Modified Alvarado score versus Tzanaki’s Score in diagnosing acute appendicitis: An observational study

Background: Appendix is a blind muscular tube derived from the midgut. During the embryogenic development, in the 6th week appendix and cecum appear as out pouching from midguts caudal limb. Acute appendicitis is one the most common diagnosis made whenever patient presents with right illac fossa pain and mostly encountered in young and middle-aged individuals. The diagnosis and management of acute appendicitis depend on clinical presentation, that is, clinical signs and symptoms. The most common presentations in these cases have abdominal pain along with fever, anorexia, nausea, and vomiting. Various Scoring systems are developed to diagnose acute appendicitis based mainly on the presenting signs and symptoms, but widely none of them are used as an uniform scoring system. Aims and Objectives: The purpose of this study was to assess effectiveness and comparison of modified Alvarado score and Tzanaki’s Score in the early diagnosis of acute appendicitis. Materials and Methods: A prospective observational study was done in department of General Surgery JLN Medical College Hospital, Ajmer which included 200 patients presenting with the signs and symptoms of acute appendicitis, clinically. During admission the patients were evaluated by Modified Alvarado score and Tzanaki’s Score and final surgical decision was taken by the treating surgeon. Finally, the scores were compared with the histopathological examination of the surgically operated specimen. Results: The sensitivity and specificity of Modified Alvarado Score was 84.26% and 72.7%, respectively, with a positive predictive value of 96.15% and negative predictive value of 36.3%. The sensitivity and specificity of Tzanaki’s score was 88.2% and 72.7%, respectively, with a positive predictive value of 96.31% and negative predictive value of 43.24%. The diagnostic accuracy of Alvarado score was 83% and that of Tzanaki’s score was 86.5%. Conclusions: Our study showed that Modified Alvarado scoring system is a simple tool with limited features for bedside diagnosis of acute appendicitis, but its effectiveness is not as good as that of Tzanaki’s scoring system.

A comparative study of the RIPASA and Alvarado scores in geriatric patients diagnosed with acute appendicitis

SUMMARY OBJECTIVE: While abdominal pain is one of the most prevalent reasons for seeking medical attention, diagnosing elderly adults with acute appendicitis (AA) may be difficult. In this study, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado ratings were evaluated for diagnostic accuracy in patients who reported to the emergency department complaining of abdominal pain and received surgery for AA. METHODS: The data of patients over the age of 65 years who reported to the ER and had appendectomy after being diagnosed with AA were evaluated in this retrospective cohort study. For each patient, the diagnostic accuracy of the Alvarado and RIPASA scores was determined individually. RESULTS: A total of 86 patients were included in the research. The average patient was 71.2 years old, with a male preponderance of 46.5%. Alvarado's score was found to have an area under the curve (AUC) of 0.799, the Youden's index of 0.549, and a p-value of 0.001 after a receiver operating characteristic (ROC) study of the Alvarado score in identifying the diagnosis of AA. The AUC was 0.886 (95%CI 0.799-0.944), the Youden's index was 0.642, and a p-value of 0.001 was found in the ROC analysis of the RIPASA score in identifying the diagnosis of AA. CONCLUSIONS: When comparing the two scores used to diagnose AA, we found no statistically significant difference between the RIPASA and Alvarado scores (p=0.09), although the Youden's index for the RIPASA score was higher.

Role Of Raised C-Reactive Protein (CRP) As the Indicator for Surgical Intervention in Clinically Diagnosed Acute Appendicitis

Background: The diagnosis of acute appendicitis relies more on the clinical acumen of the surgeon than on the investigations. As the condition is associated with an acute-phase reaction the analysis of WBC, neutrophil percentage and serum level of CRP has been demonstrated to be important diagnostic tools. Surprisingly the level of CRP becomes proportionately raised with increasing severity of the histopathological variety of the appendix. Aim of the study: The aim of this study was to compare the preoperative CRP level with postoperative histological findings and find out a predictive value of CRP as an indicator for surgical intervention in acute appendicitis.Material & Methods:It was a prospective, cross-sectional, observational study executed in the Department of Surgery, Dhaka Medical College Hospital from January to December of 2015 where 107 patients were included in this study. Preoperative level of CRP and WBC count was done in all selected patients. Histopathological severity of the resected specimen of the appendix was determined postoperatively. The correlation between preoperative clinical factors and the actual histological severity and identification of surgical indication markers was assessed to determine whether only the CRP level significantly differs between the surgical treatment necessary group and the possible non-surgical treatment group.Results:54% (58) of the patients were female out of a total of 107. Peak incidence (25.2%) was in the 16-20 years age group. Neither age nor gender had any significance with the type of appendicitis. Among the patients 28.1% (30) had gangrenous appendicitis. In patients with histopathologically proven acute appendicitis, both the WBC count and serum CRP level were raised. But only the CRP level significantly differs between gangrenous appendicitis and uncomplicated appendicitis (p-value<0.0001). The specificity and sensitivity of serum CRP for gangrenous appendicitis were 97% and 71% respectively. The ROC curve indicated that the cutoff value of CRP for gangrenous appendicitis is 6.2 mg/dl. Conclusions:A normal pre-operative serum CRP measurement in patients with suspected acute appendicitis is most likely associated with a normal or uncomplicated inflammation of the appendix. The rate of unnecessary appendectomies would probably reduce in this patient group by deferring surgery. Only the CRP level is consistent with the severity of appendicitis and can be considered to be a surgical indication marker for acute appendicitis.

