What is the effectiveness of the Tzanakis scoring system modified by the Delta Neutrophil Index in the diagnosis of acute appendicitis in pregnant women?

Introduction: Acute appendicitis is the most common cause of abdominal pain that is unrelated to pregnancy in pregnant women. The aim of this study was to evaluate the performance of the Alvarado, Ohmann, and Tzanakis scores in the prediction of acute appendicitis in pregnant women and compare the hematological parameters. Patients and methods: Herein, 1542 patients, aged 18-49 years, who were admitted to the emergency department with abdominal pain and underwent appendectomy were evaluated retrospectively. Of these, 140 female patients, including 35 who were pregnant and had been diagnosed with acute appendicitis, were included in the study. The obtained data were used to calculate the Alvarado, Tzanakis, and Ohmann scores. Histopathological evaluation reports were examined, and the diagnosis of acute appendicitis was confirmed. Those with different histopathological diagnoses were recorded as negative appendectomy. Results: In the pregnant and non-pregnant women, the Tzanakis scoring system showed the best predictive performance in terms of the sensitivity and accuracy percentage from the Alvarado and Ohmann scoring systems (84.85%, 85.71% vs. 92.93%, and 92.38%, respectively). When the parameters showing infection were compared, the Delta Neutrophil Index (DNI) was significantly higher in the pregnant appendicitis patients (P = 0.012). When the Tzanakis scoring system was modified with the DNI, the sensitivity, accuracy, and negative predictive values were significantly increased (93.94%, 94.29%, 50% vs. 94.95%, 94.29%, and 50%, respectively). Conclusion: The Tzanakis scoring system appeared to be more effective than the other scoring systems in the diagnosis of acute appendicitis. Modification of the Tzanakis scoring system with the DNI was more successful in predicting appendicitis in pregnant women. (C) 2021 Elsevier B.V. All rights reserved.