Tzanski Score Vs Modified Alvarado Score in Diagnosis of Acute Appendicitis
Authors: - Dr Praveen Shandil , - Dr Brahmjeet Atrish , - Prof . U.K. Chandel , - Prof. A.K. Kaundal 
Published: April 2024

Background:	Acute appendicitis is the most common non-traumatic surgical acute abdominal pain. Acute appendicitis is a frequent reason for emergency hospital admission, and appendectomy is one of the most common emergency procedures performed in contemporary medicine. The lifetime risk of developing appendicitis is 8.6% for males and 6.7% for females, with the highest incidence in the second and third decades. Complications are more common in extreme age group of patients who have greater perforation rate with more chances of intraperitoneal spread of infection due to their poor localizing capability. (6,7) Alvardo score [8] is widely used in diagnosing acute appendicitis, a score of 7 or more is considered diagnostic requiring surgery [9]. Its sensitivity and specificity ranges from 73-90% and 87-92% respectively [10-11]. Tzanaki score [12] is a combination of clinical evaluation and ultrasonography and inflammatory markers. There are together 4 variables and 15 points and a score of more than 8 is diagnostic for appendicitis requiring surgery. This study compares the efficacy of Tzanaki and Alvardo scoring to diagnose acute appendicitis and reduce the rate of negative appendicectomy.
Objectives: This study aims to reduce the rate of negative appendicectomy by comparing the Tzanakis score and modified Alvarado score in diagnosis of acute appendicitis.
Methodology: Patients admitted to IGMC and Hospital Shimla from June 2020 to Sept 2022 who underwent appendicectomy for acute appendicitis were included in the study. For each patient clinical, biochemical and radiological investigations were done and graded with both Alvarado scoring and Tzanakis scoring. Histology results from the biopsy were followed up and the negative appendicectomy rate was then calculated. The results of both Alvarado score and Tzanakis score to determine sensitivity, specificity, Positive predictive value, negative predictive value were calculated and compared.
Results: 120 cases of acute appendicitis were admitted in IGMC&H and studied. There is a male predominance with a ratio of 4:1.There is a higher prevalence of acute appendicitis in second decade (52%) Right iliac fossa pain (90%) and anorexia (82%) were the consistent symptoms. Right iliac fossa tenderness is the most consistent clinical sign(62%) Most number of patients presented between 12-24 hours after the onset of symptoms. Retrocaecal was the most common location of the appendix (60%). Alvarado score is a simple aid in diagnosing acute appendicitis but significant number of cases are missed if entirely relied upon, with a negative appendicectomy rate of 8%. Though acute appendicitis is a clinical diagnosis, the Tzanakis scoring system can complement the clinical diagnosis. There was no post-operative mortality in our study.
Conclusion: Tzanakis scoring is significantly more efficient when compared to Alvarado scoring for the diagnosis of acute appendicitis. The incorporation of ultrasound in the Tzanakis score improves the diagnostic precision. Good clinical judgement aided by investigations and scoring systems can help to reduce the negative appendicectomy rate. Tzanakis scoring system can be used as an effective modality to establish the accurate diagnosis of acute appendicitis with reasonably low negative appendicectomy rate.