{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T04:28:22Z","timestamp":1793593702905,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute appendicitis (AA) is one of the most common causes of acute abdominal pain requiring emergency surgery. This study compared the diagnostic accuracy of the Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), Appendicitis Inflammatory Response (AIR) and Tzanakis scoring systems in patients undergoing appendectomy for suspected AA, with emphasis on predicting complicated appendicitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective observational study was conducted at the University of Health Sciences Bursa Y\u00fcksek \u0130htisas Training and Research Hospital between June 2021 and February 2022. Patients consecutively undergoing appendectomy for suspected AA were enrolled. Clinical, laboratory and imaging data were prospectively collected and all four scores calculated at emergency department evaluation. Diagnostic performance was assessed by ROC curve analysis, with histopathological examination as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 303 patients were included; 193 (63.7%) were male, with a median age of 33\u2009years (IQR: 24\u201343). AA was confirmed in 296 patients (97.7%), with perforated appendicitis in 53 (17.5%) and plastron appendicitis in 20 (6.6%). Alvarado, RIPASA and AIR scores were significantly higher in confirmed appendicitis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for all). AUC values were 0.850, 0.878 and 0.871, respectively, with no significant difference among these three systems. The AIR score achieved the highest AUC of 0.754 for predicting perforated appendicitis, outperforming all other systems.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Alvarado, RIPASA and AIR scoring systems demonstrated comparable diagnostic performance for AA. The AIR score showed a superior ability to predict complicated appendicitis preoperatively, supporting its role in risk stratification and clinical decision\u2010making in the emergency department.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70895","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:55:58Z","timestamp":1785718558000},"page":"3106-3115","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Alvarado,\n                    <scp>RIPASA<\/scp>\n                    ,\n                    <scp>AIR<\/scp>\n                    and Tzanakis Scores in Acute Appendicitis: Prediction of Complicated Disease"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7257-0868","authenticated-orcid":false,"given":"Ebru","family":"Adal\u0131","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6389-5361","authenticated-orcid":false,"given":"Ye\u015fim","family":"I\u015fler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2005-6100","authenticated-orcid":false,"given":"Halil","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0793-3693","authenticated-orcid":false,"given":"Melih","family":"Y\u00fcksel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1061-5327","authenticated-orcid":false,"given":"Mehmet O\u011fuzhan","family":"Ay","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8972-9989","authenticated-orcid":false,"given":"Mert","family":"Adal\u0131","sequence":"additional","affiliation":[{"name":"Department of General Surgery University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1854-4765","authenticated-orcid":false,"given":"Yurdakul Deniz","family":"Firat","sequence":"additional","affiliation":[{"name":"Department of General Surgery University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital  Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00275-5"},{"key":"e_1_2_7_3_1","first-page":"764","article-title":"Acute Appendicitis in Childhood and Adulthood","volume":"117","author":"Teoule P.","year":"2020","journal-title":"Deutsches \u00c4rzteblatt International"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2018.05.006"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-020-00306-3"},{"key":"e_1_2_7_6_1","first-page":"261","article-title":"Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis","volume":"6","author":"Gomes C. 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