Evaluación de la Escala de Alvarado en el diagnóstico clínico de la apendicitis aguda en el Servicio de Urgencias del Hospital Nacional de Itauguá en los años 2018 y 2019 / Evaluation of the Alvarado Scale in the clinical diagnosis of acute appendicitis in the Emergency Department of the Hospital Nacional Itauguá in the years 2018 and 2019

RESUMEN Introducción: la estratificación del riesgo de los pacientes con sospecha de apendicitis aguda mediante sistemas de puntuación clínica podría orientar la toma de decisiones para reducir los ingresos, optimizar la utilidad de las imágenes diagnósticas y prevenir exploraciones quirúrgicas negativas. Objetivo: evaluar la utilidad de la Escala de Alvarado para el diagnóstico de apendicitis aguda en el Servicio de Urgencias del Hospital Nacional de Itauguá de enero del 2018 a diciembre del 2019. Metodología: estudio observacional descriptivo de corte transversal con muestreo no probabilístico de casos consecutivos. Para la recolección de datos se utilizó una planilla electrónica de Microsoft Excel contenidos en las fichas de los pacientes para su posterior análisis y presentación estadística descriptiva. Resultados: se registraron 121 casos de apendicitis aguda, de los cuales 53.71% fueron del sexo masculino. El 100% de la muestra presentó dolor en fosa iliaca derecha; la presencia del signo de Blumberg se detectó en el 67% de los pacientes. El 49.85% de la muestra presentó un puntaje 8-10 según la Escala de Alvarado. El 90.08% de los pacientes presentó algún tipo de apendicitis en la anatomía patológica. Conclusión: el trabajo revela que la Escala de Alvarado es una herramienta útil e importante para la aplicación sistemática de un score diagnóstico en los servicios de urgencia, lo cual permite disminuir consecuentemente el margen de error diagnóstico y las posibles implicaciones sanitarias, económicas y legales.

ABSTRACT Introduction: risk stratification of patients with suspected acute appendicitis using clinical scoring systems could guide decision-making to reduce admissions, optimize the usefulness of diagnostic imaging and prevent negative surgical scans. Objective: to evaluate the usefulness of the Alvarado Scale for the diagnosis of acute appendicitis in the Emergency Department of the Hospital Nacional Itauguá from January 2018 to December 2019. Methodology: descriptive observational cross-sectional study with nonprobabilistic sampling of consecutive cases. A Microsoft Excel electronic spreadsheet contained in the patient files was used for the collection of data for further analysis and descriptive statistical presentation. Results: 121 cases of acute appendicitis were recorded, of which 53.71% were male. 100% of the sample presented pain in the right iliac fossa; the presence of Blumberg sign was detected in 67% of the patients. 49.85% of the sample presented an 8-10 score according to the Alvarado Scale. 90.08% of the patients presented some type of appendicitis in the pathological anatomy. Conclusion: the study reveals that the Alvarado Scale is a useful and important tool for the systematic application of a diagnostic score in emergency services, which allows to reduce consequently the margin of diagnostic error and the possible sanitary, economic and legal implications.

Desempeño comparativo de la escala de Alvarado y la escala de apendicitis pediátrica en escolares y adolescentes

RESUMEN Introducción: La escala de Alvarado y la escala de apendicitis pediátrica se utilizan para la estratificación de pacientes pediátricos con sospecha de apendicitis. Objetivo: Comparar el desempeño diagnóstico de estas escalas en escolares y adolescentes, en general y según edad y sexo. Métodos: Estudio observacional prospectivo de 452 pacientes entre 5 y 18 años de edad, ingresados en el Hospital Pediátrico Docente Centro Habana, por dolor abdominal o apendicitis aguda, entre 2016 y 2017. Resultados: La escala de Alvarado tuvo a los 7 puntos: especificidad 96,15 %, razón de verosimilitud positiva 10,3. La escala de apendicitis pediátrica presentó a los 8 puntos: especificidad 96,15 %, razón de verosimilitud positiva 5,60. Las áreas bajo la curva fueron similares en general (0,851-0,858), siendo más altas y similares entre sí en escolares masculinos (0,918-0,923). En adolescentes femeninas, el área bajo la curva para la escala de apendicitis pediátrica (0,841) fue mayor que para la de Alvarado (0,802). Conclusiones: La escala de Alvarado resulta más específica, mientras que la escala de apendicitis pediátrica es más sensible. Se deben considerar diferentes puntos de corte para cada escala al estratificar según probable apendicitis. El desempeño discriminativo se comporta similar en general para ambas escalas, y muy bien en escolares masculinos. La mayor diferencia en desempeño ocurre en adolescentes femeninas, a favor de la escala de apendicitis pediátrica.

