC curve was shown by both Alvarado and Modified Alvarado score. Of the eight clinical scoring systems, RIPASA has the highest diagnostic accuracy, sensitivity, and NPV. All scores have diagnostic accuracies which are either good or sufficient. Out of the 4 scores that do not require elaborate laboratory or radiological investigations (Modified Alvarado, Ohmann, Lintula, and Fenyo-Lindberg Score), Ohmann Score has the highest PPV, specificity, and positive LR.