Alvarado Score In Acute Appendicitis Research Articles

AI in the ED: Assessing the efficacy of GPT models vs. physicians in medical score calculation

Background and aimsArtificial Intelligence (AI) models like GPT-3.5 and GPT-4 have shown promise across various domains but remain underexplored in healthcare. Emergency Departments (ED) rely on established scoring systems, such as NIHSS and HEART score, to guide clinical decision-making. This study aims to evaluate the proficiency of GPT-3.5 and GPT-4 against experienced ED physicians in calculating five commonly used medical scores. MethodsThis retrospective study analyzed data from 150 patients who visited the ED over one week. Both AI models and two human physicians were tasked with calculating scores for NIH Stroke Scale, Canadian Syncope Risk Score, Alvarado Score for Acute Appendicitis, Canadian CT Head Rule, and HEART Score. Cohen's Kappa statistic and AUC values were used to assess inter-rater agreement and predictive performance, respectively. ResultsThe highest level of agreement was observed between the human physicians (Kappa = 0.681), while GPT-4 also showed moderate to substantial agreement with them (Kappa values of 0.473 and 0.576). GPT-3.5 had the lowest agreement with human scorers. These results highlight the superior predictive performance of human expertise over the currently available automated systems for this specific medical outcome. Human physicians achieved a higher ROC-AUC on 3 of the 5 scores, but none of the differences were statistically significant. ConclusionsWhile AI models demonstrated some level of concordance with human expertise, they fell short in emulating the complex clinical judgments that physicians make. The study suggests that current AI models may serve as supplementary tools but are not ready to replace human expertise in high-stakes settings like the ED. Further research is needed to explore the capabilities and limitations of AI in emergency medicine.

The Correlation between Alvarado Score and Histopathological Profile of Appendicitis in Academic Hospital of Universitas Gadjah Mada

Background: Appendicitis is an inflammation of the appendix vermiformis, which is the most common cause of acute abdominal emergency and requires immediate surgical treatment. Anamnesis and clinical examinations in Alvarado score results can be used as early detection to determine further treatment. The use of histopathological examination is to confirm the diagnosis of appendicitis. This study was to determine the correlation between the Alvarado score and the histopathological profile of appendicitis. It assesses appendicitis diagnosis accuracy based on the Alvarado score at the Academic Hospital of UGM.Methods: This study was a cross-sectional design study with a diagnostic test method using secondary data from 173 appendicitis patients from 1 January to 31 December 2019, who met the inclusion and exclusion criteria.Results: According to the histopathology result, the finding of acute appendicitis was 95.95%, which Alvarado score of ≥7 was 71.68%. The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of Alvarado score for acute appendicitis were 73.49%, 71.43%, 73.41%, 98.39 %, 10.20%, respectively. Conclusion: The Alvarado score is a sensitive, specific, and accurate scoring system that functions as a diagnostic tool for acute appendicitis.

Combining Abdominal Ultrasound with the Alvarado Score in Acute Appendicitis

Combining Abdominal Ultrasound with the Alvarado Score in Acute Appendicitis

Evaluation of Clinical and Paraclinical Findings in Cases of Pregnancy Appendectomy in Ali Ebn-e Abitaleb Hospital Within 2015 - 2019

Background: Abdominal pain is one of the most common complaints during pregnancy and is always debated due to its numerous differential diagnoses. Acute appendicitis is the most common complication requiring surgery during pregnancy. Objectives: The present study aimed to investigate symptoms, signs, and paraclinical findings in cases of pregnancy appendectomy within 2015 - 2019. Methods: This retrospective study examined the frequency of appendectomy in pregnant women referring to Ali ibn Abi Talib Hospital of Zahedan in Iran. This study assessed 58 pregnant women who referred to Ali Ebne-e Abitaleb hospital and underwent appendectomy from April 2015 to March 2019. Finally, the data were evaluated in terms of age, gravidity, gestational age, body temperature, clinical symptoms, complications of appendectomy, type of surgery, and white blood cells (neutrophil). For data analysis, the information was entered into SPSS software (version 22). Results: In the present study, the most common symptoms and signs of patients were tenderness and right lower quadrant (RLQ) pain (87.93%), nausea (75.9%), leukocytosis (72.4%), migration of pain (65.5%), vomiting (58.6%), and anorexia (53.4%). Additionally, the most common appendicitis trimester for appendicitis in pregnancy was the second thermistor (62.1%). Conclusions: Tenderness in the RLQ area was the most important feature of appendicitis; however, nausea and leukocytosis were also common. Ultrasound was not a powerful imaging method due to the identification of less than half of the patients; nevertheless, the Alvarado score for acute appendicitis was helpful in numerous cases.

