Comparison of Tzanakis Score Vs Alvarado Score in The Effective Diagnosis of Acute Appendicitis
Comparison of Tzanakis Score Vs Alvarado Score in The Effective Diagnosis of Acute Appendicitis
Comparison of Tzanakis Score Vs Alvarado Score in The Effective Diagnosis of Acute Appendicitis
ABSTRACT
Department of Surgery Background
Dhulikhel Hospital- Kathmandu University Hospital Acute appendicitis is the most frequent surgical emergency encountered worldwide.
Kathmandu University School of medical Science
This study was conducted to compare the efficacy of Tzanakis score and Alvarado
Dhulikhel, Kavre, Nepal score in diagnosing acute appendicitis.
Objectives
Corresponding Author
The aim of this study is to compare the efficacy of Tzanakis scoring system with
Alvarado scoring system in diagnosing AA.
Bala Ram Malla
Methods
Department of Surgery
This was a retrospective and nonrandomized observational study conducted in
Dhulikhel Hospital- Kathmandu University Hospital Dhulikhel hospital. It included 200 clinically diagnosed cases of acute appendicitis
Kathmandu University School of Medical Science
who underwent emergency open or laparoscopic appendectomy during the year
Dhulikhel, Kavre, Nepal 2012. Final diagnosis of acute appendicitis was based on histological findings given
by pathologist.
E-mail: [email protected]
Results
The sensitivity, specificity, positive predictive value and negative predictive value
Citation of Tzanakis score was 86.9%, 75.0, 97.5% and 33.3% respectively. The sensitivity,
Malla BR, Batajoo H. Comparison of Tzanakis Score specificity, positive predictive value and negative predictive value of Alvarado score
vs Alvarado Score in the Effective diagnosis of acute was 76.0%, 75.0%, 97.2% and 21.4% respectively. Negative appendectomy was
Appendicitis. Kathmandu Univ Med J 2014;45(1):48- 8.0%.
50.
Conclusion
KEY WORDS
Acute appendicitis, alvarado score, tzanakis score
INTRODUCTION
Appendicitis is the most common abdominal emergency Tzanakis scoring system is a combination of clinical
worldwide.1-4 Lifetime risk of acute appendicitis(AA) is examination, ultrasonography and inflammatory markers.13
8.6% and 6.7% for man and women respectively.5-7 Clinical Out of 15 scores, a score of 8 or more is considered AA
examination is helpful in diagnosis of AA in only 70-87% of requiring surgical treatment. Its sensitivity, specificity and
the cases.8,9 accuracy are 95.4%, 97.4% and 96.5% respectively.
Alvarado scoring system is widely used to diagnose AA.10 The aim of this study is to compare the efficacy of Tzanakis
It consists of symptoms, signs and inflammatory markers. scoring system with Alvarado scoring system in diagnosing
Out of 10 scores, a score of 7 or more is considered AA AA.
requiring emergency surgical treatment.10 Its sensitivity and
specificity ranges from 70-90% and 87-92% respectively.11,12
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Original Article
RESULT DISCUSSION
During the year 2012, there were 213 cases who were AA is the most common surgical emergency, it is always
diagnosed clinically as AA. Out of those cases, seven patients a difficult task for surgeon to diagnose AA.2,3 Different
refused to undergo surgical intervention and discharged scoring systems like RIPASA, Alvarado, Ohman, Tzanakis
on request. Further, six patients went to other hospital for are developed to help the surgeon in decision making in
the further management. A total of 200 cases underwent doubtful cases
emergency appendectomy after clinical diagnosis of AA of
Tzanakis et al have reported that its scoring system had
which 128 cases underwent open appendectomy and 72
sensitivity and specificity of 95.4% and 97.4% respectively.13
cases underwent laparoscopic appendectomy. However,
As per our study, sensitivity of Tzanakis scoring system
sixteen patients (8%) had negative appendectomy which
was 86.5% which is comparable to Tzanakis et al. The
was confirmed by histological report. In the present study,
specificity of Tzanakis scoring system was low in our study
the most common position of the appendix was found to
in comparison to the findings reported by Tzanakis et al.
be retrocaecal (79%).
The low specificity of tzanakis score in our study could be
In the attempt of comparing Tzanakis scoring system and due to low sensitivity rate of ultrasonography (USG) which
the Alvarado scoring system, the cut off score of 813 and had 68% sensitivity rate. It is quite low in compare to other
cut off score of 710 were considered for Tzanakis scoring studies which had shown the sensitivity rate of 85-96%.10-12
system and the Alvarado scoring system respectively. The disparity might be due to various experience level of
Table 1. Tzanakis score and histological diagnosis. ultrasonologists who were involved in this procedure. So,
disparity due to individual can not be avoided.
Tzanakis Acute appen- Normal appendix Total patients
Score dicitis Alvarado score had sensitivity of 73-91% and specificity
≥8 160 4 164 of 78 -92% in varies studies.10-12 The sensitivity(76%) and
<8 24 12 36 specificity (75%) of Alvarado Score in the current study is
Total Patients 184 16 200 comparable.
The aim of this study is to compare the efficacy of Tzanakis
On the basis of Tzanakis scoring system, out of 200 patients
score and Alvarado score in the diagnosis of AA. Tzanakis
who underwent appendectomy, 160 patients were found
score was found superior in terms of sensitivity and
to be true positive which was confirmed by histological
negative predictive value. The specificity of Tzanakis score
examination (Table 1). Similarly, 4 patients having scored
and Alvarado score was found the same. However, the
equal to or more than 8 were false positive. Further, among
specificity of Tzanakis score can be improved by increasing
36 patients with score less than 8, 24 were found to be false
the sensitivity rate of USG if the experienced ultrasonologist
negative (Table 1). The sensitivity and specificity of the
do the USG.
Tzanakis scoring system in diagnosing AA was 86.95% and
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