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Diagnostic Accuracy Rates of Appendicitis Scoring Systems for the Stratified Age Groups
Emre Gonullu1, Zulfu Bayhan2, Recayi Capoglu3
1Sakarya University, Faculty of Medicine, Department of Gastrointestinal Surgery, Serdivan, Sakarya, Turkey.
Insights
Age impacts acute appendicitis scoring system accuracy. The Alvarado system is best for younger adults, Fenyo-Lindberg for middle-aged, and Eskelinen for older adults, though caution is advised for the latter.
Area of Science:
- Surgical diagnostics
- Medical scoring systems
- Geriatric medicine
Background:
- Acute appendicitis is a common surgical emergency.
- Existing scoring systems may have varying accuracy across different age demographics.
- Physiological changes in older adults can affect diagnostic assessments.
Purpose of the Study:
- To compare the predictive performance of various acute appendicitis scoring systems across distinct age groups.
- To identify age-specific optimal scoring systems for diagnosing acute appendicitis.
- To inform clinical practice regarding the selection of diagnostic tools based on patient age.
Main Methods:
- Prospective study including 203 patients with prediagnosed acute appendicitis.
- Patients categorized into three age groups: 18-45, 46-65, and >65 years.
- Comparison of nine common acute appendicitis scoring systems within each age group.
Main Results:
- The Alvarado scoring system was most accurate for the 18-45 age group.
- The Fenyo-Lindberg scoring system demonstrated highest accuracy for the 46-65 age group.
- The Eskelinen scoring system was most accurate for the >65 age group, but with limitations.
Conclusions:
- Patient age is a critical factor in selecting an appropriate acute appendicitis scoring system.
- The Alvarado and Fenyo-Lindberg systems are recommended for younger and middle-aged adults, respectively.
- The Eskelinen system shows promise for older adults, but further validation is needed for standalone use.
Background:
Many scoring systems have been developed for acute appendicitis, which is the most common emergent disorder in surgical practice. Considering the physiological changes and chronic diseases occurring with advancing age, an applied scoring system may not produce the same score in similar patients in all age groups.
Objectives:
We aimed to compare the predictive values of scoring systems in different age groups.
Methods:
In this prospective study, the patients operated on in our clinic with a prediagnosis of acute appendicitis between March 2020 and March 2021 were included. We divided them into three age groups as 18-45 years (group 1), 46-65 years (group 2), and >65 years (group 3). We compared the scores of the nine acute appendicitis scoring systems most commonly used in the literature for these age groups.
Results:
A total of 203 patients were included in our study. The Alvarado scoring system yielded the most accurate results for group 1, whereas the Fenyo-Linberg scoring system was the most accurate system for group 2 and the Eskelinen scoring system for group 3.
Conclusion:
Age should be considered as a major parameter during the selection of the scoring system to be applied for patients with prediagnosis of acute appendicitis. Our study revealed the Alvarado and the Fenyo-Lindberg scoring systems as the most accurate systems for the differential diagnosis of appendicitis in the 18-45 and 46-65 years age groups, respectively. Although we found the Eskelinen scoring system as the most accurate one in the >65 years age group, the confidence intervals indicated that it may not be appropriate for use alone in this group.
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