Research Article
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Komplike Olmayan Apandisit Ayırımında Kullanılan Bir Puanlama Sisteminin Geçerliliği ve Etkinliği

Year 2022, Volume: 6 Issue: 1, 72 - 79, 27.03.2022
https://doi.org/10.30565/medalanya.995148

Abstract

Amaç: Komplike-komplike olmayan apandisit vakalarını ayırt etmek için çeşitli parametreler kullanılmakta ve hatta bu parametrelerin birlikte kullanıldığı skorlama sistemleri oluşturulmaktadır. Bu çalışmanın amacı, bu puanlama sistemlerinden birinin etkinliğini dış doğrulama ile değerlendirmektir.

Yöntemler: Ocak 2018-Ocak 2021 tarihleri arasında apendektomi yapılan hastaların klinik, radyolojik ve laboratuvar bulguları retrospektif olarak değerlendirildi. Görüntüleme sonucunda akut apandisit düşünülen her hasta için daha önce tanımlanan skorlama sistemleri kullanılarak skorlama yapıldı. Klinik ve patolojik değerlendirme sonuçlarına göre komplike apandisit ve komplike olmayan apandisit gruplarına ayrıldılar.

Bulgular: 425 hasta değerlendirilirken hastaların %48'inde ultrasonografi, %52'sinde tomografi kullanıldı. Tomografi kullanan grupta ≤6 puanın anlamlı etkinliği gözlendi (p<0,001, EAA: 0.838, Duyarlılık %83,3, pozitif öngörü değeri %50,8, özgüllük %84,3, negatif öngörü değeri %96,3). Ultrasonografi grubunda ≤5 skorunun anlamlı etkinliği gözlendi (p<0,001, EAA: 0.790, Duyarlılık %85,7, pozitif prediktif değer %39,0, spesifisite %72,2, negatif prediktif değer %96,1).

Sonuç: Komplike olmayan apandisit vakalarının seçimi için oluşturulan puanlama sisteminin etkili olduğu gösterilmiştir ve harici olarak doğrulanmıştır. Skorlama sisteminde kullanılan parametrelerin her biri bağımsız etkinliğinden daha yüksek verimliliğe sahip olduğundan; klinik, radyolojik ve laboratuvar değişkenlerini bir arada değerlendiren skorlama sistemleri klinik uygulamada daha iyi sonuçlar vermektedir.

