Comparative diagnostic accuracy of the Tzanakis Score versus the Alvarado Score in acute appendicitis among non-pregnant women: A retrospective study at Zagazig University Hospitals

Background: Accurate diagnosis of acute appendicitis in non-pregnant women remains challenging due to overlapping symptoms with gynecological pathologies. This study compares the diagnostic performance of the Tzanakis Score (incorporating ultrasonography) and the Alvarado Score (clinical and laboratory-based) in this population. Objectives: To compare the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the Alvarado and Tzanakis Score. To assess the diagnostic performance of both scoring systems. Methods: we included retrospectively 120 non-pregnant women presenting with suspected appendicitis at Zagazig University Hospitals (July–December 2024). Both scoring systems were applied, and histopathology post-appendectomy served as the diagnostic gold standard. Sensitivity, specificity, PPV, NPV, accuracy, and ROC curves were analyzed using SPSS v20. Results: The Tzanakis Score demonstrated superior sensitivity (92% vs. 78%), specificity (88% vs. 72%), and accuracy (90% vs. 75%) compared to the Alvarado Score (p < 0.05). ROC analysis showed a larger AUC for Tzanakis (0.94 vs. 0.82). Subgroup analyses confirmed consistent performance across age and symptom severity categories. Conclusion: The Tzanakis Score, integrating ultrasonography, significantly outperforms the Alvarado Score in diagnosing acute appendicitis in non-pregnant women, reducing unnecessary surgeries and optimizing resource utilization. We recommend its adoption in settings with access to imaging.