Clinical scores for acute appendicitis in adults: A systematic review and meta-analysis of diagnostic accuracy studies

Abstract

Introduction: Early diagnosis of acute appendicitis is crucial to prevent complications. Numerous scores exist, but a comprehensive review comparing them is lacking. This systematic review aimed to compare all published clinical scoring systems for diagnosing acute appendicitis in adults.

Methods: A systematic review and meta-analysis included studies assessing the diagnostic accuracy of clinical scores compared to histopathological findings for appendicitis. Sensitivities, specificities, diagnostic odds ratios (DOR), and summary receiver operating characteristics (SROC) were calculated.

Results: A total of 40 studies were included. The RIPASA score showed superior sensitivity (0.93 [95 ​% CI 0.78-0.98]; I² ​= ​96 ​%), specificity (0.81 [95 ​% CI 0.62-0.91]; I² ​= ​86 ​%), and DOR (45.3 [95 ​% CI 10.9-187.2]; I² ​= ​89 ​%). The AUC for the SROC curve of the RIPASA score was 0.913. A significant difference was found between the RIPASA score and both the Alvarado score (p ​< ​0.002) and the Modified Alvarado score (p ​< ​0.004) in SROC curves.

Conclusions: Our findings indicate that RIPASA is the most effective scoring system. Although the Alvarado score is the most studied, many other scores possess higher diagnostic accuracy.

Keywords: Acute appendicitis; Histopathology; Systematic review; clinical score.