Usefulness of Karaman Score in Treatment Guidance and Prognosis for Acute Appendicitis – a Prospective Single Centre Study

Abstract

Objective: Acute appendicitis (AA) is one of the most common causes of surgical abdominal pain in emergency departments. While most scoring systems focus on diagnosis, their role in guiding treatment and predicting prognosis remains limited. This prospective single-centre cohort study aimed to evaluate whether the Karaman Score (KS) is predictive of treatment selection and disease severity in AA. Methods: Between January and December 2023, 69 adult patients prospectively diagnosed with AA in a tertiary emergency department were included. The KS was calculated at initial evaluation by emergency physicians, while treatment decisions were made independently by surgeons. Patients were classified according to treatment modality (surgical vs non-operative management) and disease severity (uncomplicated vs complicated AA). Diagnostic and prognostic performance of KS and laboratory parameters was assessed using chi-square analysis, binary logistic regression, and receiver operating characteristic (ROC) analysis. Results: Fifty-one patients (73.9%) underwent appendectomy. A KS ≥9 predicted surgical treatment with a sensitivity of 70.6% and specificity of 77.8% and was identified as an independent predictor of surgery (OR 7.93, 95% CI 1.55–40.74; p<0.05). A KS ≥10 was significantly associated with complicated appendicitis (p<0.05). ROC analysis demonstrated moderate discriminatory ability of KS for predicting both surgical treatment (AUC 0.693) and complicated appendicitis (AUC 0.695). Among laboratory parameters, the neutrophil-to-lymphocyte ratio showed the highest discriminatory performance for predicting complicated appendicitis (AUC 0.737). Conclusion: The KS appears to be a practical and easily applicable tool that may assist clinicians not only in diagnosis but also as an adjunct in treatment selection and risk stratification for disease severity in acute appendicitis. Larger multicentre prospective studies are warranted to validate its prognostic utility.