Appendicitis Inflammatory Response Score in Comparison to Alvarado Score in Acute Appendicitis

Appendicitis is a common differential diagnosis of right lower quadrant pain. Clinical evaluation alone results in high negative appendicectomy rates. Alvarado scoring is the most commonly used clinical prediction rule. The study aimed to compare the recently developed appendicitis inflammatory response (AIR) score with the Alvarado score. This cross-sectional observational study included patients who underwent appendicectomy for clinical suspicion of appendicitis. The clinical and laboratory parameters required for obtaining Alvarado score and AIRS were gathered. Area under ROC curve was calculated for both Alvarado score and AIRS. The study included 130 patients (77 males and 53 females). The negative appendicectomy rate was 10.7%. The perforation rate was 10.3%. The area under ROC for Alvarado score was 0.821 and for AIR score was 0.901. The Alvarado score had a sensitivity of 72% and a specificity of 79% at score ≥6. The appendicitis inflammatory response score had a sensitivity of 98% for scores ≥5 and a specificity of 97% for score ≥6. The C-reactive protein (CRP) value was the best performing individual parameter with an area under ROC of 0.789, followed by WBC count with an area under ROC of 0.762. Appendicitis inflammatory response score is a recently developed score that outperforms the Alvarado score. AIR score has a higher specificity. The sound construction, gradation of parameters, the inclusion of CRP, and avoidance of subjective parameters make the AIR score an attractive clinical prediction rule which can decrease the rate of negative appendicectomy.

Are Appendix Weight and Length Related to Inflammatory Parameters and Alvarado Score in Acute Appendicitis?

Are Appendix Weight and Length Related to Inflammatory Parameters and Alvarado Score in Acute Appendicitis?

English

English

Comparison of Alvarado score and ultrasonography in diagnosis of acute appendicitis

Background: Appendicitis is a common cause of acute abdomen in all age groups and a simple appendicitis can progress to perforation which is associated with much higher morbidity and mortality. Acute appendicitis is the most common surgical condition and appendectomy is the most common operation done on emergency basis. This study aims at studying diagnostic accuracy of ultrasonography and Alvarado score for acute appendicitis and decreasing the negative appendectomy rate in cost effective manner. Methods: In all 200 patients suspected to have acute appendicitis were examined and evaluated with modified Alvarado scoring and ultrasonography. Accuracy of alvarado scoring and ultrasonography in diagnosing acute appendicitis was calculated after correlating with the histopathological finding. Results: The sensitivity and specificity of clinical diagnosis i.e modified alvarado scoring and ultrasonography were 89.17, 44.44 and 94.26, 88.88 respectively. Conclusion: The diagnostic accuracy of clinical diagnosis was 84.57 and that of ultrasonography was 88%. Thus ultrasonography may be suggested as a useful diagnostic method for acute appendicitis . However the difference in their diagnostic values is not statistically significant.

English

English

A Comparative Study of RIPASA Score and Modified Alvarado Score in Acute Appendicitis in Nepalese Population

Introduction: Although acute appendicitis is a common surgical condition, its diagnosis can be elusive at times with misdiagnosis leading to serious complications. Various scoring systems have been developed to overcome this dilemma and the reported accuracies of these scores vary greatly.Materials and Methods: A retrospective review of charts was carried out to identify all patients admitted to KIST medical college teaching hospital from May 2015 to April 2016 with the diagnosis of acute appendicitis. A total of 120 cases that underwent surgery for suspected acute appendicitis were included. Modified Alvarado score and RIPASA scores were computed for each patient and the suggested cutoff values were used to find out the accuracy of these scores. Histopathological confirmation/report was considered as the standard for comparison.Results: A negative appendectomy rate of 11.67 % was observed (9.64 % for males and 16.22 % for females). Complicated appendicitis was found in 27.36% of patients. Modified Alvarado score had a sensitivity of 61.32 % and specificity of 71.43 % at a cut of value of 7. At cut off of > 7.5 for acute appendicitis, RIPASA score had a sensitivity of 97.17% and specificity of 57.14%. The accuracy of Modified Alvarado score was 62.5% while it was 92.5% for RIPASA score.Conclusions: RIPASA score demonstrated higher sensitivity and accuracy but lower specificity compared to the modified Alvarado score in our study group. More studies with larger sample size need to be carried out for further validation of this new score.

