Alvarado Score Research Articles

Evaluation of Factors Predicting Successful Outcome in Patients Undergoing Expectant Management of Uncomplicated Acute Appendicitis.

Expectant management, or non-operative management (NOM), with standalone intravenous antibiotic therapy, has emerged as an effective alternative to appendectomy for the treatment of uncomplicated acute appendicitis. Various clinical, biochemical, and radiological factors have been implicated in predicting the success or failure of outcomes. Therefore, it is important to identify patients at the onset who are likely to have successful outcomes for conservative management of uncomplicated acute appendicitis. We prospectively enrolled 85 surgical patients diagnosed with uncomplicated acute appendicitis in our study. On admission, clinical features such as duration of symptoms, pulse rate (PR), history of fever within 24 hours of admission, modified Alvarado score and adult appendicitis score, biochemical parameters such as C-reactive protein (CRP), and hematological parameters such as total leukocyte count (TLC) were recorded. Radiological imaging of patients, namely ultrasonography and contrast-enhanced CT abdomen to evaluate appendix diameter and mural enhancement, was also undertaken. The outcome of expectant management for these patients (success or failure) was recorded, and the above-mentioned factors were evaluated to find a possible correlation with successful expectant management. We found that among 85 patients, 77.6% had a successful NOM of appendicitis, whereas 22.4% had a failed NOM of appendicitis. The duration of symptoms, pulse rate, fever within 24 hours of admission, TLC, percentage of neutrophils, CRP level, appendix diameter, modified Alvarado score, and adult appendicitis scorewere found to be statistically significant predictors of successful NOM of appendicitis according to univariate analysis. According to multivariable analysis, pulse rate and appendix diameter value were found to be statistically significant predictors of successful NOM of appendicitis. With each beat per minute (bpm) increase in pulse rate, there was a 0.30% decrease in the probability of a successful NOM of appendicitis. With each mm increase in appendix diameter, there was an 82% decrease in the probability of a successful NOM of appendicitis. From our study, it can be concluded that patients who met the following criteria, i.e., duration of symptoms before presenting to surgical emergency less than two days, presence of fever within 24 hours of presenting to surgical emergency, pulse rate >90 bpm, TLC >12000 cells/dL, CRP >20 mg/L, appendix diameter >10 mm, modified Alvarado score ≥ 9, and adult appendicitis score ≥ 18, have a higher probability of failure of NOM and hence should be excluded from expectant management.

Comparison of Diagnostic Accuracy of Modified Alvarado's Score Vs AIR Score in Acute Appendicitis

Objective: To determine the diagnostic accuracy of MASS Vs AIR score in patients with acute appendicitis taking histopathology as gold standard. Material and Methods: Study design is cross sectional study (Validation). The study took place in the Department of General Surgery Nishtar Hospital Multan form 2nd august 2022 to 1 Feb 2023. The technique used for sampling is Non-Pro-bability consecutive sampling. Sample size is calculated using PASS 11, through formula for paired sensitivities (McNemar test). In total, 148 patients with diagnosis of acutely inflamed appendix, fulfilling the inclusion criteria, after taking informed consent, were enrolled. Baseline data including age, gender, MASS and AIRS was noted. Results: patients were having a mean age of 32.91±9.06 years. There were 97(65.54%) male and 51(34.46%) female. Histopathology showed 114(77.03%) patients had acute appendicitis. Sensitivity, specificity, PPV, NPV& DAwas 71.05%, 85.29%, 94.18%, 46.77%&74.23% respectively for MASS. Sensitivity, specificity, PPV, NPV& DAwas 94.49%, 88.23%, 96.49%, 88.23% &94.59% respectively for AIR. Conclusion: AIR score is an improved diagnostic scoring system than MASS for acute appendicitis.AIR is more sensitive and more specific than MASS. In addition, the two scores can be easily computed through a detailed history and clinical exam and basic laboratory tests.

