Scoring System For Diagnosis Research Articles

Validity of Hematological scoring system in diagnosis of neonatal sepsis at Birat Medical College Teaching Hospital

Introduction: Newborns are vulnerable to infections. Timely diagnosis of neonatal sepsis can avoid major morbidity and mortality. Neonates with sepsis present with non-specific signs and symptoms. Timely diagnosis is important. Though blood culture is gold standard, it consumes time. Hematological scoring system (HSS) using hematological parameters can be effective in early diagnosis of sepsis. Objectives: To evaluate the effectiveness (Sensitivity, specificity, Positive Predictive value (PPV), Negative Predictive value (NPV) of HSS and their individual parameters in diagnosis of neonatal sepsis. Methodology: This was the cross-sectional study done at tertiary care hospital for period of six months. Neonates with clinical suspicion of sepsis were included in the study. Blood was drawn from neonate in two vials, one was sent for culture and other for calculation of hematological parameters as per Rodwell Hematological scoring system. Diagnostic study parameters were calculated. Result: Total of 143 neonates clinically suspected of sepsis were included in the study with 83 having positive blood culture. Highest sensitivity (86.7%) was recorded for Total Polymorph neutrophil (PMN) while highest specificity (93.3) and PPV (81.8) for I: T PMN ratio. A sensitivity of 67.5% and specificity of 91.7% was seen along with PPV of 91.8% and NPV of 67.1% with HSS greater than or equal to 5. Conclusion: HSS of greater than or equal to 5 can be considered to be the reliable screening tool for diagnosis of sepsis.

Cross sectional study to evaluate modified Alvardo score in the diagnosis of acute appendicitis

Background: Appendectomy is one of the most commonly performed emergency operation. The diagnosis requires distinguishing from other causes of pain in that region of the abdomen like acute ureteric colic, right sided salphingoophoritis. Presently ultrasonogram and contrast enhanced CT scan are the diagnostic modalities of choice. Although these facilities are readily available in urban areas but rural areas still suffer from lack of timely diagnosis and negative appendectomy, enhancing the need for a reliable scoring system for diagnosis of acute appendicitis. Here we will evaluate modified Alvardo scoring system in diagnosis of acute appendicitis. Methods: This is an observational cross-sectional hospital-based study at KPC medical college, Kolkata with 92 consecutive cases of suspected acute appendicitis, who were admitted, investigated and treated during 1st February 2022 to 31st January, 2023. Modified Alvardo score is calculated of each patient and compared with the histopathological findings of operated appendix. Results: The above study shows that modified Alvardo score 7-9 has high sensitivity of 93.10% in men and in female sensitivity is 77.78%. Overall sensitivity of modified Alvardo score of 7-9 came out to be 83.63%. Conclusions: It can be concluded that modified Alvardo score of 7-9 can be used as a potent diagnostic tool in male. But in females due to lower sensitivity and significant number of negative appendectomy, it can be used an diagnostic aid in addition to imaging studies for diagnosis.

AN OBSERVATIONAL CLINICAL STUDY OF ASSOCIATION OF LINTULA SCORE IN SUSPECTED CASE OF ACUTE APPENDICITIS IN TERTIARY CARE HOSPITAL

Acute appendicitis is the most common general surgical emergency. About 8% of people have appendicitis at some time during their life. (1) Early surgical intervention improves outcomes. (1) Lintula scoring system is based solely on clinical examination. This might improve the clinical outcomes in adults with suspected appendicitis. A study was conducted on 50 patients suspected of having acute appendicitis were admitted in surgery department. The variables of the Lintula score were recorded and the sum of the score for each patient was calculated. Patients were treated according to standard protocol decided by consultant. The result of the score will be compared to intraoperative diagnosis using chi square test.After comparing positive and negative appendicitis with positive and negative Lintula scores, sensitivity and specificity of Lintula scoring system in diagnosis of acute appendicitis were found to be 55% and 90% respectively. The positive predictive value and diagnostic accuracy of the test has been found to be 95.65% and 80% respectively. (p value <0.05).