ABSTRACT Introduction: Alvarado scale and the pediatric appendicitis scale are used for the stratification of pediatric patients with suspected appendicitis. Objective: Compare the diagnostic performance of these scales in schoolchildren and adolescents, in general and according to age and sex. Methods: Prospective observational study of 452 patients between 5 and 18 years of age, admitted to Centro Habana Pediatric Teaching Hospital due to abdominal pain or acute appendicitis in the period 2016-2017. Results: Alvarado scale had at 7 points: specificity 96.15 %, positive likelihood ratio 10.3. The paediatric appendicitis scale presented at 8 points: specificity 96.15 %, positive likelihood ratio 5.60. The areas under the curve had a similar overall (0.851 - 0.858), being higher and similar to each other in male schoolchildren (0.918 - 0.923). In female adolescents, the area under the curve for the pediatric appendicitis scale (0.841) was greater than for Alvarado's (0.802). Conclusions: Alvarado scale is more specific, while the pediatric appendicitis scale is more sensitive. Different cut-off points should be considered for each scale when stratifying according to probable appendicitis. Discriminative performance behaves similar in general for both scales, and very well in male schoolchildren. The biggest difference in performance occurs in female adolescents, in favor of the pediatric appendicitis scale.

Interêt du score d'Alvarado dans la prise en charge de l'appendicite aiguë au centre hospitalier universitaire Sourô Sanou de Bobo Dioulasso / interest of score d'Alvarado in the management of acute appendicitis at the Sourô Sanou university teaching hospital in Bobo Dioulasso

Le but de ce travail était d'appliquer le score d'Alvarado et d'évaluer son intérêt dans la prise en charge des patients suspects d'appendicite aigue. Patients et méthodes : Il s'est agi d'une étude transversale à visée descriptive allant du 1er janvier 2019 au 31 Mars 2021, incluant les patients admis pour suspicion d'appendicite aiguë. Résultats : Notre étude a porté sur 152 patients avec un sex-ratio de 1,7, une moyenne d'âge de 28,6 ans. Le score d'Alvarado était supérieur ou égal à 7 chez 65,8 % des patients, compris entre 4 et 7 chez 31 %, et inférieur à 4 chez 3,3 %. Pour un score compris entre 7 et 10, les données de performance du score sont de 71,5 %, 86,7 %, 98 %, 2 % et 5,1 pour la sensibilité, la spécificité, la valeur prédictive positive, la valeur prédictive négative, et le rapport de vraisemblance positif respectivement. Parmi les patients, 124 ont réalisé une échographie abdominale, 145 ont été opérés, 137 avaient un diagnostic final d'appendicite aigue. Quinze patients n'avaient pas une appendicite aigue et le taux d'appendicectomie sur appendicite sain était de 5,5%. Conclusion : le score d'Alvarado permet de réduire les hospitalisations, les examens d'imagerie et le délai de prise en charge dans les appendicites aiguës.

The aim of this work was to apply the Alvarado score and to evaluate its interest in the management of patients suspected of acute appendicitis. Patients and methods: This was a descriptive cross-sectional study from January 1, 2019 to March 31, 2021, including patients admitted for suspected acute appendicitis. Results: Our study involved 152 patients with a sex ratio of 1.7, an average age of 28.6 years. The Alvarado score was greater than or equal to 7 in 65.8% of patients, between 4 and 7 in 31%, and less than 4 in 3.3%. For a score between 7 and 10, the score performance data are 71.5%, 86.7%, 98%, 2% and 5.1 for sensitivity, specificity, positive predictive value, negative predictive value, and the positive likelihood ratio respectively. Among the patients, 124 performed an abdominal ultrasound, 145 were operated, 137 had a final diagnosis of acute appendicitis. Fifteen patients did not have acute appendicitis and the white laparotomy rate was 5.5%. Conclusion: the Alvarado score reduces hospitalizations, imaging examinations and the time to treatment in acute appendicitis.

Correlação entre a escala de alvarado e o grau de inflamação na apendicite aguda / Correlation between the alvarado scale and the level of inflammation in acute appendicitis

A apendicite aguda representa a causa mais comum de emergência abdominal. O diagnóstico é predominantemente clínico, mas pode ser desafiador. Os objetivos deste estudo foram avaliar a associação entre a pontuação do escore de Alvarado, achados cirúrgicos e o resultado anatomopatológico do apêndice.Trata-se de estudo transversal, quantitativo e descritivo, que obteve informações por meio de prontuários eletrônicos de todos os pacientes que foram operados por suspeita de apendicite. Foram analisados 42 prontuários. Desses, 6 foram excluídos, resultando em uma amostra de 36 pacientes. Com relação à escala de Alvarado, o dado mais frequente foi a dor à palpação em FID, apendicectomia negativa foi de 13,9%. À inspeção cirúrgica, a maioria das apendicectomias estavam em estados iniciais da doença, com hiperemia e edema. Os compatíveis com grau I foram classificaram entre 5 e 8 na escala. Foi possível observar que os que tiveram apendicectomias negativas tinham tendência de graus mais altos. Em conclusão, a escala de Alvarado representa ferramenta útil na triagem de pacientes com suspeita de apendicite, podendo orientar as condutas a serem aplicadas.

