CORRELATION OF SCORING SYSTEMS WITH HISTOPATHOLOGICAL FINDINGS AND THEIR IMPORTANCE IN REDUCING THE PERCENTAGE OF UNNECESSARY APPENDECTOMIES

Abstract

Introduction. Acute appendicitis (AA) is one of the most common emergency surgical conditions, where emergency laparotomy is necessary. However, perforation rates and negative laparotomies during this procedure have not been reduced. The purpose of this paper was to evaluate the importance of the scoring systems in the differenttial diagnosis for setting an indication for appendectomy. Method. Prospective comparisons of the values of 4 scoring systems were performed among 60 patients: Alvarado, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis. Values for the scores were determined in all patients treated with lower right quadrant (LRQ) abdominal pain, under a differential diagnosis of AA. After the appendectomy (open surgery or laparoscopic), a correlation was obtained between the histopathologic findings (HP) and the corresponding latent values. Results. In the study 63.33% of the patients were male. Distribution of patients according to the values of the three different systems (Alvarado, RIPASA and Tzanakis) showed that the largest number of patients had values higher than 8 and AIR values of 7- 8. In the study, 95% of the operated patients were positive for appendicitis compared to the histopathological finding. 80% of the surgeries included on-time appendectomy, 15% delayed diagnosis, and 5% were found to be with an unnecessary appendectomy. According to the HP findings of those with positive findings, 77.2% of the cases had appropriate preoperative ultrasonographic (US) diagnosis. A statistically significant association of the scores with HP findings (promptly phlegmonous, promptly gangrenous, late perforated and unnecessary) was found only for the Alvarado, AIR, Tzanakis, and no statistically significant association was found for the RIPASA score. Conclusion. Scoring systems are useful diagnostic tools for appendectomy indication. Using one or a combination of two or more scoring systems reduces the percentage of unnecessary appendectomies.