Mehmet Altuntaş, Murat Çetin, Gürkan Altuntaş

Akut Apandisit Tanısında Alvarado ve RIPASA Skorlama Sistemlerinin Etkinliğinin Retrospektif Değerlendirilmesi

Amaç: Bu çalışmanın amacı acil servise başvuran ve akut apandisit tanısı ile apendektomi yapılan hastalarda Alvarado ve RIPASA skorlarının etkinliğini incelemektir. Gereç ve Yöntemler: Akut apandisit tanısı alan hastaların incelendiği tek merkezli, retrospektif bir çalışma olarak planlandı. Çalışmamızda, hastaların post-operatif histopataolojik tanıları altın standart kabul edilerek, hastalardan başlangıç muayenelerinde bakılan Alvarado ve RIPASA klinik skorlar ile karşılaştırılması planlandı. Bulgular: Akut apandisit tanısı ile opere edilen 125 hastanın; 81’i erkek (%64,8) 44’ü kadındı (%35,2). Hastaların 95’inde (%76) non-komplike apandisit, 21’inde (%16,8) reaktif lenfoid hiperplazi, 9’unda (%7,2) komplike apandisit tanısı konulmuştur. Alvarado ve RIPASA skorlarının ROC eğrisi ve eğri altında kalan alanı değerlendirildiğinde RIPASA skoru AUC=0.811 iken Alvarado için AUC=0.762 idi. Cut-off değer olarak her iki skorda da en iyi değer ≥7 olarak belirlendi. Alvarado ve RIPASA skorları arasındaki karşılaştırmada istatistiksel olarak anlamlı bir fark bulunmadı. Sonuç: Akut apandisit kesin tanısı histopatolojik olarak konulabilen bir cerrahi acildir. Hızlı ve doğru teşhisini sağlamak için çeşitli skorlama sistemleri acil hekimleri tarafından daha sık kullanılmalıdır Acil serviste skorlama sistemleri tanı koymada faydalı olup birbirlerine üstünlükleri bulunmamıştır. Hem RIPASA hem de Alvarado skorlama sistemlerinin daha sık kullanılması ile negatif apendektomi oranı azaltılabilir.

Retrospective Evaluation of the Effectiveness of Alvarado and RIPASA Scoring Systems in the Diagnosis of Acute Appendicitis

Aim: The aim of this study is to examine the effectiveness of Alvarado and RIPASA scores in patients who applied to the emergency department and underwent appendectomy with the diagnosis of acute appendicitis. Material and Methods: This is a single-center, retrospective study examining patients diagnosed with acute appendicitis. In our study, the post-operative histopathological diagnosis of the patients was accepted as the gold standard. The patients were divided into two groups and the clinical scores of Alvarado and RIPASA obtained during the initial examination were compared between the two groups of patients. Results: Of 125 patients who were operated with the diagnosis of acute appendicitis; 81 (64.8%) were male and 44 (35.2%) were female. Non-complicated appendicitis was diagnosed in 95 (76%) of the patients, reactive lymphoid hyperplasia in 21 (16.8%), and complicated appendicitis in 9 (7.2%). In the comparison between both groups, when the ROC curve and the area under the curve of Alvarado and RIPASA scores were evaluated, the RIPASA score was AUC=0.811, while for Alvarado it was AUC=0.762. As the cut-off value, the best value was determined as ≥7 in both scores. No statistically significant difference was found in the comparison between Alvarado and RIPASA scores. Conclusion: The definitive diagnosis of acute appendicitis is surgical emergency, which can be made histopathologically. Various scoring systems should be used more frequently by emergency physicians to ensure rapid and accurate diagnosis in the emergency department. With the more frequent use of both RIPASA and Alvarado scoring systems, the negative appendectomy rate can be reduced.

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