References

  • 1. Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet. 2011;377(9777):1573-9. PMID: 21550483.
  • 2. Santos D, Ledet CR, Limmer A, Gibson H, Badgwell B. Use of non-operative treatment and interval cholecystectomy for cholecystitis in patients with cancer. Trauma Surg Acute Care Open. 2020;5(1):e000439. PMID: 32420452.
  • 3. Ruffolo C, Fiorot A, Pagura G, Antoniutti M, Massani M, Caratozzolo E, et al. Acute appendicitis: what is the gold standard of treatment? World J Gastroenterol 2013;19(47):8799-807. PMID: 24379603.
  • 4. Gorter RR, Eker HH, Gorter-Stam MA, Abis GS, Acharya A, Ankersmit M, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668-90. PMID: 27660247.
  • 5. Sallinen V, Akl E, You J, Agarwal A, Shoucair S, Vandvik P, et al. Meta‐analysis of antibiotics versus appendicectomy for non‐perforated acute appendicitis. Br J Surg 2016;103(6):656-67. PMID: 26990957.
  • 6. Parekh D, Jain D, Mohite S, Phalgune D. Comparison of outer diameter of appendix, c-reactive protein, and serum bilirubin levels in complicated versus uncomplicated appendicitis. Indian J Surg. 2020;82(3):314-8. doi: 10.1007/s12262-019-01931-2.
  • 7. Çelik B, Nalcacioglu H, Ozcatal M, Altuner Torun Y. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg 2019;25(3):222-8. PMID: 31135939.
  • 8. Shin DH, Cho YS, Kim YS, Ahn HC, Oh YT, Park SO, et al. Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly. J Clin Lab Anal. 2018;32(1):e22177. PMID: 28238210.
  • 9. Sengul S, Guler Y, Calis H, Karabulut Z. The Role of Serum Laboratory Biomarkers for Complicated and Uncomplicated Appendicitis in Adolescents. J Coll Physicians Surg Pak. 2020;30(4):420-4. PMID: 32513365.
  • 10. Bom W, Bolmers M, Gans S, van Rossem C, van Geloven A, Bossuyt P, et al. Discriminating complicated from uncomplicated appendicitis by ultrasound imaging, computed tomography or magnetic resonance imaging: systematic review and meta-analysis of diagnostic accuracy. BJS Open. 2020;5(1):zraa030. PMID: 33688952.
  • 11. Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg. 2018;56:307-14. PMID: 30017607.
  • 12. Kim HY, Park JH, Lee SS, Jeon J-J, Yoon CJ, Lee KH. Differentiation between complicated and uncomplicated appendicitis: diagnostic model development and validation study. Abdom Radiol (NY). 2021;46(3):948-59. PMID: 32914350.
  • 13. Atema JJ, van Rossem CC, Leeuwenburgh MM, Stoker J, Boermeester MA. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102(8):979-90. PMID: 25963411.
  • 14. Geerdink T, Augustinus S, Atema J, Jensch S, Vrouenraets B, de Castro S. Validation of a Scoring System to Distinguish Uncomplicated from Complicated Appendicitis. J Surg Res. 2021;258:231-8. PMID: 33038600.
  • 15. Lastunen K, Leppäniemi A, Mentula P. Perforation rate after a diagnosis of uncomplicated appendicitis on CT. BJS open. 2021;5(1):zraa034. PMID: 33609386.
  • 16. Yeh DD, Eid AI, Young KA, Wild J, Kaafarani HM, Ray-Zack M, et al. Multicenter study of the treatment of appendicitis in America: acute, perforated, and gangrenous (MUSTANG), an EAST multicenter study. Ann Surg. 2021;273(3):548-56. PMID: 31663966.
  • 17. Yeşiltaş M, Karakaş DÖ, Gökçek B, Hot S, Eğin S. Can Alvarado and Appendicitis Inflammatory Response scores evaluate the severity of acute appendicitis? Ulus Travma Acil Cerrahi Derg. 2018;24(6):557-62. PMID: 30516256.
  • 18. Köse E, Hasbahçeci M, Aydın MC, Toy C, Saydam T, Özsoy A, et al. Is it beneficial to use clinical scoring systems for acute appendicitis in adults? Ulus Travma Acil Cerrahi Derg. 2019;25(1):12-9. PMID: 30742281.
  • 19. Deiters A, Drozd A, Parikh P, Markert R, Shim JK. Use of the Alvarado score in elderly patients with complicated and uncomplicated appendicitis. Am Surg. 2019;85(4):397-402. PMID: 31043201.
  • 20. Collins GS, de Groot JA, Dutton S, Omar O, Shanyinde M, Tajar A, et al. External validation of multivariable prediction models: a systematic review of methodological conduct and reporting. BMC Med Res Methodol. 2014;14:40. PMID: 24645774.
  • 21. Eddama M, Fragkos K, Renshaw S, Aldridge M, Bough G, Bonthala L, et al. Logistic regression model to predict acute uncomplicated and complicated appendicitis. Ann R Coll Surg Engl. 2019;101(2):107-18. PMID: 30286649.
  • 22. Birben B, Sönmez BM, Er S, Özden S, Kösa MT, Tez M. External validation of the AppendistatTM score and comparison with CRP levels for the prediction of complicated appendicitis. Ulus Travma Acil Cerrahi Derg. 2021;27(2):187-91. PMID: 33630294.
  • 23. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004;141(7):537-46. PMID: 15466771.
  • 24. Nordin AB, Diefenbach K, Sales SP, Christensen J, Besner GE, Kenney BD. Gangrenous appendicitis: No longer complicated. J Pediatr Surg. 2019;54(4):718-22. PMID: 30551843.

