A Novel and Comprehensive Scoring System (TUST Score) for Diagnosing Acute Appendicitis

Ghulam Rasool Tariq; Saqib Ur Rehman; Uzma Rasool

doi:10.51253/pafmj.v76i3.12433

Authors

Ghulam Rasool Tariq Department of General Surgery, Combined Military Hospital Kharian/National University of Medical Sciences (NUMS) Pakistan
Saqib Ur Rehman Department of General Surgery, Combined Military Hospital Kharian/National University of Medical Sciences (NUMS) Pakistan
Uzma Rasool Department of Diagnostic Radiology, Combined Military Hospital Kharian/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i3.12433

Keywords:

Acute Appendicitis, Diagnosis, Histopathology, Score, Sensitivity and Specificity, TUST, Ultrasonography

Abstract

Objective: To develop a novel, comprehensive and all-inclusive Scoring System (TUST Score) for the diagnosis of Acute Appendicitis using USG as a routine along with Clinical features and Laboratory Investigations.

Study Design: Prospective Longitudinal Study.

Place and Duration of Study: Department of Surgery, Combined Military Hospital, Tarbela Pakistan, from Sep 2020 to Mar 2024.

Methodology: After their informed consent, 260 patients who fulfilled all criteria of TUST Score for diagnosis of Acute Appendicitis and underwent Appendicectomy with proven diagnosis on Histopathology were included in this study.

Data was entered on a Proforma comprising patient’s Demographic Parameters, Clinical Features, Laboratory Investigations, Radiological as well as their Operative Findings and Histopathological Reports.

Results: Out of 260 patients, 150(57.7%) were male while remaining 110(42.3%) were female. Minimum age was 10 years and maximum age 49 years with mean age of 24.15±0.154 years. Sensitivity of TUST Score in diagnosing Acute Appendicitis was 93%, Specificity 85%, Positive Predictive Value96%, Negative Predictive Value 75%, and Diagnostic Accuracy was 91%.

Conclusion: Being comprehensive and all inclusive, TUST Score at a cut-off value of (10/26) is a very useful tool to diagnose Acute Appendicitis and is far better than any other score developed so far.

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References

1. Chalya PL, Mchembe M. Is Invagination of Appendicular Stump in Appendicectomy Necessary? A Prospective Randomized Clinical Study. East Cent Afr J surg 2012; 17(1): 85-89.

2. Chalazonitis AN, Tzovara I, Sammouti E, Ptohis N, Sotiropoulou E, Protoppapa E et al. CT in appendicitis. Diagn Interventional Radiol 2008; 14(1): 19-25.

3. 3.Cole MA, Maldonado N. Evidence-based management of suspected appendicitis in the emergency department. Emerg Med Pract 2011; 13(10): 1-29.

4. Zakaria O, Sultan TA, Khalil TH, Wahba T. Role of clinical judgment and tissue harmonic imaging ultrasonography in diagnosis of paediatric acute appendicitis. World J Emerg Surg 2011; 6(1): 39. https://doi.org/10.1186/1749-7922-6-39

5. Guan L, Liu Z, Pan G, Zhang B, Wu Y, Gan T, et al. The global, regional, and national burden of appendicitis in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. BMC Gastroenterol 2023; 23(1): 44.

https://doi.org/10.1186/s12876-023-02678-7

6. Seetahal SA, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Frederick W, et al. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg 2011; 201(4): 433-437.

https://doi.org/10.1016/j.amjsurg.2010.10.009

7. Addis DG, Shaffer M, Fowler BS, Tauxe RV. The epidemiology of appendicitis and Appendicectomy in the United States. Am J Epidemiol 1990; 132 (5): 910-925.

https://doi.org/10.1093/oxfordjournals.aje.a115734

8. Wilasrusmee C, Siribumrungwong B, Phuwapraisirisan S, Poprom N, Woratanarat P, Lertsithichai P, et al. Developing and validating of Ramathibodi Appendicitis Score (RAMA-AS) for diagnosis of appendicitis in suspected appendicitis patients. World J Emerg Surg 2017; 12: 49.

