Clinical Scoring Systems to Diagnose Complicated Acute Appendicitis in a Rural Hospital: Are They Good Enough?

Area of Science:

• General Surgery
• Diagnostic Medicine

Background:

• Acute appendicitis (AA) is a common surgical emergency, particularly in younger adults.
• Accurate diagnosis in rural settings is challenging due to limited access to imaging and specialized labs.
• Existing prediction scores are primarily used for uncomplicated AA, with less focus on complicated cases.

Purpose of the Study:

• To evaluate the efficacy of clinical prediction scores (Alvarado, RIPASA, Tzanakis, Ohmann) in diagnosing complicated AA without imaging or C-reactive protein (CRP) levels in a rural hospital.
• To determine if these scores can differentiate between complicated and uncomplicated AA.

Main Methods:

• A retrospective study of 76 patients with AA over 13 months.
• Clinical data, including symptoms and physical examination findings, were collected.
• Scoring systems were calculated, and statistical analyses (Chi-squared, t-tests, ROC analysis) were performed to assess diagnostic accuracy for complicated AA.

Main Results:

• Clinical prediction scores did not significantly differentiate between complicated and uncomplicated AA.
• While Tzanakis and Ohmann scores showed significance in diagnosing AA, they were not accurate for predicting complicated cases.
• The RIPASA score demonstrated the highest sensitivity and specificity for diagnosing complicated AA among the tested scores, though not with high confidence (AUC=0.663).

Conclusions:

• Clinical scoring systems alone are insufficient for accurately predicting complicated appendicitis in resource-limited rural settings.
• Reliance on clinical scores without imaging or intraoperative findings can be fallible.
• Histopathological examination of the resected appendix is mandatory for definitive diagnosis of acute appendicitis and its complications.