Validation and Efficiency of a Scoring System Used in the Differentiation of Uncomplicated Appendicitis

Year 2022, Volume: 6 Issue: 1, 72 - 79, 27.03.2022
https://doi.org/10.30565/medalanya.995148

Abstract

Aim: Various parameters are used to differentiate between complicated-uncomplicated appendicitis cases and even scoring systems are created where these parameters are used together. The aim of this study is to evaluate the effectiveness of one of these scoring systems by external validation.

Method: Retrospective evaluation was performed on the clinical, radiological and laboratory findings of patients who underwent appendectomy between January 2018 and January 2021. Scoring was performed using the previously described scoring systems for each patient considered to have acute appendicitis as a result of imaging. They were divided into complicated appendicitis and uncomplicated appendicitis groups according to clinical and pathological evaluation results.

Results: While evaluating 425 patients, ultrasonography was used in 48% and tomography in 52% of the patients. Significant effectiveness of the score of ≤6 was observed in the group using tomography (p<0.001, AUC: 0.838, Sensitivity 83.3%, positive predictive value 50.8%, specificity 84.3%, negative predictive value 96.3%). Significant effectiveness of the score of ≤5 was observed in the ultrasonography group (p<0.001, AUC: 0.790, Sensitivity 85.7%, positive predictive value 39.0%, specificity 72.2%, negative predictive value 96.1%).

Conclusion: The scoring system created for the selection of uncomplicated appendicitis cases has been shown to be effective and has been externally validated. Since each of the parameters used in the scoring system has higher efficiency than its independent effectiveness, scoring systems that evaluate clinical, radiological and laboratory variables together give better results in clinical practice.