Clinical Relevance of Modified Alvarado Score in Acute Appendicitis in Present Scenario

Clinical Relevance of Modified Alvarado Score in Acute Appendicitis in Present Scenario

The Alvarado score should be used to reduce emergency department length of stay and radiation exposure in select patients with abdominal pain.

Abdominal pain is the common reason patients seek treatment in emergency departments (ED), and computed tomography (CT) is frequently used for diagnosis; however, length of stay (LOS) in the ED and risks of radiation remain a concern. The hypothesis of this study was the Alvarado score (AS) could be used to reduce CT scans and decrease ED LOS for patients with suspected acute appendicitis (AA). A retrospective review of patients who underwent CT to rule out AA from January 1, 2015, to December 31, 2015, was performed. Patient demographics, medical history, ED documentation, operative interventions, complications, and LOS were all collected. Alvarado score was calculated from the medical record. Time to CT completion was calculated from times the patient was seen by ED staff, CT order, and CT report. Four hundred ninety-two patients (68.1% female; median age, 33 years) met the inclusion criteria. Most CT scans (70%) did not have findings consistent with AA. Median AS for AA on CT scan was 7, compared with 3 for negative CT (p < 0.001). One hundred percent of female patients with AS of 10 and males with AS of 9 or greater had AA confirmed by surgical pathology. Conversely, 5% or less of female patients with AS of 2 or less and 0% of male patients with AS of 1 or less were diagnosed with AA. One hundred six (21.5%) patients had an AS within these ranges and collectively spent 10,239 minutes in the ED from the time of the CT order until the radiologist's report. Males with an AS of 9 or greater and females with AS of 10 should be considered for treatment of AA without imaging. Males with AS of 1 or less and females with AS of 2 or less can be safely discharged with follow-up. Using AS, a significant proportion of patients can avoid the radiation risk, the increased cost, and increased ED LOS associated with CT. Diagnostic IV, therapeutic IV.

The Alvarado score in acute appendicitis: A 3-year audit to evaluate the usefulness in predicting negative appendicectomies in ≤16 s at QHBFT

ObjectiveTo evaluate the diagnostic accuracy of the Alvarado score in reducing the rate of negative appendicectomy at Queen’s Hospital, a small district general hospital in England. MethodologyThe retrospective, analytical study included all children who were ≤16 years old with a preliminary diagnosis of acute appendicitis undergoing appendicectomy subsequently. Children with other causes of acute abdominal pain were excluded from the study. A total of 118 patients were included. Based on their calculated Alvarado scores, they were stratified into two groups: Group A (Alvarado score <6) and Group B (Alvarado score ≥6). Alvarado scores were compared with the histopathology reports, the gold standard for diagnosing acute appendicitis. The data gathered was then subjected to statistical analysis to measure our objective. ResultsOut of the 118 patients (85 males, 33 females), 46 belonged to Group A and 72 to Group B.Final diagnosis of acute appendicitis from histopathology reports was confirmed in 94 cases (79.6%). The overall sensitivity and positive predictive value of Alvarado score for acute appendicitis were 92% and 94% respectively. The area under the ROC curve was 0.9 indicating a highly accurate test.The sensitivity was only slightly higher for males with a score of <6 than females (94.9% vs. 89.5%, p < 0.05).However, for scores ≥6, sensitivity among males was significantly higher than females (79% vs. 62.6%; p < 0.05).A multivariate analysis revealed that anorexia, right iliac fossa tenderness and rebound tenderness are significantly correlated with a correct diagnosis of acute appendicitis (p = 0.025, 0.037 and 0.026 respectively). ConclusionThe presence of a high Alvarado score (≥6) is highly predictive of acute appendicitis.In women of childbearing age and Alvarado scores of <6, other pathologies that mimic appendicitis must be considered. An US scan of abdomen and pelvis should be considered in a woman of child-bearing age before proceeding to a surgical intervention.