Acute appendicitis represents the most common cause of abdominal emergence. Diagnosis is predominantly clinical but can be challenging. The objectives of this study were to evaluate the association between the Alvarado score, surgical findings and the anatomopathological result of the appendix. This is a cross-sectional, quantitative and descriptive study, which obtained information through electronic medical records of all patients who were operated on for suspected appendicitis. 42 medical records were analyzed. Of these, 6 were excluded, resulting in a sample of 36 patients. Regarding the Alvarado scale, the most frequent data was pain on palpation in FID, negative appendectomy was 13.9%. Upon surgical inspection, most appendectomies were in the early stages of the disease, with hyperemia and edema. Grade I compatibles were rated between 5 and 8 on the scale. It was possible to observe that those who had negative appendectomies tended to have higher grades. In conclusion, the Alvarado scale represents a useful tool in the screening of patients with suspected appendicitis and can guide the procedures to be applied.

La escala de Alvarado para la apendicitis aguda pediátrica en grupos de edad y sexo / Scale of Alvarado for pediatric acute appendicitis in age and sex groups

Introducción: La escala de Alvarado es una herramienta útil para estratificar pacientes pediátricos con dolor abdominal según riesgo de apendicitis aguda. Objetivo: Determinar las diferencias en el desempeño diagnóstico de la escala de Alvarado para la apendicitis aguda pediátrica según grupos de edad y sexo. Métodos: Estudio observacional, analítico y prospectivo, en 452 pacientes de 5 a 18 años de edad que ingresaron en el servicio de Cirugía Pediátrica del Hospital Pediátrico Docente Centro Habana, con diagnóstico de dolor abdominal o apendicitis aguda, entre enero de 2016-2017. La muestra se dividió en dos grupos: con apendicitis y sin apendicitis. Se usó el diagnóstico histológico como principal elemento discriminante. Resultados: El 54,8 por ciento de los pacientes con diagnóstico negativo de apendicitis aguda fueron adolescentes femeninas. A los 7 puntos de la escala como patrón de corte, para estas pacientes hubo menor sensibilidad con respecto a los adolescentes de sexo masculino y a los escolares de ambos sexos (44,9 por ciento vs. 64,1 por ciento 72,3 por ciento, y 71,2 por ciento, respectivamente). El área bajo la Curva de Características Operativas del Receptor fue de 0,918 para los escolares masculinos, significativamente superior al grupo de edad adolescente, en particular respecto a las adolescentes femeninas, con área bajo la curva de 0,802. Conclusiones: En los pacientes sin apendicitis hubo un predominio significativo de adolescentes femeninas. La escala tuvo un buen valor discriminativo en los escolares masculinos, comparativamente superior al grupo de edad adolescente, encontrándose el desempeño discriminativo más pobre en las adolescentes de sexo femenino(AU)

Introduction: The Scale of Alvarado is a useful tool to stratify pediatric patients with abdominal pain according to the risk of acute appendicits. Objective: To determine the differences in the diagnostic performance of the scale of Alvarado for acute apendicitis in children according to age and sex groups. Methods: Observational, analytic and prospective study in 452 patients in the ages from 5 to 18 years that were admitted with abdominal pain or acute appendicitis in the Pediatric Surgery service of Centro Habana Teaching-Pediatric Hospital from January 2016 to January 2017. The sample was divided in two groups: with appendicitis and without appendicitis. It was used the hystological diagnosis as the main differentiation element. Results: The 54.8 percent of the patients with negative diagnosis of acute apendicitis were female adolescents. For these patients, in the 7 points of the scale as a cut pattern there was less sensitivity than in the case of male adolescents and school chlidren of both sexes (44.9 percent vs. 64.1 72.3 percent and 71.2 percent), respectively. The area under the Curve of Operative Characteristics of the Receptor was of 0,918 for male school children, significantly superior to the group of adolescents age, particularly in comparisson with the female adolescents that had an area under the curve of 0,802. Conclusions: In the patients without appendicitis there was a significative predominance of female adolescents. The scale had a good value of differentiation in male school children, comparatively higher to the group of adolescents age, finding the poorest differentiattion performance in the female adolescents(AU)

Evaluation of Alvarado scoring system (MANTRELS scoring) as a diagnostic aid in preoperative diagnosis of acute appendicitis at Nalanda Medical College and Hospital, Patna