A Study on Agreeability between Clinical Stroke Scoring Systems in Diagnosis of Stroke

A Study on Agreeability between Clinical Stroke Scoring Systems in Diagnosis of Stroke

Application of alvarado scoring system in diagnosis of acute appendicitis

Acute appendicitis is a common cause of abdominal pain and can be difficult to diagnose, especially during the early stages. There is still appreciable morbidity and occasionally mortality which may be related to the failure of making an early diagnosis (1) As a result of their concern these surgeons create for themselves 'a surgical security zone which allows them to accept a 15-30% negative laparotomy rate with impunity (2), Although various aids exist to facilitate more accurate diagnosis and reduce the rate of negative appendectomy, many are complex. Whereas simple scoring systems have been available for some time, they have not been widely tested. The aim of this study was conducted to assess one of these scoring systems which were described by Alvarado in 19851(1), by comparing it to the histopathology results of operated patients. This retrospective study of consecutive patients admitted to the surgical ward at Benghazi Aljala hospital with suspicion of having acute appendicitis during the period of January 2008 to January 2010. The Alvarado scoring system was computed from admission notes and records correlated with histopathology, all cases with insufficient data or no histopathology result were excluded from the study Out of 153 patients, 90 underwent appendectomy with the intention to treat appendicitis and diagnosis was confirmed in 80 patients. The reliability of the system was assessed by calculating the negative appendectomy rate and positive predictive value which was 85%, and the normal appendectomy frequency was 12%. Alvarado scoring system is an easy, cheap, and useful tool in the preoperative diagnosis of acute appendicitis and can work effectively in routine practice.

Usefulness of Haematological Scoring System in Early Diagnosis of Neonatal Sepsis

Background: Neonatal sepsis is one of the major causes of morbidity and mortality of the new born, especially in developing countries. The major concerns of the clinicians are its non-specific presentation and unavailability of tests with a high predictive value. Therefore, the need is for an infallible test that can be easily performed, quick, simple and cost-effective. Objectives: To assess the reliability of Haematological scoring system in diagnosis of suspected neonatal sepsis at early stage. Materials and Methods: A total of 84 suspected cases of neonatal sepsis were included in this prospective cross-sectional study carried out in Khulna City Medical College Hospital during the period from July 2021 to June 2022. The peripheral blood smears from all 84 patients were analysed using HSS of Rowell et al by pathologists. HSS assigns a score of 1 for each of seven findings significantly associated with sepsis such as total leukocyte count, total polymorphonuclear neutrophil count, elevated immature PMN count, elevated immature: total PMN ratio, Immature: mature PMN ratio >0.3, platelet count <150000/cmm, and pronounced degenerative or toxic changes in PMNs. The HSS score of >5 was interpreted as sepsis, blood culture was done as gold standard for diagnosis of sepsis. Each haematological parameter was assessed for its individual performance and sensitivity, specificity, positive and negative predictive values were calculated. Results: Among the total 84 suspected cases, 20 cases were diagnosed neonatal sepsis, (23.8%), 31 cases had probable infection (36.9%), and 33 cases were normal (39.3%). Elevated immature: total PMN count ratio (>0.2) and Immature: Mature PMN ratio (>0.3) were the most sensitive and specific parameter for sepsis. It was also seen that with increasing score, the likelihood of sepsis also increases. Conclusion: The sensitivities and specificities of the various parameters of HSS were found to be satisfactorily significant in identifying ........

Ripasa versus Alvarado as a Scoring System in Diagnosis of Acute Appendicitis in Al-Yarmouk Teaching Hospital

Background: Appendicitis is one of the most frequent diagnoses for emergency department visits resulting in hospitalization. A number of scoring systems have been developed to try to identify people who are likely to have appendicitis and are eligible for surgery. Aim of study: is to compare the accuracy of RIPASA to Alvarado score in the diagnosis of acute appendicitis. Methods: A prospective comparative study that was conducted at Al-Yarmouk Teaching Hospital / Baghdad during the period of one year from 1st of Feb. 2019 till 1st of Feb. 2020. It included 200 patients attended the outpatient clinic or the emergency department in Al-Yarmouk Teaching Hospital complaining from lower abdominal and/or right iliac fossa pain suggestive of acute appendicitis. Scoring was done to diagnose appendicitis by two scoring systems (Alvarado and RIPASA) using the data for each patient. The individual scores were then compared to the final diagnosis made by the clinician and to the recommendations of each scoring system. Results: In this study, most of the patients (172 patients, 86%) underwent appendectomy. We noticed that 44.8% of the operated cases were diagnosed as catarrhal appendicitis. Incidences of rebound tenderness, leukocytosis, migratory pain, ROVSING sign, and right iliac fossa guarding were significantly higher in patients diagnosed with appendicitis than those in patients diagnosed as normal appendix. Means of ALVARADO and RIPASA scores were significantly increased with severity to reach the highest level in patients diagnosed with severe appendicitis than other findings. ALVARADO score was 69.7% sensitive, 87.5% specific, and 74% accurate. RIPASA score was 94.1% sensitive, 62.5% specific, and 86.5% accurate. Conclusion: RIPASA score is more accurate and more sensitive than Alvarado score, in spite of the lower specificity, so that it can be effectively conducted for the better evaluation of acute appendicitis. RIPASA score is simple, non-invasive, and cost effective way to be used in resource limited conditions.

