Evaluation of Tzanakis scoring system in acute appendicitis: a prospective study

Lakshminarasimhaiah, Arun Kumar S.; Nagaraja, A; Srinivasaiah, M

doi:10.18203/2349-2902.isj20174173

Cited by 15 publications

(11 citation statements)

References 3 publications

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“…ROC analysis for prediction of delayed appendectomy has shown that with an AUC value of 0.696 and a sensitivity of 69% and a specificity of 60.8%, this score has sufficient discriminatory ability to distinguish patients with delayed and timely appendectomy. This coincides with data from the literature where this test shows the greatest sensitivity and specificity, even up to 99% sensitivity, 91% specificity, and an average diagnostic accuracy of 95% [27][28][29].…”

Section: Discussionsupporting

confidence: 90%

Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis

Nikolovski

Ambardjieva

et al. 2020

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Introduction. The diagnosis of acute appendicitis (AA), as the most common cause of acute abdominal pain, has changed in the past decade by introducing scoring systems in addition to the use of clinical, laboratory parameters, and radiological examinations. This study aimed to assess the significance of the four scoring systems (Alvarado, Appendicitis Inflammatory Response (AIR), Raya Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis) in the prediction of delayed appendectomy. Materials and methods. The study included 100 respondents, who were diagnosed with AA in the period from January 2018 to February 2019 and were also operated on. In addition to the clinical, laboratory, and ultrasonographic examinations, four scoring systems (Alvarado, AIR, RIPASA, and Tzanakis) were used to diagnose AA. According to the obtained histopathological (HP) findings, the patients were divided into 3 groups: timely appendectomy, delayed appendectomy and unnecessary appendectomy. Using the sensitivity and specificity of all 4 scoring systems, ROC analysis was performed to predict delayed appendectomy. Results. In the study that included 100 patients (58% men, 42% women), after the appendectomy was performed, the resulting HP showed that 74% had a timely appendectomy, while 16% had delayed and 10% had an unnecessary appendectomy. For the prediction of delayed appendectomy, the area under the ROC curve showed a value of 0.577 for the Alvarado score, 0.504 for the AIR, 0.651 for the RIPASA, and 0.696 for the Tzanakis. Sensitivity and specificity for the Alvarado score was 54% and 62%, for RIPASA 62.5% and 63.5%, for Tzanakis 69% and 60.8%, respectively. Combining the three scoring systems (Alvarado, RIPASA, and Tzanakis), the surface area under the ROC curve was 0.762 (95% CI 0.521–0.783), with a sensitivity of 85% and a specificity of 62%. Conclusion. In our study, the diagnostic accuracy of RIPASA and Tzanakis showed better results than Alvarado, while AIR cannot be used to predict delayed appendectomy in our population. However, the simultaneous application of all three scoring systems, RIPASA, Tzanakis and Alvarado, has shown much better discriminatory ability, with higher sensitivity and specificity, as opposed to their use alone. Combining scoring systems should help in proper diagnosis to avoid negative appendectomy, but additional studies with a larger number of patients are needed to support these results.

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Section: Discussionsupporting

confidence: 90%

Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis

Nikolovski

Ambardjieva

et al. 2020

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“…This has probably led to a more accurate preoperative diagnosis and hence the lower rate of negative appendectomy in our setup as was also observed by Kumar et al in their study. 8 In our study the sensitivity and specificity of Tzanakis score in diagnosing acute appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.…”

Section: Discussionsupporting

confidence: 45%

External validation of Tzanakis scoring system in acute appendicitis in a rural hospital

et al. 2019

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Background: Acute appendicitis is one of the most common cause of acute abdomen surgery. Several scoring systems have been adopted by physicians to aid in the diagnosis and decrease the negative appendicectomy rate. Tzanakis scoring system is one such score. Objective of present study was the validation of this scoring system in our population and compare its accuracy with histopathological examination (HPE).Methods: A retrospective study was carried out at the Department of Surgery at Mohammad Afzal Beigh Memorial Hospital Anantnag India. Tzanakis score was calculated in 288 patients who underwent appendicectomy from September 2016-2018 and HPE results were analysed.Results: 276 patients were eligible for the study. The sensitivity and specificity of Tzanakis score in diagnosing appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.Conclusions: Tzanakis scoring system is an accurate modality in establishing the diagnosis of acute appendicitis and preventing a negative laparotomy.

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“…9 Sigdel et al found the effectiveness of Tzanakis score in 100 patients undergone emergency appendectomy having sensitivity, specificity, and overall diagnostic accuracy was 91.48% and 66.66% and 90%. 10 12 A larger negative appendectomy rate of 15% to 25% has been allowed in the past in the cost of preventing appendicular perforation in the studies of Raja et al and Joshi et al 13,14 Hsiao et al conducted a retrospective study and found sensitivity and specificity for an Alvarado score ≥7 were 60% and 61% respectively. 15 Rezak et al, in their retrospective study, found a higher sensitivity and specificity-92% and 82% respectively.…”

Section: Discussionmentioning

confidence: 99%

A comparison of Tzanakis and Alvarado scoring system in the diagnosis of acute appendicitis

Anupriya¹,

Babu²,

Rajan³

2019

Int Surg J

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Background: Appendicitis is the most common abdominal emergency worldwide. Lifetime risk of acute appendicitis is 8.6% and 6.7% for man and women respectively. Clinical examination is helpful in diagnosis of acute appendicitis in only 70-87% of the cases. To compare Tzanaki and Alvarado scoring system in diagnosing acute appendicitis. Methods: This was a prospective, comparative, cross-sectional study, which was conducted at the Mahatma Gandhi Medical College and Research Institute Hospital. Patients with acute appendicitis were included in the study. Relevant history, examination and laboratory investigations done. Patients were scored according to both Alvarado scoring system and Tzanakis scoring, and both were documented in the proforma. Sensitivity, specificity, positive predictive value, negative predictive value were assessed and compared for both scoring systems. Results: 70 patients were included in this study. 54.3% of patients have Tzanakis score more than 8. 35.7% of patients have Alvarado score more than 7. 82.9% of patients had evidence of appendicitis in histopathological examination. Tzanakis score: sensitivity-65.52%, specificity-100%, PPV-100%, NPV-37.50%, accuracy-71.43%. Alvarado score: sensitivity-36.21%, specificity-66.67%, PPV-84%, NPV-17.78%, accuracy-41.43%. Conclusions: Tzanakis scoring system is an effective scoring system in diagnosing acute appendicitis.

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Evaluation of Tzanakis scoring system in acute appendicitis: a prospective study

Cited by 15 publications

References 3 publications

Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis

Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis

External validation of Tzanakis scoring system in acute appendicitis in a rural hospital

A comparison of Tzanakis and Alvarado scoring system in the diagnosis of acute appendicitis

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