Background: Acute appendicitis is one of the commonest surgical emergencies. The rate of negative appendicectomy has been reported to be between 20-30%. The aim of this study is to evaluate the efficacy of Alvarado scoring system in cutting down the rate of negative appendicectomy without increasing morbidity and mortality.Methods: A study of 100 patients presenting with pain abdomen and diagnosed provisionally as acute appendicitis, was undertaken. Depending on individual presentation, a score was calculated for each case, based on Alvarado scoring system. Operative and conservative intervention was undertaken in patients with scores between 5 and 10 and <5 respectively. The results of Alvarado scoring system, on table operative findings and HPE, were reviewed.Results: A total of 94 patients with score of 7-10 and 5-6 were operated. Among males with score of 7-10, 33 patients were operated and 31 were found to have inflamed appendix. Among females with score of 7-10, 33 patients were operated and 28 were found to have inflamed appendix. The sensitivity of Alvarado scoring system in males with score of 7-10 was found to be 81.57% and among females with score of 7-10 was found to be 75.67%.Conclusions: The Alvarado scoring system is a fast, simple, reliable, non-invasive, repeatable and safe diagnostic modality without extra expense and complications.

A comparative study to assess efficacy of Tzanakis score and Alvarado score for effective diagnosis of patients with acute appendicitis at a tertiary care centre in North Karnataka: a one-year prospective analytical study

Background: Acute appendicitis standout amongst the most widely recognized reasons for intense stomach torment. There is no ideal symptomatic assessment apparatus to distinguish acute appendix if indications are ambiguous, bringing about longer analytic procedure and it might prompt deferring of medical procedure and related increment in morbidity and fatality. In the meantime, speedy management may prompt negative appendectomy with expanded morbidity and consumption of healthcare resources.Methods: A Hospital based one year prospective study was conducted at KLEs Dr Prabhakar Kore Hospital Belagavi, Karnataka from 1st January 2018 to 31st December 2018 and required data was collected from 100 patient who were clinically diagnosed to have acute appendicitis and all patients were assessed using Alvarado score and Tzanakis score and HPR for all patients were used as gold standard to evaluate the efficacy of both scoring systems.Results: The sensitivity and specificity of Tzanakis score was 80.6% (at score >8) and 100% (at score >8) respectively.  positive predictive value in present study being 100% and negative predictive value being 41.3%. The sensitivity and specificity of Alvarado score was 11.3% (at score >8) and 100% (at score >8) respectively.Conclusions: Tzanakis Score outperformed Alvarado score displaying higher sensitivity with similar specificity.

Evaluation of procalcitonin as a predictor of severity of acute appendicitis

Background: Acute appendicitis is the most common surgical emergency worldwide. The treatment of choice is emergency appendectomy. A delayed diagnosis and hence a delayed treatment increases the complication rate. Despite the best efforts negative appendectomy rate is still high since there is no single best test available to reach the diagnosis.Methods: This was an institutional study conducted at DRPGMC Tanda, comprising of 28 patients and 7 healthy controls. The patients with clinical diagnosis of acute appendicitis were subjected to appendectomy after taking a blood sample for serum procalcitonin and performing an ultrasonogram of abdomen.Results: We observed that mean levels of procalcitonin (PCT) were significantly higher in patients of acute appendicitis in comparison to healthy controls. The range of PCT levels in group 2 i.e., patients with uncomplicated acute appendicitis were from 0.54 to 0.74 ng/ml with mean value of 0.61 ng/ml, whereas in group 3 i.e. patients with complicated acute appendicitis, the range were from 1.14 to 2.56 ng/ml with mean value of 1.62 ng/ml. PCT levels were significantly higher in group 3 as compared to group 1 and group 2 (p<0.0001). In group 2, mean PCT levels were significantly higher in comparison to group 1 (p<0.0001). Statistical analysis of our data shows a cut-off value of procalcitonin to be 0.203 ng/ml. We observed sensitivity and specificity of PCT to be 96% and 100% respectively.Conclusions: This study concludes that levels of serum PCT can be used as a laboratory marker for making a diagnosis of acute appendicitis and also for predicting its severity.

Evaluación de la escala de Alvarado como herramienta diagnóstica en la apendicitis aguda / Assessment of the Alvarado Score as a Diagnostic Tool for Acute Appendicitis

RESUMEN Introducción: La apendicitis aguda es la enfermedad quirúrgica más común en cirugía de urgencia; sin embargo, sigue siendo un problema diagnóstico. Objetivos: Evaluar la escala de Alvarado como herramienta diagnóstica en la apendicitis aguda. Métodos: Se desarrolló un estudio observacional y descriptivo con fases analíticas en un universo de 107 pacientes con sospecha diagnóstica de apendicitis aguda, en el Hospital Universitario "Carlos Manuel de Céspedes", Bayamo, Granma, en el período de enero a mayo de 2019. Los datos fueron procesados en el sistema Excel estimándose los parámetros predictivos de efectividad clínica. Resultados: Predominaron los pacientes masculinos (63,55 por ciento) con una edad media de 29,64 años y un tiempo medio de evolución de los síntomas de 33,74 horas. La aplicación de la escala de Alvarado resultó en 87 pacientes (81,31 por ciento) con probable diagnóstico de apendicitis aguda y donde el 3,74 por ciento de los pacientes no padecían la enfermedad. La escala demostró una sensibilidad (84 por ciento) y una especificidad (80 por ciento) que la hace recomendable para la práctica clínica habitual. Conclusiones: La escala de Alvarado es un sistema de puntuación predictivo simple, no invasivo y recomendable para su uso en la práctica clínica habitual en cualquier escenario y por cualquier médico de asistencia(AU)