The Value of IOTA Simple Rules Combined With CEUS Scoring System in the Diagnosis of Benign and Malignant Ovarian Masses and Its Correlation With MVD and VEGF: A Preliminary Study.

To investigate the diagnostic value of International Ovarian Tumor Analysis (IOTA) simple rules combined with contrast-enhanced ultrasound (CEUS) scoring system in the differential diagnosis of ovarian tumors, and the correlations of the scoring system with microvessel density (MVD) and vascular endothelial growth factor (VEGF). One hundred eighty-nine patients with ovarian tumors were examined by routine ultrasound and CEUS. The enhanced characteristics of CEUS were observed, and the masses were classified by IOTA simple rules. To compare the diagnostic value of IOTA simple rules combined with CEUS scoring system and IOTA simple rules in the diagnosis of ovarian tumors. Immunohistochemistry was used to detect the expression of MVD and VEGF in postoperative tissue samples. The correlations between the new scoring system with MVD and VEGF were analyzed. The sensitivity (93.98%), specificity (94.34%), positive predictive value (92.86%), negative predictive value (95.24%), and accuracy (94.18%) of IOTA simple rules combined with CEUS scoring system in the diagnosis of ovarian tumors were higher than those of IOTA simple rules alone (all P < .05). The score system was significantly positively correlated with MVD and VEGF, and the r values were 0.77 and 0.63, respectively (P < .001). IOTA simple rules combined with CEUS scoring system was helpful to improve the accuracy of ultrasound diagnosis of ovarian tumors, which was significantly correlated with MVD and VEGF. It could provide important reference information for treatment scheme formulation and prognosis evaluation.

Value of shear wave elastography combined with the Toronto clinical scoring system in diagnosis of diabetic peripheral neuropathy.

To evaluate the diagnostic values of shear wave elastography (SWE) alone and in combination with the Toronto clinical scoring system (TCSS) on diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM).The study included 41 DPN patients, 42 non-DPN patients, and 21 healthy volunteers. Conventional ultrasonography and SWE were performed on the 2 sides of the tibial nerves, and cross-sectional area (CSA) and nerve stiffness were measured. TCSS was applied to all patients. A receiver operating characteristic curve analysis was performed.The stiffness of the tibial nerve, as measured as mean, minimum or maximum elasticity, was significantly higher in patients in the DPN group than the other groups (P < .05). The tibial nerve of subjects in the non-DPN group was significantly stiffer compared to the control group (P < .05). There was no significant difference of the tibial nerve CSA among the 3 groups (P > .05). Mean elasticity of the tibial nerve with a cutoff of 71.3 kPa was the most sensitive (68.3%) and had a higher area under the curve (0.712; 0.602–0.806) among the 3 shear elasticity indices for diagnosing DPN when used alone. When combining SWE with TCSS in diagnosing DPN, the most effective parameter was the EMax, which yielded a sensitivity of 100.00% and a specificity of 95.24%.SWE is a better diagnostic tool for DPN than the conventional ultrasonic parameter CSA, and a higher diagnostic value is attained when combining SWE with TCSS.

