Comparison of Tzanakis score and Alvarado score in acute appendicitis: a diagnostic accuracy study
DOI:
https://doi.org/10.52442/jrmi.v12i1.1016Keywords:
Acute Appendicitis, Alvarado Score, Diagnostic Accuracy, Tzanakis ScoreAbstract
Introduction: The diagnosis of Acute appendicitis (AA) remains challenging, leading to negative appendectomy rates of up to 30%. The Alvarado Score (AS) is widely used but has variable sensitivity and specificity. The Tzanakis Score (TZS) has shown potential to improve diagnostic accuracy.
Objective: To compare the diagnostic validity of AS and TZS using histopathology as the gold standard.
Materials and Methods: This prospective diagnostic accuracy study was conducted in Department of General Surgery, Federal Government Polyclinic (PGMI), Islamabad Pakistan. A total of 100 patients, aged 13–55 years, with suspected acute appendicitis were enrolled. Patients were scored using AS (positive ≥7) and TZS (positive ≥8) before undergoing appendectomy. Histopathological findings were used as the reference standard. Sensitivity, specificity, predictive values, diagnostic accuracy, and likelihood ratios were calculated using SPSS v26.
Results: Among 100 patients, 60% were male and 40% female, with a mean weight of 62.5 ± 8.4 kg. Histopathology confirmed AA in 78% of cases. The AS showed 89.7% sensitivity, 54.5% specificity, 87.5% Positive Predictive Value (PPV), 60.0% Negative predictive value (NPV), and 82.0% accuracy [Positive Likelihood Ratio (PLR) 1.97, Negative Likelihood Ratio (NLR) 0.19]. The TZS demonstrated superior results with 96.2% sensitivity, 77.3% specificity, 93.8% PPV, 85.0% NPV, and 92.0% accuracy (PLR 4.24, NLR 0.05). Differences in sensitivity, specificity, predictive values, and diagnostic accuracy were statistically significant for TZS (p<0.05).
Conclusion: The Tzanakis Score provides higher diagnostic accuracy than the Alvarado Score and can be considered a more reliable tool for diagnosing acute appendicitis, potentially reducing negative appendectomy rates.
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