Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation?

BACKGROUND: Acute appendicitis is one of the most common causes of abdominal pain seen in surgical clinics. Although it can be easily diagnosed, the picture may be confusing, particularly in premenopausal women and the elderly. The present study is an evaluation of 2 of the current scoring systems with respect to accurate diagnosis of the disease and indication of inflammation severity.
METHODS: A total of 105 patients diagnosed with acute appendicitis were included in the study. Subsequent to Alvarado and Ohmann scoring, ultrasonography image was obtained and appendectomy was performed. A unique intraoperative severity scoring system was used to measure severity of inflammation and to compare Alvarado and Ohmann scoring system results to assess accuracy of predictive value for acute appendicitis.
RESULTS: Moderate positive correlation was found between Alvarado score and Ohmann score (r=0.508; p<0.001). Rate of Alvarado score successfully predicting diagnosis of acute appendicitis based on histopathological results was statistically significant (p=0.027), while rate of Ohmann score was not statistically significant (p=0.807). Correlation between both scores and grading of inflammation performed during the operation was weak, but statistical significance was observed between Alvarado scoring system and intraoperative severity scoring (r=0.30; p=0.002). No statistical difference was observed between Ohmann scoring and intraoperative severity scoring (r=0.09; p=0.384).
CONCLUSION: Alvarado score is better able to predict acute appendicitis and provide an idea of severity of inflammation. Ohmann score is more useful to provide guidance and eliminate acute appendicitis from consideration when conditions are more uncertain and obscured.

Alvarado ve Ohmann skorlamalarý apandisit tanýsýnda ve enflamasyonun þiddetinde gerçek yol gösterici olabilir mi?

AMAÇ: Akut apandisit cerrahi kliniklerinde görülen en yaygýn karýn aðrýsý sebeplerinden birisidir. Taný kolay konulabilse de özellikle premenopozal kadýnlar ve yaþlýlarda karýþtýrýlabilmektedir. Bu sebeple mevcut bazý skorlama sistemlerinin hastalýðýn kolay taný konabilmesine ve hastalýðýn enflamasyon þiddetine yol göstermesine katkýsýný araþtýrmak istedik.
GEREÇ VE YÖNTEM: Akut apandisit tanýsý konan toplam 105 hasta çalýþmaya dahil edildi. Alvarado ve Ohmann skorlamalarý yapýlan hastalara ultrasonografi yapýlýp apendektomi uygulandý. Ameliyatta “intraoperatif þiddet skorlamasý” uygulandý ve bu skorlamalarýn birbiriyle korelasyonu, Alvarado ve Ohmann skorlarýnýn akut apandisiti ön görmede önemi araþtýrýldý.
BULGULAR: Alvarado skoru ile, Ohmann skoru arasýnda pozitif yönde orta derecede korelasyon bulundu (r=0.508, p<0.001). Histopatolojik sonuçlara göre Alvarado skorunun akut apandisit tanýsýný ön görme oraný istatistiksel olarak anlamlý iken (p=0.027) Ohmann skorlamasýnýn ön görme oraný istatistiksel olarak anlamlý bulunmadý (p=0.807). Ameliyatta þiddet skoruna bakýldýðýnda ise, her iki skorun da ameliyat sýrasýnda yapýlan skorlama ile baðýntýsý zayýf bulunurken Alvarado skorlamasý ile intraoperatif þiddet skorlamasý arasýnda anlamlýlýk saptandý (r=0.30, p=0.002). Ohmann skorlamasý ile intraoperatif þiddet skorlamasý arasýnda anlamlýlýk saptanmadý (r=0.09, p=0.384).
TARTIÞMA: Alvarado skorlamasý akut apandisiti ön görme ve enflamasyon þiddeti hakkýnda fikir verebilirken, Ohmann skorlamasý daha çok akut apandisiti dýþlama konusunda fikir vermektedir.