Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis

Table 1 Clinical approaches advised by the authors regarding the scoring systems

	High probability	Probable/should be followed	Appendicitis with high probability
Alvarado	< 4	5-6	> 7
Eskelinen	< 48	48-57	> 57
Ohhmann	< 6	6-11.5	> 12
RIPASA	< 5	5-7	> 7.5

Table 2 Frequency of symptoms, examination findings and laboratory results n (%)

		Group A	Group N-A	P value
Symptoms
Loss of appetite	Yes	25 (69)	66 (86)	0.072
	No	11 (31)	11 (14)
Nausea-Vomiting	Yes	20 (56)	52(68)	0.294
	No	16 (44)	25 (32)
Time pain started	< 48	21 (58)	59 (77)	0.074
	> 48	15 (42)	18 (23)
Starting point of pain	Around stomach	8 (22)	37 (48)	0.021
	Lower right quadrant	25 (69)	38 (49)
	Anywhere	3 (8)	2 (3)
Relocalization of the pain to the lower right quadrant	Yes	7 (19)	33 (43)	0.020
	No	29 (81)	44 (57)
Urinary system complaint	Yes	9 (25)	8 (10)	0.052
	No	27 (75)	69 (90)
Similar pain history	Yes	19 (53)	13 (17)	< 0.001
	No	17 (47)	64 (83)
Findings
Sensitivity on lower right quadrant	Yes	36 (100)	76 (99)	0.999
	No	0 (0)	1 (1)
Defense-rigidity	Yes	23 (64)	77 (100)	< 0.001
	No	13 (36)	0 (0)
Rebound	Yes	16 (44)	75 (97)	< 0.001
	No	20 (56)	2 (3)
Rowsing finding	Yes	7 (19)	31 (40)	0.034
	No	29 (81)	46 (60)
Fever	> 37.3	5 (14)	28 (36)	0.015
	< 37.3	31 (86)	49 (64)
Laboratory results
Neutrophil	> %75	10 (28)	49 (64)	0.001
	< %75	26 (72)	28 (36)
Leukocyte	< 10000	15 (42)	13 (17)	0.009
	≥ 10000	21 (58)	64 (83)
Urine analysis	Normal	24 (67)	75 (97)	< 0.001
	Abnormal	12 (33)	2 (3)

Group A: Appendicitis group; Group N-A: Non-appendicitis group.

Table 3 Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy values of the scoring systems

	Alvarado (cut-off = 7)	Ohhmann (cut-off = 12)	Eskelinen (cut-off = 57)	RIPASA (cut-off = 7.5)
Sensitivity	82%	96%	100%	100%
Specificity	75%	42%	44%	28%
PPV	88%	78%	79%	75%
NPV	66%	83%	100%	100%
Diagnostic accuracy	80%	79%	82%	77%
Neg. app. rate	12%	22%	21%	25%

PPV: Positive predictive value; NPV: Negative predictive value; Neg. app. rate: Negative appendectomy rate.

Table 4 Cut-off values for the maximum sensitivity and specificity values of the scoring systems

Measurements	AUC	Cut-off	Sensitivity	Specificity
Alvarado	0.818	6.50	81.8	75.0
Ohmann	0.899	13.75	83.1	80.6
Eskelinen	0.867	63.72	80.5	83.3
RİPASA	0.857	10.25	83.1	75.0

AUC: Area under the curve.