Publication:

A comparative study of appendicitis inflammatory response score and Tzanakis score for diagnosing patients with acute appendicitis

Background Accurate diagnosis of acute appendicitis remains challenging, and negative appendectomy rates remain significant when decision-making is based on clinical suspicion alone. Clinical scoring systems combine symptoms, signs, laboratory parameters and imaging to improve diagnostic accuracy. This study aimed to compare the diagnostic performance of the Appendicitis Inflammatory Response (AIR) score and the Tzanakis score in suspected acute appendicitis.

Methods This prospective comparative study was conducted in the Department of General Surgery, Mamata General Hospital, Khammam, for 2 years. 94 patients above 16 years of age with clinically suspected acute appendicitis were included. All patients were evaluated using both AIR and Tzanakis scoring systems. Histopathological examination (HPE) of the resected appendix was considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for both scoring systems.

Results The mean age was 33.2±14.87 years; males constituted 55.3% (M:F=1.2:1). On histopathological examination, out of 94 patients 80(85.1%) had acute appendicitis, 4 (4.3%) had follicular hyperplasia, and 10 (10.6%) had normal appendix. With cutoff >8, Tzanakis score showed sensitivity 98.8%, specificity 78.6%, PPV 96.3%, NPV 91.7%, and diagnostic accuracy 95.7%. With cutoff >8, AIR score showed sensitivity 67.5%, specificity 71.4%, PPV 93.1%, NPV 27.8%, and diagnostic accuracy 68.1%.

Conclusions The Tzanakis score demonstrated higher diagnostic accuracy than the AIR score. The inclusion of ultrasonography improves reliability, making it a practical and effective tool for clinical decision-making, particularly in resource-limited settings.