The role of high serum bilirubin as a predictor of complicated appendicitis: a retrospective cohort study

Introduction: An appendectomy is one of the most common emergency surgeries. The delay in diagnosis and treatment of appendicitis can lead to complicated appendicitis. The definitive predictive factor that can diagnose complicated appendicitis is still lacking. The authors aim to assess the role of high serum bilirubin level as a predictor of complicated appendicitis. Methods: A retrospective cohort study was conducted among patients with acute appendicitis (AA) between March 2017 and March 2018. Appendicitis cases diagnosed with the help of the Alvarado score undergoing surgery were taken in study and based on the histopathological report, the cases were classified into two groups: uncomplicated and complicated. Preoperatively, biochemical parameters like increased white blood cell count (>11000/cubic millimeter), and level of serum bilirubin >1.4 mg/dl were studied. Informed written consent for the study was taken from the patients with AA. A χ 2 test was applied for the association between categorical variables. Statistical analysis was done with a statistical package for the social sciences (SPSS) version 20; P-value less than 0.05 was considered statistically significant. Results: A total of 100 patients were enrolled in the study with a mean age of 31.2±18.3 years, and 60% were male. Seventy-four (74%) had uncomplicated appendicitis and 26 (26%) had complicated appendicitis. Mean bilirubin was 1.2±0.8 mg/dl in uncomplicated and 1.8±0.8 mg/dl in complicated groups (P <0.05). The sensitivity and specificity of hyperbilirubinemia as a predictor of complicated appendicitis were 50 and 78.38%, respectively. Conclusion: The study revealed that patients with AA and a higher serum bilirubin level have a higher risk of having complicated appendicitis. Serum bilirubin level helps to predict complicated appendicitis and thus plan for timely and appropriate management. Thus, the study concludes that bilirubin should be used together with clinical examination and other laboratory investigations in the assessment of patients with suspected AA.

COMPARISON OF RIPASA AND ALVARADO SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS IN TERTIARY CARE

Introduction: Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendectomy rates. RIPASA and ALVARADO scores are new diagnostic scoring systems for diagnosis of acute appendicitis . RIPASA scoring system has more sensitivity, specificity and diagnostic accuracy than ALVARADO score in diagnosis of acute appendicitis in Asian population. Hence this study conducted to compare RIPASA AND ALVARADO score in diagnosis of acute appendicitis in tertiary care hospital. RIPASA score includes more parameters than ALVARADO score such as age, gender, duration of symptoms prior to presentation Aims and objectives: To compare RIPASA and Alvarado score in diagnosing acute appendicitis using histopathology as gold standard Materials and Methods: Source of Data: Basaveshwar teaching and general hospital from august 1st to 30th september 2022 Study Design: Prospective observational study. Study Population: 74 patients Inclusion criteria All patients who presented with right lower quadrant abdomen pain and diagnosed as acute appendicitis. Exclusion Criteria: Patients under 18 years of age. Patients with right iliac fossa mass. Patients with features of peritonitis All these patients were scored as per RIPASA and Alvarado scoring system after taking history , clinical examination and laboratory investigations. RIPASA includes 18 parameters and Alvarado 8 parameters. A score of 7.5 taken as high probability of acute appendicitis as per RIPASA and score of 7 for Alvarado scoring system. The decision of appendicectomy solely based on surgeonÂ’s own clinical judgement After the surgery, histopathological reports of operated cases correlated with scoring systems.

The Efficacy of Appendicitis Inflammatory Response Score in Diagnosis of Acute Appendicitis

Background: Acute appendicitis is one of the most common cause of acute abdominal pain. The management of suspected appendicitis represents a prime target for improved decision-making in emergency surgical care (OPD, Emergency room). The aim of the work is to evaluate the appendicitis inflammatory response (AIR) score and compare its performance in predicting the risk of appendicitis to the Alvarado score. Objective: To evaluate the diagnostic performance of the AIR score and potential benefits of risk stratification to guide clinical decision making. Methods: This prospective observational study was conducted in the OPD and Emergency department, Sir Salimullah Medical College & Mitford Hospital, Dhaka. From June’2021 to May’2022. A total 240 patients with right lower abdominal pain. History, clinical examination, hematological, radiological investigations were done. AIR score was calculated. Considering histopathology report as gold standard the score was compared. Histopathology report was done in Pathology Department of SSMC, Dhaka. Results: Right iliac fossa pain (100%) was the most common symptom, followed by vomiting (58.3%), temperature (29.5%), and rebound tenderness. After applying AIR scorings, 44(18.3%) patients in low-risk group (0-4), 112(46.7%) patients in the intermediate risk group (5-8) and 84(35.0%) patients in the high-risk category (9-12). Amongst the 240 applying the AIR score, Sensitivity of inflammatory response score vs histopathology findings was 97.9%, specificity 78.4%, accuracy 93.8%, positive and negative predictive values were 94.4% and 90.9% respectively. Conclusion: Risk stratification of patients with suspected appendicitis by the AIR score could guide decision-making to reduce admissions, length of hospital stay, cost and case fatality rate, optimize utility of diagnostic imaging and to decrease negative exploration. Sir Salimullah Med Coll J 2023; 31: 47-52

A Comparison of the Modified Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (Ripasa) Score in a Southeast Asian Population With Histopathology as the Gold Standard.