References

  • 1. Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet. 2011;377(9777):1573-9. PMID: 21550483.
  • 2. Santos D, Ledet CR, Limmer A, Gibson H, Badgwell B. Use of non-operative treatment and interval cholecystectomy for cholecystitis in patients with cancer. Trauma Surg Acute Care Open. 2020;5(1):e000439. PMID: 32420452.
  • 3. Ruffolo C, Fiorot A, Pagura G, Antoniutti M, Massani M, Caratozzolo E, et al. Acute appendicitis: what is the gold standard of treatment? World J Gastroenterol 2013;19(47):8799-807. PMID: 24379603.
  • 4. Gorter RR, Eker HH, Gorter-Stam MA, Abis GS, Acharya A, Ankersmit M, et al. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc. 2016;30(11):4668-90. PMID: 27660247.
  • 5. Sallinen V, Akl E, You J, Agarwal A, Shoucair S, Vandvik P, et al. Meta‐analysis of antibiotics versus appendicectomy for non‐perforated acute appendicitis. Br J Surg 2016;103(6):656-67. PMID: 26990957.
  • 6. Parekh D, Jain D, Mohite S, Phalgune D. Comparison of outer diameter of appendix, c-reactive protein, and serum bilirubin levels in complicated versus uncomplicated appendicitis. Indian J Surg. 2020;82(3):314-8. doi: 10.1007/s12262-019-01931-2.
  • 7. Çelik B, Nalcacioglu H, Ozcatal M, Altuner Torun Y. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in identifying complicated appendicitis in the pediatric emergency department. Ulus Travma Acil Cerrahi Derg 2019;25(3):222-8. PMID: 31135939.
  • 8. Shin DH, Cho YS, Kim YS, Ahn HC, Oh YT, Park SO, et al. Delta neutrophil index: A reliable marker to differentiate perforated appendicitis from non‐perforated appendicitis in the elderly. J Clin Lab Anal. 2018;32(1):e22177. PMID: 28238210.
  • 9. Sengul S, Guler Y, Calis H, Karabulut Z. The Role of Serum Laboratory Biomarkers for Complicated and Uncomplicated Appendicitis in Adolescents. J Coll Physicians Surg Pak. 2020;30(4):420-4. PMID: 32513365.
  • 10. Bom W, Bolmers M, Gans S, van Rossem C, van Geloven A, Bossuyt P, et al. Discriminating complicated from uncomplicated appendicitis by ultrasound imaging, computed tomography or magnetic resonance imaging: systematic review and meta-analysis of diagnostic accuracy. BJS Open. 2020;5(1):zraa030. PMID: 33688952.
  • 11. Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg. 2018;56:307-14. PMID: 30017607.
  • 12. Kim HY, Park JH, Lee SS, Jeon J-J, Yoon CJ, Lee KH. Differentiation between complicated and uncomplicated appendicitis: diagnostic model development and validation study. Abdom Radiol (NY). 2021;46(3):948-59. PMID: 32914350.
  • 13. Atema JJ, van Rossem CC, Leeuwenburgh MM, Stoker J, Boermeester MA. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg. 2015;102(8):979-90. PMID: 25963411.
  • 14. Geerdink T, Augustinus S, Atema J, Jensch S, Vrouenraets B, de Castro S. Validation of a Scoring System to Distinguish Uncomplicated from Complicated Appendicitis. J Surg Res. 2021;258:231-8. PMID: 33038600.
  • 15. Lastunen K, Leppäniemi A, Mentula P. Perforation rate after a diagnosis of uncomplicated appendicitis on CT. BJS open. 2021;5(1):zraa034. PMID: 33609386.
  • 16. Yeh DD, Eid AI, Young KA, Wild J, Kaafarani HM, Ray-Zack M, et al. Multicenter study of the treatment of appendicitis in America: acute, perforated, and gangrenous (MUSTANG), an EAST multicenter study. Ann Surg. 2021;273(3):548-56. PMID: 31663966.
  • 17. Yeşiltaş M, Karakaş DÖ, Gökçek B, Hot S, Eğin S. Can Alvarado and Appendicitis Inflammatory Response scores evaluate the severity of acute appendicitis? Ulus Travma Acil Cerrahi Derg. 2018;24(6):557-62. PMID: 30516256.
  • 18. Köse E, Hasbahçeci M, Aydın MC, Toy C, Saydam T, Özsoy A, et al. Is it beneficial to use clinical scoring systems for acute appendicitis in adults? Ulus Travma Acil Cerrahi Derg. 2019;25(1):12-9. PMID: 30742281.
  • 19. Deiters A, Drozd A, Parikh P, Markert R, Shim JK. Use of the Alvarado score in elderly patients with complicated and uncomplicated appendicitis. Am Surg. 2019;85(4):397-402. PMID: 31043201.
  • 20. Collins GS, de Groot JA, Dutton S, Omar O, Shanyinde M, Tajar A, et al. External validation of multivariable prediction models: a systematic review of methodological conduct and reporting. BMC Med Res Methodol. 2014;14:40. PMID: 24645774.
  • 21. Eddama M, Fragkos K, Renshaw S, Aldridge M, Bough G, Bonthala L, et al. Logistic regression model to predict acute uncomplicated and complicated appendicitis. Ann R Coll Surg Engl. 2019;101(2):107-18. PMID: 30286649.
  • 22. Birben B, Sönmez BM, Er S, Özden S, Kösa MT, Tez M. External validation of the AppendistatTM score and comparison with CRP levels for the prediction of complicated appendicitis. Ulus Travma Acil Cerrahi Derg. 2021;27(2):187-91. PMID: 33630294.
  • 23. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004;141(7):537-46. PMID: 15466771.
  • 24. Nordin AB, Diefenbach K, Sales SP, Christensen J, Besner GE, Kenney BD. Gangrenous appendicitis: No longer complicated. J Pediatr Surg. 2019;54(4):718-22. PMID: 30551843.
There are 24 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Research Article
Authors

Mehmet Kubat 0000-0002-3422-194X

Serdar Sahin 0000-0002-8398-2219

Publication Date March 27, 2022
Submission Date September 14, 2021
Acceptance Date February 8, 2022
Published in Issue Year 2022 Volume: 6 Issue: 1

Cite

Vancouver Kubat M, Sahin S. Validation and Efficiency of a Scoring System Used in the Differentiation of Uncomplicated Appendicitis. Acta Med. Alanya. 2022;6(1):72-9.

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