Comparison of Two Different Cut-Off Values of Scoring System for Diagnosis of Hirschsprung-Associated Enterocolitis After Transanal Endorectal Pull-Through

Background: Hirschsprung-associated enterocolitis (HAEC) is a major contributor in the mortality of Hirschsprung disease (HSCR) patients that can occur both preoperatively and post-operatively. Several cut-off values of HAEC score have been used, i.e., ≥10 and ≥4. Here, we compared the HAEC frequency after transanal endorectal pull-through (TEPT) using two cut-offs of scoring system and associated them with the risk factors.Methods: Cross-sectional analysis was conducted using medical records of HSCR patients who were aged ≤18 years old and underwent TEPT at our institution, Indonesia between 2009 and 2016. HAEC was determined using the scoring system with cut-off values of ≥10 and ≥4.Results: Seventy subjects were used in the final analysis, consisting of 44 males and 26 females. There was a significant difference in one HAEC finding between the ≥10 and ≥4 cut-off groups; diarrhea with explosive stools (p = 0.002). The HAEC frequency was 5/70 (7.1%) and 49/70 (70%) patients using cut-off values of ≥10 and ≥4 (p < 0.0001), respectively. We found that patients with anemia (i.e., iron deficiency anemia) had a higher risk of HAEC after TEPT than patients with normal hemoglobin level with OR of 3.77 (95% CI = 1.28–11.1; p = 0.027), while no associations were found between other variables, including sex, age at diagnosis, age at definitive therapy, albumin level, and nutritional status and HAEC following TEPT (p = 0.87, 0.15, 0.33, 0.26, and 0.60, respectively). Also, no associations were observed between maternal education level, mother's age at pregnancy and gestational age and HAEC after definitive surgery (p = 0.10, 0.46, and 0.86, respectively).Conclusions: This report is the first study comparing two different cut-off values of scoring system to evaluate the HAEC frequency after TEPT and results suggest further using cut-off of ≥4 to expand the diagnosis of HAEC. Moreover, we also show for the first time that hemoglobin level is a strong risk factor for the HAEC development after TEPT.

Autoimmune hepatitis-is histology conclusive?

Liver biopsy is an essential and necessary element in the diagnosis and management of autoimmune hepatitis, and is of very special importance in the scoring system for diagnosis. Histopathology shows moderate to severe inflammatory infiltrates with abundant plasma cells in the enlarged portal tracts with interface hepatitis and moderate to severe necroinflammatory lesions in the lobules with lymphoplasmacytic reaction. Regeneration develops with rosette formation and regenerative nodules. One important issue is the differentiation between acute onset of autoimmune hepatitis and a flare up of chronic disease; this cannot be diagnosed in some cases clinically and therefore requires a biopsy to evaluate the stage of the disease. There are some variants of the disease with cholestatic features such as autoantibody negative autoimmune hepatitis and giant cell hepatitis as well as overlap syndromes with primary biliary cholangitis and primary sclerosing cholangitis. Clinically, three types of autoimmune hepatitis are differentiated according to autoantibody formation and the clinical picture, however, histopathologically there is no difference between these three types. Differential diagnosis of autoimmune hepatitis includes drug-induced liver injury with minocycline, alpha methyldopa, nitrofurantoin and checkpoint inhibitors such as infliximab. Wilson´s disease is also an important differential diagnosis especially in young adults. A liver biopsy is mandatory to confirm the diagnosis of autoimmune hepatitis but histopathology alone is not conclusive.

Utility of Hematological Scoring System in Diagnosis of Neonatal Sepsis

Background: Neonatal septicemia is defined as a clinical syndrome characterized by systemic signs and symptoms caused by a bacterial infection and gives positive blood culture in the first month of life. It is associated with high morbidity and mortality, but early diagnosis and treatment significantly improve the outcomes. The present study brings out a quick and cost- effective Hematological Scoring System that enables early diagnosis of neonatal sepsis&#x0D; Method: This study was conducted in the Department of Pathology of Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Thiruvananthapuram over 1 year. Eighty neonates with clinical suspicion of sepsis were studied with respect to their peripheral smear findings, blood culture and C-reactive protein levels.&#x0D; Result: Among the eighty cases, twelve neonates were culture positive. Male gender and late- onset of sepsis were the significant risk parameters. Escherichia coli and Staphylococcus aureus were the most common isolated organisms. Of the different parameters studied I:T ratio and Absolute neutrophil count showed the highest specificity and immature neutrophil count had the highest sensitivity. Forty-one percent of neonates had a high Hematological Scoring System score. The specificity of Hematological Scoring System with a score &gt; 5 was 92%&#x0D; Conclusion: Hematological Scoring System is a cost-effective, rapid and easy to perform screening test that can be used to rule out sepsis thus avoiding unnecessary administration of antibiotics to unaffected babies. It should be adopted as a routine screening procedure by minimally qualified rural doctors with minimal resources to ensure appropriate action immediately for children with high index of suspicion of sepsis.

