Clinical effectiveness study of the new diagnostic score of acute appendicitis in the elderly

Abstract

Abstract. Introduction. Acute appendicitis is among the three most frequent surgical diseases. The lifetime likelihood of developing acute appendicitis is around 7%. The incidence of acute appendicitis reduces with age after adolescence. Several studies evaluated the relevance of the current scores to the general population, mostly children, but a limited number of studies have studied the elderly population. This study aims to assess the clinical effectiveness of the new diagnostic score for the elderly population in comparison to both the Alvarado score and the non-standardized score. Material and methods. In order to evaluate the effectiveness of the diagnostic score of acute appendicitis, we examined 78 patients who were admitted to emergency unit of the Saint Archangel Michael Municipal Clinical Hospital during 2018- 2021 with the presumptive diagnosis of acute appendicitis. Of all patients admitted, Acute Appendicitis was confirmed on pathological examination in 22 (28.2%) patients. The average age of patients was 73.5±13.5 years (minimum - 60 years, maximum - 87 years). The ratio of males to females was 1:1.6. Results. Comparative evaluation of the new diagnostic score of acute appendicitis and the non-standardized clinical-echographic examination for acute appendicitis diagnosis showed better performance indicators of the new diagnostic score of acute appendicitis compared to the non-standardized clinical method for acute appendicitis diagnosis. The high sensitivity of the new diagnostic score of acute appendicitis was statistically demonstrated (ƛ2 = 4.32; p < 0.05), a lower rate of missed acute appendicitis cases in the new diagnostic score of acute appendicitis (ƛ2 = 4.32; p < 0.05), the „grey area” is lower in the new diagnostic score of acute appendicitis (ƛ2 = 5.28; p < 0.05), than in the non-standardized diagnosis. It was shown to have a lower rate of acute appendicitis cases in the „grey area” of the total number of acute appendicitis cases (ƛ2 = 4.9; p < 0.05). Benchmarking indicators such as specificity and diagnostic accuracy showed no statistically significant differences. At the same time, a definite increase in specificity and accuracy was observed for the new diagnostic score of acute appendicitis compared to non-standardized clinical diagnosis. Conclusions. Diagnosing acute appendicitis in elderly patients remains challenging due to the numerous potential diagnoses with similar clinical manifestations that are observed in this patient population. It was necessary to utilize clinical risk-scoring systems that could aid in the prompt identification of patients with acute appendicitis. This study concludes that the New diagnostic score has higher clinical efficiency in diagnosing acute appendicitis in elderly patients. It has a sensitivity of up to 93.15%, compared to the unstandardized clinical method and the Alvarado diagnostic score, and is independent of „risk factors” such as obesity and atypical vermiform appendix localization.