Usefulness of scales to improve the diagnostic suspicion of acute appendicitis in the Emergency room of the Hospital General Puyo, 2021

Abstract

Context: Over the years, several scales have been developed to support the diagnosis and predict the severity of cases with a framework suggestive of acute appendicitis. In this investigation, these scales are compared.

Objective: To determine the degree of diagnostic certainty of the Alvarado and RIPASA scales as diagnostic support for Acute Appendicitis, at Hospital General Puyo, from 2021 to December 2021.

Methodology: Analytical, comparative, retrospective research, with diagnostic accuracy. Population and sample: Clinical histories of 105 adult patients admitted with a diagnosis of acute appendicitis during the study period. The SPSS v25.0 program was used, sensitivity (S), specificity (E), predictive values (PPV and NPV), likelihood ratios (LR+ and LR-), diagnostic OR (ORD), 95% CI and Receiver Operating Characteristic (ROC) curves. As reference questions, the criterion of the surgeon and the histopathological examination were taken. To compare both curves, the Hanley and McNeil statistics were used.

Results: Diagnostic accuracy: Alvarado: Sensitivity: 49.0% (35.9%-62.3%), Specificity: 50.0% (37.1%-62.9%); Positive Predictive Value: 48.1% (34.2%-62.2%); Negative Predictive Value: 50.9% (37.0-64.7%), Positive Likelihood Ratio: 0.9 (0.7-1.4), Negative Likelihood Ratio: 1.0 (0.7 -1.5); Odds diagnostic ratio: 0.9 (0.4-2.1), Area under the curve: 51.8% (40.6%-63.0%). RIPASA: Sensitivity: 76.5% (62.2%-86.7%), Specificity: 12.9% (5.8%-25.5%), Positive Predictive Value: 45.3% (34.7 %-56.4%), Negative Predictive Value: 36.8% (17.2%-61.4%), Positive Likelihood Ratio: 0.88 (0.73-1.06), Negative Likelihood Ratio: 1.82 (0.78-4.25), Odds diagnostic ratio: 0.48 (0.17-1.35), Area under the curve: 60.8% (49.7%-71.9%).

Conclusions: There were no significant differences between the RIPASA and Alvarado scales in relation to the diagnostic accuracy of acute appendicitis at the Hospital General de Puyo. In both cases, the performance was “discrete”; but, due to the characteristics of the show, this finding should not be generalized