ABSTRACT Introduction: Acute appendicitis is the commonest surgical disease in emergency surgery; however, it remains a diagnostic problem. Objectives: To evaluate the Alvarado score as a diagnostic tool for acute appendicitis. Methods: We carried out an observational and descriptive study, with analytical phases, of a population of 107 patients with suspected diagnosis of acute appendicitis, at Carlos Manuel de Céspedes University Hospital in Bayamo, Granma, from January to May 2019. The data were processed in the Excel system, and the predictive parameters of clinical effectiveness were estimated. Results: Male patients (63.55 percent) predominated, with a mean age of 29.64 years and a mean time of evolution of symptoms of 33.74 hours. Application of the Alvarado score resulted in 87 patients (81.31 percent) with a probable diagnosis of acute appendicitis, 3.74 percent of which did not suffer from the disease. The score demonstrated a sensitivity (84 percent) and a specificity (80 percent) that makes it recommendable for routine clinical practice. Conclusions: The Alvarado score is a simple, noninvasive predictive scoring system recommended to be used in routine clinical practice in any setting and by any attending physician(AU)

Ultrasonogram in Acute Appendicitis, A Surgeon’s Perspective: Original Article

Introduction: The diagnosis of acute appendicitis has essentially been clinical, but USG abdomen has been said to be highly accurate in diagnosing AA. The surgeon’s perspective may not always be the same. Materialsand methods: Appendectomy data of 106 patients from two hospitals of Kangra region was retrospectively analysed. The data was collected for age, sex, initial pre-operative diagnosis, USG findings, intra-operative findings, Histo-pathological examination (HPE) report, post operative hospital stay. Observations:It revealed a sensitivity of about 54% and specificity of 100% for diagnosing AA with the help of USG abdomen. AA was seen most commonly in males as compared to females. Mean age of presentation was 29.34 +/-14.4 years. Mean hospital stay was 3.68 +/-2.25 days. Most common initial preoperative diagnosis was AA (84%). Most common position of the appendix during surgery was retrocecal (53.7%). HPE report revealed AA in 105 patients. Conclusion:USG abdomen is often falsely assuring, leading to unnecessary delay in effectively managing a patient of AA further leading to increased complications. Only the clinically equivocal cases require further radiological investigations where CECT abdomen is the preferred investigation, but it should be used judiciously.

Alvarado score and computerized tomography scan as impact indicator in intervening negative appendectomy rate

Background: The objective of this study is to study the impact of combined use of Alvarado score and computed tomography (CT) scan on negative appendectomy rate.Methods: This prospective observational study comprising of patients presenting with clinical features of appendicitis admitted to department of general surgery, VIMSAR, Burla from November 2017 to October 2019, where Alvarado score and ultrasonography (USG) findings are mismatching each other. Alvarado scores calculated and categorized in 2 groups as negative (score <4) and positive (score ≥4). These patients were also subjected to USG and categorized as negative (USG -ve) and positive (USG +ve). Those patients having discrepancy in both the findings were subjected to CT scan. On histopathological examination, inflamed appendix in 63 (97%) patients and non-inflamed in 2 (3%). Rest patients were either discharged (both -ve) or operated (both +ve). Results: Total 84 patients showed discrepancy between Alvarado score and USG findings and are subjected to CT scan abdomen and pelvis. CT scan was positive for appendicitis in 65 cases (where appendectomy done) and negative for appendicitis in 19 cases (where the diagnosis is different). patient. Thus, negative appendectomy (NAR) is 3% in this study.Conclusions: Alvarado score and ultrasonography could not be used as absolute tool in doubtful and equivocal cases, where combined use of CT scan with Alvarado score and USG has definitely has an edge by diagnosing the differentials and reducing NAR followed by reduction in cost and length of hospital stay.

A Study to Evaluate the Combined Use of Alvarado Score and Imaging for Diagnosis of Acute Appendicitis.