Correlation of Alvarado score for acute appendicitis with pathological acute appendicitis

Background: The vermiform appendix is important in surgery due to its propensity for inflammation which results in the clinical syndrome known as acute appendicitis. Approximately 7% of the population will have appendicitis in their life time, with the peak incidence occurring between 10 and 30 years. There occur numerous instances in the practice of medicine which demand of the physician expert diagnostic skill, sound judgment, quick and competent treatment. In 1986, Alvarado evaluated common clinical and laboratory findings in relation to pathologically proven acute appendicitis. Alvarado score had sensitivity of 81% and a specificity of 74%. The main objective is to study efficacy of Alvarado score in diagnosis of acute appendicitis Methods: This is a randomized study comprising of 138 patients of suspected acute appendicitis. The patients with suspected acute appendicitis are evaluated on the basis of the Alvarado scoring system on admission and divided into 3 groups (A, B and C). Patients were treated based on the clinical impression, following all standard surgical principals. The surgical specimen was sent for histopathological examination for confirmation of diagnosis. Data was collected, recorded and then processed. Results: Out of total 138 patients included in study, 117 patients were subjected to emergency appendectomy. 111 patients out of 117 patients operated were true positive for acute appendicitis, confirmed by histopathology report. Rest 6 patients out of 117 had normal appendix on histopathology. The Sensitivity of Alvarado score was 92.79%, specificity was 77.77%, positive predictive value was 94.49% and negative predictive value was 72.14% in our study. Conclusions: Alvarado scoring system is a good diagnostic indicator for acute appendicitis. It helps in reducing the number of negative appendicectomies.

Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort

PurposeTo evaluate whether C-reactive protein (CRP) level and ultrasound (US) results on admission could aid the diagnostic accuracy of Alvarado score. MethodsA prospective study was performed on children <14 years admitted for suspected acute appendicitis. Patients were categorized into three groups based on the Alvarado score: group I: score 7-10, group II: score 5-6, group III: score 0-4. ResultsThe difference between predictive values of Alvarado score alone and Alvarado score with CRP was not statically significant. The PPV increased from 74.29% (Alvarado score and CRP) to 93.75% (Alvarado score and US) in group 1 (P = .001) and the NPV increased from 64.86 and 79.69% (Alvarado score and CRP) to 82.6 and 88.2% (Alvarado score and US) in group 2 (P = .01) and group 3 (P = .001), respectively. ConclusionsAlvarado score and ultrasound taken together improve the predictive value of diagnosing acute appendicitis in children.

Alvarado score: can it reduce unnecessary CT scans for evaluation of acute appendicitis?

ObjectiveThe objective of the study is to assess the utility of Alvarado score in the diagnosis of acute appendicitis and the utility of computed tomographic (CT) scan for evaluation of acute appendicitis when stratified by Alvarado scores. Materials and methodsRetrospective cohort study comprised adult patients who underwent abdominal CT for suspected acute appendicitis between January 2006 and December 2009. Two abdominal radiologists independently reviewed the CT scans; any discrepancies were resolved by a consensus review. Alvarado scores were calculated and categorized as low (0-3), equivocal (4-6), or high (7-10) probability for appendicitis. The diagnostic utility of CT scans and Alvarado score for acute appendicitis were compared with the criterion standard of combined medical chart review and pathology findings. ResultsIn a cohort of 158 subjects, 73 (46.2%) had clinical diagnoses of acute appendicitis. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT scan in the diagnosis of acute appendicitis were 97.5%, 98.6%, 96.5%, 96.0%, and 98.8%, respectively. The mean Alvarado score for subjects with complicated appendicitis was significantly higher (7.95) than subjects with uncomplicated appendicitis (6.67) and those with other diagnoses (5.95). Acute appendicitis was confirmed in 2 (13.3%) of 15 subjects with low probability Alvarado scores, 16 (30.8%) of 52 subjects with equivocal scores, and 55 (60.4%) of 91 subjects with high probability scores. ConclusionThe CT scan had high diagnostic utility for acute appendicitis. The Alvarado score was not a reliable independent predictive tool for acute appendicitis and could not replace CT scan.

