Diagnostic Scores for Appendicitis: A Systematic Review of Scores’ Performance.
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Date
2014-01-11
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Abstract
Aims: Several scoring systems have been developed for diagnosis of appendicitis. This
study aims to systematically explore how those scores were derived and validated, and
to compare their performance.
Study Design: Systematic review.
Place and Duration of Study: We searched Medline from 1949 and EMBASE from
1974 to March 2012 to identify relevant articles published in English.
Methodology: Information about model development and performance was extracted. The “risk of bias” assessment tool was developed based on a critical appraisal guide for
clinical prediction rules. Calibration (O/E ratio) and discrimination (C-statistic) coefficients
were estimated. A meta-analysis was applied to pool calibration coefficients and Cstatistics.
Results: Forty-four out of 468 studies were eligible. Of these, 14 developed or modified
diagnostic scoring systems and 30 validated existing models. Four scores had been
most frequently validated, i.e., Alvarado, modified Alvarado, Fenyo, and Eskelinen.
Among them, only the Eskelinen model was derived based on a multivariate regression
whereas the rest used univariate or non-statistical methodology. All studies reported very
good but imprecise calibration. For discrimination, the pooled C-statistics for these
corresponding scores were 0.77, 0.86, 0.81, and 0.84 respectively. In the external
validation, the discriminative performance decreased about 25.3% and 10.1% for the
Alvarado and Fenyo scores respectively.
Conclusion: The research methods for scoring systems of appendicitis were
inconsistent. More efficient scoring systems which have been internally and externally
validated are required.
Description
Keywords
Appendicitis, prediction score, systematic review, C-statistic, calibration
Citation
Wilasrusmee Chumpon, Anothaisintawee Thunyarat, Poprom Napaphat, McEvoy Mark, Attia John, Thakkinstian Ammarin. Diagnostic Scores for Appendicitis: A Systematic Review of Scores’ Performance. British Journal of Medicine and Medical Research. 2014 Jan; 4(2): 711-730.