Acute appendicitis is one of the most common abdominal emergencies encountered in surgical practice. The diagnosis of acute appendicitis is an enigmatic challenge. Several studies have reported a variable diagnostic accuracy with a negative appendicectomy rate varying from 3% up to 20% using combined diagnostic modalities or using Alvarado score alone. The present study was carried out to evaluate the diagnostic efficacy of combined use of Alvarado score and imaging modalities (USG and / or CECT abdomen) for preoperative diagnosis of acute appendicitis.METHODSThe present study was a prospective observational study carried out in a tertiary hospital of a metropolitan city. The study period extended over two years, from January 2016 till December 2018. The study included 118 adults who presented with clinical features of acute appendicitis. Alvarado scoring system based mainly on clinical features was applied and graded. Compression USG was performed on all patients. CECT of abdomen was done in 30 patients having inconclusive results on USG. Appendicectomy was performed on all the patients after the Alvarado scoring and imaging. The histopathological findings of the surgical specimens were noted to confirm the pathological diagnosis. The sensitivity, specificity, PPV, NPV and accuracy of the diagnostic methods were calculated.RESULTSOut of 118 appendicectomies, 104 were found to be positive on histopathology, with an overall 11.86% negative appendicectomy rate. Combined use of imaging with a high Alvarado score (7-10) had a sensitivity of 95.74%, specificity of 100%, accuracy of 95.8%. Combined use of imaging with a low Alvarado score (3-6) had a sensitivity of 89.47%, specificity of 53.8%, accuracy of 82.85%. Alvarado score alone had a sensitivity of 45.19%, specificity of 92.85% and accuracy of 50.8%. USG alone showed a sensitivity of 71.15%, specificity of 71.42% and accuracy of 71.18%. CECT alone had a sensitivity of 88%, specificity of 60% and accuracy of 83.3%.CONCLUSIONSImaging modalities have a valuable role in terms of diagnostic accuracy particularly in cases having low Alvarado score. CECT though expensive is preferable to USG. However, the combined methodology of Alvarado scoring, and imaging is a rational approach for accurate diagnosis preventing surgical complications and minimizing negative appendicectomy rate.

Raja Isteri Pengiran Anak Saleha Appendicitis score for the diagnosis of acute appendicitis in comparison with the Alvarado score

Background: Different scoring systems have been created to increase diagnostic accuracy, and they are inexpensive, non-invasive, and easy to use and reproduce. The modified Alvarado score is widely used in emergency services. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was formulated in 2010 and has greater sensitivity and specificity. The aim of our article was to compare the usefulness of modified RIPASA score and Alvarado score in the diagnosis of patients with abdominal pain and suspected acute appendicitis.Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis, conducted at the Narayana medical college hospital, Nellore. The questionnaires used for the evaluation process were applied to the patients suspected of having appendicitis.Results: A total of 100 patients, 95% underwent laparoscopic procedure. The cut-off threshold point of the Alvarado score was set at 7.0, which yielded a sensitivity of 65% and a specificity of 52%. The positive predictive value was 65%. The cut-off threshold point of the modified RIPASA score was set at 7.5, which yielded 90% sensitivity and 72% specificity. The positive predictive value was 89% and the NPV was 30%.Conclusions: On comparing both the scores, sensitivity and specificity was higher for modified RIPASA score. The positive predictive value was higher for the Alvarado and negative predictive value was higher for RIPASA score. Bothe p values were statistically significant.

Usefulness of Modified Alvarado Score in Acute Appendicitis Incorporating Ultrasound.

Acute appendicitis affects human beings irrespective of age, nationality and region. Acute appendicitis is the most common surgical cause of emergency laparotomy. Considering the difficulties and challenges involved in accurate clinical diagnosis, there is a need for a validated, objective protocol for enabling the diagnosis. This study was carried out to validate the modified Alvarado score (MASS) and correlate with ultrasound and post-operative histopathological examination.METHODSThis cohort study was carried out among 100 patients who were suspected with acute appendicitis. Upon clinical evaluation and ultrasound evaluation, Modified Alvarado Score was computed, and patients were taken up for laparotomy/ laparoscopic surgery. The resected specimens were sent for histopathological examination.RESULTSMajority of the participants had a score >7 (74%) of which 51 were males, 21 were females and two were children. Ultrasound detected positive cases in 90% of the participants, while acute appendicitis by histopathology was present in 54% of the participants. There was a statistically significant correlation with Modified Alvarado score (p<0.0001). Negative appendicectomy was prevalent in 21% of the participants.CONCLUSIONSModified Alvarado Scoring system is ideal for the diagnosis of acute appendicitis since it is simple to use, easy to apply and relies only on history, clinical examination and basic lab investigations.