How reliable is the Alvarado score in acute appendicitis?

We aimed to investigate the reliability of the Alvarado score (AS) in determining acute appendicitis and the different parameters that affect the AS. Three hundred and thirteen patients suspected of acute appendicitis (AA) aged 18-70 years were included in this study. Patient data including AS calculated from emergency services and at discharge, follow-up, and operations were recorded. Patients were divided into three groups according to the AS, as AS <4, AS 5-7 and AS 8-10. AA and appendicitis perforation rates were compared according to the different parameters. The mean age of patients (55% females, 45% males) was 30.8±10.8 years. The AA (appendix perforation) rates of 211 patients who underwent operation were found as: AS ≤4: 56.5% (7.7%), AS 5-7: 75.9% (10%), and AS 8-10: 89% (27.8%). The percentage of negative appendectomy was 19.4%. The scoring was more reliable in males with AS 5-7, and the reliability weakened as body mass index (BMI) increased in all groups. Patients with AS ≤4 must be followed up and should be informed at the time of their discharge about the slight possibility of appendicitis. The effect of AS in determining the diagnosis of appendicitis is not influenced by age or symptom duration.

Design and Implementation of an Ontology for the Computable Representation of Clinical Prediction Rules

Objective: A lack of acceptance has hindered the widespread adoption and implementation of clinical prediction rules (CPRs). The use of clinical decision support systems (CDSSs) has been advocated as one way of facilitating a broader dissemination and validation of CPRs. This requires computable models of clinical evidence based on open standards rather than closed proprietary content. Methods: The on-going TRANSFoRm project has developed ontological models of CPRs suitable for providing CPR based decision support. Results: This paper describes the design and implementation of a generic ontology model for the representation of computable CPRs. The conceptual validity and implementation of the ontology is discussed using an illustrative example of a CPR in the form of the Alvarado Score for acute appendicitis. Conclusions: We demonstrate how the model is used to query the structure of this particular rule, providing a generic computable representation suitable for the representation of CPRs in general.

Predictive value of C‐reactive protein with Alvarado score in acute appendicitis

The aim of the study was to evaluate whether C-reactive protein (CRP) level on admission could aid the diagnostic accuracy of Alvarado score in acute appendicitis. We retrospectively evaluated hospital records and database of 234 patients (men 116, women 118, median age 28 years, range 15-87 years) who underwent appendicectomy for acute appendicitis. Patients were categorized into three groups retrospectively based on the Alvarado score. Group I: score 7-10 (n = 155), group II: score 4-6 (n = 71), group III: score less than 3 (n = 10). Negative (NPV) and positive predictive values (PPV) of CRP was calculated. Overall, 169 of 234 (72.2%) had histopathological confirmation of acute appendicitis. The predicted accuracy of Alvarado score was 84.5% in group I, 50.7% in group II and 25% in group III. The PPV of high CRP and NPV of normal CRP for group I was 88% and 36.4%, in group II, 63% and 72%, in group III, 33% and 86%, respectively. The Alvarado score and CRP taken together improve the predictive value of diagnosing acute appendicitis. Having a normal CRP in the equivocal group of Alvarado 4-6, should be further evaluated by advanced imaging before proceeding to appendicectomy.

An ontological treatment of clinical prediction rules implementing the Alvarado score.

A lack of acceptance has hindered the widespread adoption and implementation of clinical prediction rules (CPRs). The use of clinical decision support systems (CDSSs) has been advocated as one way of facilitating a broader dissemination and validation of CPRs. This requires computable models of clinical evidence based on open standards rather than closed proprietary content. The on-going TRANSFoRm project has developed ontological models of CPRs suitable for providing CPR based decision support. This paper presents a description of the design and implementation of the ontology model for CPRs that has been proposed. The conceptual validity of the ontology is discussed using the example of a specific CPR in the form of the Alvarado Score for acute appendicitis. We demonstrate how the model is used to query the structure of this particular rule, providing a computable representation suitable for CPRs in general.