https://doi.org/10.1186/s13017-017-0160-3

9. Nanjundaiah N, Mohammed A, Shanbhag V, Ashfaque K, Priya S A. A Comparative Study of RIPASA Score and ALVARADO Score in the Diagnosis of Acute Appendicitis. J Clin Diagn Res 2014; 8(11): NC03-5.

https://doi.org/10.7860/JCDR/2014/9055.5170

10. Andersson M, Kolodziej B, Andersson RE. Validation of the Appendicitis Inflammatory Response (AIR) Score. World J Surg 2021; 45(7): 2081-2091.

https://doi.org/10.1007/s00268-021-06042-2

11. Frountzas M, Stergios K, Kopsini D, Schizas D, Kontzoglou K, Toutouzas K. Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg 2018; 56: 307-314.

https://doi.org/10.1016/j.ijsu.2018.07.003

12. Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002; 37: 877-881. https://doi.org/10.1053/jpsu.2002.32893

13. Sammalkorpi HE, Mentula P, Leppäniemi A. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis-a prospective study. BMC Gastroenterol 2014; 14: 114. https://doi.org/10.1186/1471-230x-14-114

14. Wilasrusmee C, Siribumrungwong B, Phuwapraisirisan S, Poprom N, Woratanarat P, Lertsithichai P, et al. Developing and validating of Ramathibodi Appendicitis Score (RAMA-AS) for diagnosis of appendicitis in suspected appendicitis patients. World J Emerg Surg 2017; 12: 49.

https://doi.org/10.1186/s13017-017-0160-3

15. 15.Karaman K, Ercan M, Demir H, Yalkin O, Uzunoglu Y, Gundogdu K et al. The Karaman Score: A new Diagnostic Score for Acute Appendicitis. Ulus Travma Acil Cerrahi Derg 2018; 24: 545 – 551.

https://doi.org/10.5505/tjtes.2018.62436

16. Mir SA, Wani MD. Shabir’s SMART-LAB Score for predicting complicated appendicitis – a prospective study. Turk J Surg 2022; 38(2): 140-148.

https://doi.org/10.47717/turkjsurg.2022.5383

17. Ambreen, Farooq, Zameer S, Khadim R. Diagnostic Accuracy of Ultrasound in Acute Appendicitis in comparison with Alvarado Score keeping Histopathological Correlation as a Gold Standard. Pak Armed Forces Med J 2020; 70 (3): 807-811.

18. Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009 14; 169(22): 2078-2086. https://doi.org/10.1001/archinternmed.2009.427

19. Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, et al. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med. 2012 Apr 26; 366(17): 1596-1605.

https://doi.org/10.1056/nejmoa1110734

20. Jennings R, Guo H, Goldin A, Wright DR. Cost-effectiveness of Imaging Protocols for Suspected Appendicitis. Pediatrics 2020; 145(2): e20191352.

https://doi.org/10.1542/peds.2019-1352

21. Jaunoo SS, Hale AL, Masters JP, Jaunoo SR. An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix. Ann R Coll Surg Engl 2012; 94(7): 476-480.

https://doi.org/10.1308/003588412x13373405385377

22. Kam CT, Alsahaf M, Chongbang K, Taki M, Yusob J, Alexander S, et al. Ultrasound vs. clinical diagnosis-which is better in diagnosing acute appendicitis?: a cohort study. Ann Med Surg 2023; 85(6): 2336-2340.

https://doi.org/10.1097/ms9.0000000000000730

23. Qamar R, Mahmood K, Javed R, Sher F, Tufail I. Reliability of Diagnosis of Acute Appendicitis by Clinical assessment through Modified Alvarado Vs RIPASA Scoring System at Combined Military Hospital, Rawalpindi. Life Sci 2024; 5(2): 103–198.

https://doi.org/10.37185/LnS.1.1.346

24. 24.Saleem MM, WattuNM, Khan WA, PervaizM. Tzanaki Score as Diagnostic Tool For Acute Appendicitis Pak Armed Forces Med J 2017; 67(Suppl-1): S10-14.

25. Bl YBP, Mehra B, Ghoshal S, Dubhashi SP. Diagnostic Efficacy Study Comparing Tzanakis Scoring System With Alvarado Scoring System in Effective Diagnosis of Acute Appendicitis. Cureus 2024; 16(4): e58018.

https://doi.org/10.7759/cureus.58018