Akut apandisit tanısında alvarado, raja ısteri pengiran anak saleha appendicitis (RIPASA), ohmann ve adult appendicitis score (AAS) skorlarının geriye dönük karşılaştırılması
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Date
2022
Authors
Çavdar, Orhan
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Akut apandisit acil abdominal cerrahilerin en sık nedenlerinden biri olup, tanısında semptom ve fizik muayeneye ek olarak laboratuvar bulguları ve görüntüleme yöntemlerinden de yararlanılmaktadır. Bu amaçla tanıda yardımcı olması için; Alvarado, RIPASA, Ohmann, AAS gibi pek çok skorlama sistemi geliştirilmiştir. Çalışmamızın amacı; akut apandisit tanısı alan hastalarda bu skorların etkinliklerini değerlendirmek ve karşılaştırmaktır. Çalışmamızda Ocak 2019 – Temmuz 2021 tarihleri arasında, Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi Acil Servisi’ne başvuruları sonucu apendektomi olan 18 yaş üstü hastalar dâhil edilmiştir. Her hastanın Alvarado, RIPASA, Ohmann ve AAS skorlama sistemlerine ait puanları ayrı ayrı hesaplanmış, bu hastaların yapılan laboratuvar test sonuçları, görüntüleme sonuçları ve histopatolojik tanıları kayıt edilmiştir. Çalışmaya dâhil edilen hastalardan 95’i (%59,4) erkek, 65’i (40,6) kadın olup 150 tanesinin histopatolojik tanısı akut apandisit ile uyumlu gelmiş ve negatif apendektomi oranı % 6,3 olarak belirlenmiştir. İncelenen skorlama sistemlerinden sensitivitesi en yüksek Ohmann olarak belirlenirken, spesifitesi en yüksek olan ise Alvarado skorlama sistemidir. Tanısal doğruluk oranlarına bakıldığında Ohmann %83,1 ile başta yer alırken, onu %81,3 ile RIPASA izlemiş, daha sonra AAS ve en son olarak Alvarado gelmektedir. Çalışmamızda akut apandisit tanısında kullanılabilen skorlama sistemleri içerisinde tanısal doğruluk oranı en yüksek Ohmann olarak belirlenmiştir. Ohmann eşik değeri 12 olarak belirlendiğinde, akut apandisit ön tanısı düşünülen hastalarda risk sınıflaması yapmakta, hastaların gereksiz kalış süresini azaltıcı ve gereksiz tetkik yükünden kurtarıcı bir skorlama sistemi olarak karşımıza çıkmaktadır.
Acute appendicitis is accepted as one of most common causes of acute abdominal surgeries and physical examination of the patient in addition to laboratory findings and radiological methods are used in diagnosis. For this purpose, to assist in the diagnosis, scoring systems such as Alvarado, RIPASA, Ohmann, AAS have been developed. The aim of our study is to evaluate and compare the effectiveness of these scores in patients diagnosed with acute appendicitis. In our study, patients who are aged 18 and above and had appendectomy as a result of their admission to Bursa Uludag University Medical Faculty Emergency Department were included. The scores of each patient's Alvarado, RIPASA, Ohmann and AAS scoring systems were calculated separately, and laboratory test results, imaging results and histopathological diagnoses of these patients were recorded. Of the patients included in the study, 95 (59.4%) were male and 65 (40.6%) were female. The histopathological diagnosis of 150 of them was compatible with acute appendicitis, and the negative appendectomy rate was determined as 6.3%. Among the scoring systems, Ohmann has the highest sensitivity, while the Alvarado scoring system has the highest specificity. Considering the diagnostic accuracy rates, Ohmann was in the first line with 83.1%, followed by RIPASA with 81.3%, followed by AAS and lastly Alvarado. In our study, Ohmann was found to have the highest diagnostic accuracy between the scoring systems in acute appendicitis. If the Ohmann threshold value is set as 12, it could categorize the risk in patients with a prediagnosis of acute appendicitis, and it appears as a scoring system that viii reduces the unnecessary length of stay of the patients and saves the burden of unnecessary examinations.
Acute appendicitis is accepted as one of most common causes of acute abdominal surgeries and physical examination of the patient in addition to laboratory findings and radiological methods are used in diagnosis. For this purpose, to assist in the diagnosis, scoring systems such as Alvarado, RIPASA, Ohmann, AAS have been developed. The aim of our study is to evaluate and compare the effectiveness of these scores in patients diagnosed with acute appendicitis. In our study, patients who are aged 18 and above and had appendectomy as a result of their admission to Bursa Uludag University Medical Faculty Emergency Department were included. The scores of each patient's Alvarado, RIPASA, Ohmann and AAS scoring systems were calculated separately, and laboratory test results, imaging results and histopathological diagnoses of these patients were recorded. Of the patients included in the study, 95 (59.4%) were male and 65 (40.6%) were female. The histopathological diagnosis of 150 of them was compatible with acute appendicitis, and the negative appendectomy rate was determined as 6.3%. Among the scoring systems, Ohmann has the highest sensitivity, while the Alvarado scoring system has the highest specificity. Considering the diagnostic accuracy rates, Ohmann was in the first line with 83.1%, followed by RIPASA with 81.3%, followed by AAS and lastly Alvarado. In our study, Ohmann was found to have the highest diagnostic accuracy between the scoring systems in acute appendicitis. If the Ohmann threshold value is set as 12, it could categorize the risk in patients with a prediagnosis of acute appendicitis, and it appears as a scoring system that viii reduces the unnecessary length of stay of the patients and saves the burden of unnecessary examinations.
Description
Keywords
Apandisit, Alvarado, RIPASA, Ohmann, AAS, Appendicitis
Citation
Çavdar, O. (2022). Akut apandisit tanısında alvarado, raja ısteri pengiran anak saleha appendicitis (RIPASA), ohmann ve adult appendicitis score (AAS) skorlarının geriye dönük karşılaştırılması. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.