Effectiveness of alvarado scoring system in diagnosis of acute appendicitis

Effectiveness of alvarado scoring system in diagnosis of acute appendicitis

The "MICE" scoring system in differentiating the identical twins leptospirosis and hantavirus infection.

To develop a practical scoring system to assist clinicians in differentiating leptospirosis and hantavirus infections, whose epidemiological, clinical, and laboratory characteristics are literally like identical twins. The study population consisted of 162 patients admitted to hospital with a confirmed diagnosis of leptospirosis (LG group, n = 92) and hantavirus infections (HG, group = 70) between January 2000 and January 2019. The two groups were compared in terms of demographic, clinical and laboratory features. Sensitivity, specificity, and positive and negative predictive values were determined from ROC analysis for findings of significance in the diagnosis of leptospirosis, and a scoring system for diagnosis was developed ("MICE" score). During the development of this scoring system, we were careful to employ parameters that would not affect one another statistically, to reflect the involvement of very different systems (such as the hematological, hepatic, renal, and musculoskeletal systems) due to the multisystemic effect of the disease in the organism, and to ensure that the system should be simple to apply and understand. Accordingly, five parameters, serum WBC, creatinine, creatine kinase, total bilirubin, and C-reactive protein, were employed in the "MICE" scoring system. Three cut-off values were determined using ROC analysis for the five parameters included in the MICE system. Accordingly, scores of 0, 1, or 2 were given based on the values WBC (/μL): ≤ 7500, 7500-15,000, and > 15,000; total bilirubin (mg/dL): ≤ 3, 3-10, and > 10; CRP (mg/dL): ≤ 5, 5-15, and > 15; creatinine (mg/dL): ≤ 1.5, 1.5-3, and > 3; CK (U/L): ≤ 500, 500-1000, > 1000. AUC was calculated as 0.964 at ROC analysis, while the most noteworthy cut-off point was obtained when MICE score was ≥ 3, exhibiting 93.5% sensitivity, 92.9% specificity, PPV 94.5% and NPV 91.5%. A test score ≥ 3 was regarded as positive. In addition, our patients were evaluated using other current scoring systems in addition to "MICE," and our scoring system exhibited a greater diagnostic power in our subjects. Leptospirosis and hantavirus infections can be accurately predicted by the MICE scoring system. Early diagnosis and rational treatment will also help to lower the mortality rates in these diseases.

Use and relevance of modified alvarado scoring system in diagnosis of acute appendicitis: a cross sectional study from West Bengal, India

Background: For successful management of acute appendicitis, early diagnosis and intervention is needed. Incorrect diagnosis may allow significantly increased morbidity and mortality. Several studies across the globe shows that Modified Alvarado Scoring System (MASS) does not need high end instrument and can be done in emergency situation for accessing acute appendicitis and reducing the chances of unnecessary surgery. To access the efficacy of MASS for diagnosis of acute appendicitis in remote areas with primary health care facilities, present study was done at Siliguri of Darjeeling district of West Bengal which was 580 km distant from state capital (Kolkata).Methods: A cross sectional study over a period of 16 months was conducted among the patients admitted at North Bengal Medical College and Hospital suspected to have acute appendicitis. The diagnosis was confirmed by histopathological examination. Written consent was obtained from the patients before commencement of the study. MASS was applied to the patients and the results were compared with histopathological findings. Appropriate statistical analysis has been done by SPSS (version 16.0).Results: A total of 75 patients (44 males and 31 females) were considered. The sensitivity and specificity of MASS in this study were 75.86% (71.43% for males and 80% for females) and 82.61% (80% for males and 87.5% for females) respectively. Study revealed statistically significant (p&lt;0.000) association between Histopathological report and MASS.Conclusions: To reduce the chances of negative appendectomy and for better diagnosis of appendicitis, MASS may be more useful at primary health care centres those are located in remote areas as it was very simple, easy and cost effective.

