Comparative Evaluation of Tzanakis and Alvarado Scoring Systems in the Diagnosis of Acute Appendicitis: A Prospective Observational Study
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Abstract
Background: Acute appendicitis remains the most common surgical emergency, yet its diagnosis can be challenging due to atypical presentations. The Alvarado and Tzanakis scoring systems are commonly employed tools for preoperative diagnosis, but their relative diagnostic accuracy remains under debate. Objectives: This study aimed to compare the diagnostic efficacy of the Tzanakis score versus the Alvarado score in patients with suspected acute appendicitis and to validate these scores against histopathological findings. Methods: A prospective observational study was conducted from August 2023 to December 2024 at the Department of General Surgery, Sri Ramachandra Institute of Higher Education and Research. Ninety adult patients with clinical suspicion of acute appendicitis who underwent laparoscopic appendicectomy were included. Alvarado and Tzanakis scores were calculated preoperatively, and results were correlated with postoperative histopathology. Results: Of the 90 patients, histopathology confirmed acute appendicitis in 95.5%. Tzanakis score ≥8 had a sensitivity of 87.21% and specificity of 75%, outperforming the Alvarado score ≥7, which had a sensitivity of 76.74% and specificity of 50%. Tzanakis score also demonstrated higher predictive accuracy in identifying true positive cases. Conclusion: Both scoring systems are useful in diagnosing acute appendicitis; however, the Tzanakis score demonstrated superior diagnostic performance. Incorporation of Tzanakis scoring into routine practice may improve diagnostic accuracy and reduce negative appendectomy rates, especially in resource-constrained settings.
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Copyright (c) 2025 Monisha P, Kodali Adiseshu, Kishor RJ, Mohanapriya T
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