Background The diagnosis of acute appendicitis has remained difficult despite it being one of the most common surgical emergencies in the world. One of the most frequently used scoring systems is the Modified Alvarado Score (MAS). However, the MAS has been known to be less efficient in Asian populations. To overcome this issue, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score has been specifically developed to improve the diagnosis of acute appendicitis in Asian populations. This study aimed to evaluate the accuracy of the RIPASA score compared to the MAS for the diagnosis of acute appendicitis in a Southeast Asian population keeping histopathology as the gold standard. Methodology The study group comprised 150 patients. Data were collected from each patient using a simple proforma to ascertain both the MAS and the RIPASA score for each patient at the time of presentation. The patients then underwent open appendectomy and histopathology was used as the gold standard to determine the presence or absence of acute appendicitis in the excised specimens. Results The RIPASA score had a sensitivity and specificity of 89.83% and 59.38%, respectively, compared to 64.41% and 53.12%, respectively, for the MAS. Diagnostic accuracy was similarly higher for the RIPASA score at 83.33% versus 62.00% for the MAS. Conclusions The RIPASA score is superior to the MAS for the diagnosis of acute appendicitis. Using the RIPASA score instead of the MAS in Southeast Asian populations can lead to a more accurate and timely clinical diagnosis of patients with suspected acute appendicitis and help improve patient outcomes.

The Accuracy of Abdominal Ultrasound and the Modified Alvarado Score in the Diagnosis of Acute Appendicitis

The Accuracy of Abdominal Ultrasound and the Modified Alvarado Score in the Diagnosis of Acute Appendicitis

Diagnostic tools in diagnosing acute appendicitis - Alvarado Score, CRP, USG, and CT (Abdomen)

Aims. To evaluate scope of diagnosing tools-Alvarado score, CRP, USG, and CT in acute appendicitis. Method. Conducted observational study of 152 patients in Department of Emergency Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, India between January to December 2022. The diagnostic tool’s (Alvarado score, CRP, USG, CT (abdomen), sensitivity, specificity, accuracy, and ROC were analyzed to diagnose acute appendicitis. Results. Among 152 study patients, males - 86, females - 66, higher number of age group was <30 years, abnormal variables in study patients are BP - 79%, HR - 80%, RFP pain - 57%, anoxia - 78%, nausea/vomiting - 68%, RIF tenderness - 69%, rebound tenderness - 63.8%, elevated temperature - 62%, pain - 44.7%, leukocytosis - 70.7%, and left shift - 38.2%. In comparison, Alvarado scores-identified 98% patients, (<5 score - 8.2%, 5-6 score - 30.6%, >7-61.2%) (0.0271), CRP - identified 95.1% (<0.001), USG identified (group 1-33%, group 2-12.2%, group 3-11.3%, and group 4-43.5%, and CT identified 152/152 (100%) patients with acute appendicitis. The odds ratio/95% CI of diagnostic tools (USG - 0.878, 0.66, CRP - 7.337, 2.623, Alvarado score - 0.81, 0.687). Sensitivity (Alvarado's score - 84.74%, USG - 83.33%, CRP - 76.43%), and specificity was (Alvarado's score - 84.32, USG - 72.97%, CRP-83.86%. The PPV (Alvarado's score - 74.56%, USG - 75.5%, CRP - 33.16%), NPV (Alvarado's score - 32.5%, USG - 79.1%, CRP - 81.03%), and diagnostic accuracy (Alvarado's score - 72.01%, USG - 73.05%, CRP - 68.81%). ROC in individual tools-Alvarado score was specific than USG, and CRP. ROC in combination tools-Alvarado score and USG was specific than USG, and CRP. Conclusion. Among the diagnostic tools tested, as individual tool-Alvarado score was specific, in combination, and Alvarado score and USG were accurate, specific, sensitive, hence combination of tools will identify acute appendicitis early to reduce mortality by undiagnosed or late diagnosed.

Risk of Conversion from Laparoscopic Appendectomy to Open Surgery: The Role of Clinical and Radiological Factors in Prediction.