Study of evaluation of Alvarado scoring system in acute appendicitis

Background: Acute appendicitis is one of the most common surgically correctable acute abdomen presenting at emergency department worldwide. Inspite of all advances in diagnostic modalities and surgical techniques, diagnosis remains difficult sometimes as a challenge and delayed decision making complicates this surgical disease. Alvarado scoring system is one of available scoring system for diagnosis of acute appendicitis, based on history, clinical examination, lab investigations and easy to apply, helps in clinical decision regarding planning surgery and avoid negative laparotomies. The aim of the study was to evaluate diagnostic accuracy of Alvarado scoring system in preoperative diagnosis of acute appendicitis and correlating with postoperative findings.Methods: This study was conducted in 100 cases of suspected appendicitis admitted in surgery department of Rajiv Gandhi Speciality Hospital, Agatti Island, Lakshadweep, Union territory of India, from July 2015 to June 2017 adopting Alvarado scoring system. Results were analyzed.Results: Out of 100 patients admitted with suspected acute appendicitis, number of cases operated suspecting acute appendicitis were 83 of which 80 were found to have acutely inflamed appendix. Results of Alvarado score of operated patients are as follows: 80 patients had score 7-10, and 3 patients had score 5-6, patients with Alvarado score <5 (17 pts) were managed conservatively.Conclusions: The Alvarado scoring system is a simple and useful diagnostic tool for diagnosis of acute appendicitis with acceptable sensitivity and specificity and can be used with high degree of accuracy. Our findings suggest that patients presenting with abdominal pain and Alvarado scores greater than 7 are more likely to have appendicitis.

Role of clinical scoring system and imaging in acute appendicitis in adults: a review of literature

@#Introduction: Ultrasound is widely available, easy-to-use and less expensive than most other imaging methods. It is widely used as a non-invasive method to diagnose acute appendicitis; however, its efficiency still remains questionable, especially when compared to costlier and invasive methods such as computed tomography. Methods: An exploratory review of past literatures on the usage of ultrasound technique in the diagnosis of acute appendicitis in adult patients, and the role of other imaging techniques were undertaken for the study. Results: The gold standard for the diagnosis of acute appendicitis still remains a histopathological confirmation after appendectomy. The study further shows imaging has high diagnostic accuracy in the diagnosis of acute appendicitis with low rate of negative appendectomy (<10%). Multiple reasons are identified, including the introduction of computed tomography imaging especially in those patients where ultrasound was unequivocal, more education on imaging which leads to better operator skill or improved performances of machines. Conclusion: Imaging undoubtedly plays an important role in the diagnosis of acute appendicitis with ultrasound remaining the first-line method in patients referred with clinically suspected acute appendicitis. Nevertheless, those with borderline ultrasound findings or unable to visualize appendix on ultrasound with highly suspicious sign and symptoms were offered other imaging modalities such as CT scan. Recommendation: It is recommended that the managing team balance the risk of radiation exposure, risk of delay in urgent operation and risk of perforation prior to a decision.

Desempeño diagnóstico de la escala de Alvarado para la apendicitis aguda en el niño / Diagnostic performance of Alvarado score for acute appendicitis in children

Introducción: El diagnóstico de la apendicitis aguda en niños, no por frecuente, deja de ser aún desafiante a pesar de la mayor experiencia clínica y los mejores estudios complementarios. Objetivo: Determinar el desempeño diagnóstico de la escala de Alvarado para la apendicitis aguda en el niño. Métodos: Estudio observacional, analítico y prospectivo en 452 pacientes de 5 a 18 años de edad que ingresaron en el Servicio de Cirugía Pediátrica del Hospital Pediátrico Docente Centro Habana, con diagnóstico de dolor abdominal o apendicitis aguda, entre enero de 2016 y enero de 2017. Resultados: El 77,0 por ciento de los casos presentaron apendicitis. La especificidad y el valor predictivo positivo de la escala, con el punto de corte en 7, fueron de 0,90 y 0,95, respectivamente; sin embargo, la sensibilidad, el valor predictivo negativo y la precisión diagnóstica tuvieron valores bajos. El punto de corte de la escala más equilibrado se determinó en 6. Solamente 3 casos con apendicitis obtuvieron un puntaje menor de 4. El área bajo la Curva de Características Operativas del Receptor fue de 0,85. Conclusiones: La escala tiene una buena especificidad y valor predictivo positivo, así como un desempeño discriminativo general aceptable. No resulta apropiada como herramienta única para el diagnóstico de la apendicitis aguda en el escenario clínico real. No obstante, sería útil para descartar la enfermedad con un elevado nivel de certeza(AU)

Introduction: The diagnosis of acute appendicitis in children is although frequent still challenging and in despite of the higher clinical experience and the more effective laboratory and imaging studies. Objective: To determine the diagnostic performance of Alvarado score for acute appendicitis in children. Methods: An observational, analytic and prospective study was conducted on 452 patients aged from 5 to 18 years old whom were admitted to the Pediatric Surgery service of Centro Habana Pediatric Hospital from January 2016 to January 2017 with a diagnosis of abdominal pain or acute appendicitis, Results: 77.0 percent of admitted patients had diagnosis of appendicitis. The specificity and positive predictive value of the score were 0.90 and 0.95, respectively, considering 7 as the cutoff point; however, the sensitivity, the negative predictive value and the diagnostic accuracy had low values. The most balanced cutoff point was determined to be 6. Only 3 positive cases had scores under 4. The area under the Receiver Operating Characteristics Curve was 0.85. Conclusions: The score had good specificity and positive predictive value, as well as an acceptable general discriminative performance. However, it didn't result appropriate as a unique tool for diagnosing acute appendicitis in the clinical setting. Nevertheless, it would be useful for ruling out the condition with a high level of certainty(AU)