The XXXX score: A new diagnostic score for acute appendicitis

Abstract

BACKGROUND: The Karaman score is a novel diagnostic scoring system consisting of 6 parameters. The aim of the present study was to assess the diagnostic performance of the Karaman score in comparison with the Alvarado score. METHODS: A total of 200 patients who underwent an appendectomy were enrolled in the study (research registry number: 2290). RESULTS: The cutoff threshold of the Karaman score in distinguishing acute appendicitis from negative appendectomy was ≥9 with 84.3% sensitivity, 64.7% specificity, 92.1% positive predictive value (PPV), and 45.8% negative predictive value (NPV). The cutoff threshold of the Alvarado score in distinguishing acute appendicitis from negative appendectomy was ≥8 with 72.9% sensitivity, 70.6% specificity, 92.4% PPV, and 34.8% NPV. In multivariate logistic regression analysis, an Alvarado ≥8 score (Odds ratio [OR]:6.644, 95% confidence interval [CI]: 2.854-15.466; p<0.001) and a Karaman ≥9 score (OR:10.374, 95% CI: 4.383-24.558; p<0.001) were each individually predictive in distinguishing acute appendicitis from negative appendectomy when correction was made according to age and gender. However, when both scores were evaluated together, the Alvarado score ≥8 lost its efficacy (OR:1.838, 95% CI: 0.517-6.530; p=0.347), whereas the Karaman score ≥9 retained its predictive power (OR:6.586, 95% CI: 1.893-22.917; p=0.003). CONCLUSION: The Karaman score was more predictive than the Alvarado score in distinguishing acute appendicitis from a negative appendectomy.

Diagnostic Accuracy Rates of Appendicitis Scoring Systems for the Stratified Age Groups

“…Karaman et al conducted a study in our city in 2018 and stated that the Karaman scoring system, which consists of six parameters, is more accurate for predicting appendicitis than the Alvarado score. However, in our study, the Karaman CSS was not superior to the other scoring systems in any age group [15]. Te relatively small sample size of our study group may be the reason why Karaman's score was not found to be superior to other scores among age groups.…”

Which appendicitis scoring system is most suitable for pregnant patients? A comparison of nine different systems

“…Timely diagnosis is critical, as delays may lead to both maternal (1-4%) and fetal (1.5-35%) mortality due to perforation of the appendix [15]. To this end, various scoring methods have been developed based on imaging studies, clinical findings, and laboratory results [16][17][18][19][20][21][22][23][24]. The present study aimed to evaluate the extent to which these scoring methods are suitable for the diagnosis of appendicitis in pregnancy.…”

Comparison of scoring systems regarding the gender as a parameter with the traditional scoring systems for predicting appendicitis

“…In both Karaman and Alvarado scoring systems, gender is not considered when calculating the score. In their published study in 2018, they claimed that the Karaman scoring system is superior to the Alvarado score in predicting appendicitis and reducing the rate of negative appendectomy [ 7 ]. In our study, we found that the Karaman scoring system was more successful in predicting appendicitis either in male or female patient groups than scoring systems that considering gender.…”

“…Ultrasound (USG) is the imaging method that should be the first choice in diagnosing appendicitis due to its lower cost, easier accessibility, and no radiation exposure compared to CT, with a sensitivity of 79% and a specificity of 87% [ 6 ]. Nevertheless, USG performed by an inexperienced radiologist with a heavy patient load, especially outside of working hours, may mislead the clinician and cause overtreatment or under treatment [ 7 , 8 ].…”