A prospective study of accuracy of modified Alvarado score in patients with acute appendicitis in tertiary care hospital

Background: Acute appendicitis is the most common acute emergency of the abdomen. Clinical diagnosis of acute appendicitis is challenging in most of situation. The present study was designed to evaluate the role of modified Alvarado scoring system in diagnosis of acute appendicitis.Methods: One hundred consecutive patients presenting in the department of surgery Geetanjali Medical College and Hospital from January 2014 to 2016 were included. Demographic characteristics, symptoms and signs, laboratory results were recorded. Data was collected using a pre-tested questionnaire and analyzed using statistical calculation.Results: In the present study 100 patients were studied in a period of two years. Maximum percentage of patients were in age group 20-30 years and males dominated the series. The sensitivity and specificity of modified Alvarado score was 91.57% and 76.47% respectively with positive predictive value 95% and negative predictive value 65% and diagnostic accuracy of 89%.Conclusions: This study shows that use of modified Alvarado scoring system in patients with acute appendicitis provides a high degree of diagnostic accuracy.

Application of Alvarado Scoring System in Diagnosis of Acute Appendicitis

Application of Alvarado Scoring System in Diagnosis of Acute Appendicitis

Available, Bed-sided, Comprehensive (ABC) score to a diagnosis of Methicillin-resistant Staphylococcus aureus infection: a derivation and validation study

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) infections continue to be a leading problem in health care facilities worldwide.MethodsThis single-center retrospective cohort study consisted of a derivation phase and a validation phase. The derivation phase included all patients admitted to Osaka University Hospital between May 2010 and April 2011. We proposed a provisional available, bed-sided, comprehensive (ABC) score, and evaluated its accuracy using the clinical diagnosis as a reference. We subsequently revised ABC scores based on k coefficient scores of each variable; this revision was validated by applying it to another patient population.ResultsA total of 172 patients and 154 cases were enrolled in the derivation and validation studies, respectively. The revised ABC score consisted of four simple variables: type of clinical specimen (1 to 3 points), Gram-staining result (1 point), presence of local inflammation (2 points), and a systemic inflammatory response (2 points). A revised score of ≥5 points was sensitive (93.8%) and specific (90.6%), and the area under the receiver-operating curve was 0.969 (95% CI; 0.957–1).ConclusionsWe developed a simple and comprehensive scoring system for diagnosis of nosocomial MRSA infections; this system is applicable in a wide variety of situations.

Evaluation of Utility of Alvarado Scoring System in Diagnosis of Acute Appendicitis at a Tertiary Care Centre of Dakshina Kannada

Evaluation of Utility of Alvarado Scoring System in Diagnosis of Acute Appendicitis at a Tertiary Care Centre of Dakshina Kannada

Can clinical scoring systems improve the diagnostic accuracy in patients with suspected adult appendicitis and equivocal preoperative computed tomography findings?

ObjectiveAdult appendicitis (AA) with equivocal computed tomography (CT) findings remains a diagnostic challenge for physicians. Herein we evaluated the diagnostic performance of several clinical scoring systems in adult patients with suspected appendicitis and equivocal CT findings.MethodsWe retrospectively evaluated 189 adult patients with equivocal CT findings. Alvarado, Eskelinen, appendicitis inflammatory response, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), and adult appendicitis score (AAS) scores were evaluated, receiver operating characteristic analysis was conducted, and the optimal, low, and high cut-off values were determined for patient classification into three groups: low, intermediate, or high.ResultsIn total, 61 patients were included in the appendicitis group and 128 in the non-appendicitis group. There were no significant differences between the area under the curve of the clinical scoring systems in the final diagnosis of AA for equivocal appendicitis on CT (Alvarado, 0.698; Eskelinen, 0.710; appendicitis inflammatory response, 0.668; RIPASA, 0.653; AAS, 0.726). A RIPASA score greater than 7.5 had a high positive predictive value (90.9) and an AAS score less than or equal to 5 had a high negative predictive value (91.7) in the diagnosis of AA.ConclusionThe accuracy of clinical scoring systems in the diagnosis of AA with equivocal CT findings was moderate. Therefore, a high RIPASA score may assist in the diagnosis of AA in patients with equivocal CT findings, and a low AAS score may be used as a criterion for patient discharge. Most patients presented with intermediate scores. The patients with equivocal CT findings may be considered as a third diagnostic category of AA.