Introduction: Laparoscopic appendectomy is the most preferred surgical method in the treatment of acute appendicitis. In our study, we aim to determine the clinical and radiological factors affecting conversion from laparoscopic appendectomy to open surgery. Materials and Methods: All patients older than 18 years, who were operated on with the diagnosis of acute appendicitis in the General Surgery clinic of Prof. Dr. İlhan Varank Training and Research hospital between January 2020 and January 2022, were included in the study. The data consisting of clinical, laboratory, and radiological (computed tomography) findings of the patients were evaluated retrospectively. The patients were divided into two groups as those whose surgery was completed laparoscopically (Group 1) and those converted from laparoscopic appendectomy to open surgery (Group 2). The risk of conversion to open surgery was analyzed by binary logistic regression analysis as univariate and multivariate models. Results: Appendectomy was performed in 831 patients within the specified period. The surgery of 31 (3.73%) patients started laparoscopically; however, they were completed by converting to open surgery. Multivariable analysis showed that the risk of conversion to open surgery increased with leukocyte count, Alvarado score and with the presence of periappendiceal fluid and lymphadenopathy on CT. Conclusion: Our study shows that patients with high risk of returning to open surgery can be identified preoperatively with the risk analysis method in which clinical, laboratory, and radiological findings are evaluated together. We conclude that, starting the operation of these patients with the open technique from the beginning will prevent unnecessary expenditures and reduce morbidities.

Comparison of Pediatric Acute Appendicitis Before and During the COVID-19 Pandemic in New York City.

Background: Acute appendicitis (AA) is the most common abdominal surgical emergency in children and adolescents. In the year immediately following the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO), there was a precipitous decline in emergency department (ED) visits especially for surgical conditions and infectious diseases. Fear of exposure to severe acute respiratory coronavirus 2 infection resulted in delay in presentation and time to surgery, and a shift toward more conservative management. Objective: Our goal was to compare the incidence and severity of AA before and during the COVID-19 pandemic. Methods: Patients aged 2-18years admitted with the diagnosis of AA to Flushing Hospital Medical Center or Jamaica Hospital Medical Center in Queens, New York, were selected for chart review. Data extracted from electronic health records included demographics, clinical findings, imaging studies, and operative and pathological findings. We calculated the Alvarado score (AS) for incidence and the American Association for the Surgery of Trauma (AAST) grade for severity. We compared patients admitted between March 1, 2018-February 29, 2020 (pre-pandemic) to patients admitted between March 1, 2020-February 28, 2021 (pandemic). We then compared pre-pandemic and pandemic groups to determine differences in pediatric AA incidence and severity. Results: Of 239 patients diagnosed with AA, 184 (77%) were in the pre-pandemic group and 55 (23%) in the pandemic group. Incidence (number per year) of AA declined by 40%. The pandemic group had significantly greater overall AS of ≥7, indicating increased likelihood to require surgery, (P = 0.04) and higher AAST grade demonstrating increased severity (P = 0.02). Conclusion: There was a decline in the number of AA cases seen in our pediatric EDs and admitted during the first year of the pandemic. Clinicians need to be aware of increased severity of AA at time of presentation during public health emergencies such as a pandemic, possibly due to modified patient behavior.

RIPASA versus Alvarado score in the assessment of acute appendicitis: A prospective study.

This study aimed to compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scoring to accurately identify acute appendicitis. A cross-sectional prospective study was carried out in the department of surgery. Patients were enrolled and scored using RIPASA and Alvarado scoring systems. Appendectomy was done, and the specimen was sent for histopathology examination, which was used as the gold standard for diagnosis. Among 400 recruits, 11 patients were lost to follow-up, giving us a sample size of 389 patients. The cut-off value for RIPASA and Alvarado scores was 7.5 and 7.0, respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in diagnosing acute appendicitis of both scores were analyzed using SPSS. Among 389 patients, 256 (66%) were males, and 277 (71%) were under the age of 40 years. RIPASA was more than 7.5 in 345 cases, while Alvarado was more than 7.0 in 261 patients. RIPASA score had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 95.8%, 87.9%, 98.9%, and 65.9%, respectively. In contrast, the ALVARADO score was 71.1% sensitive and 75.8% specific. RIPASA had a diagnostic accuracy of 95.12%, while Alvarado was only 71.46% accurate in diagnosing acute appendicitis. Compared to the Alvarado scoring system, RIPASA is a better tool in terms of accuracy, sensitivity, and specificity for diagnosing acute appendicitis.

Modified Alvarado and Samuel scores: Contribution to the diagnosis of acute appendicitis in the pediatric acute and emergency department

Introduction Acute abdominal pain is a common complaint among pediatric patients. Surgical emergencies, particularly acute appendicitis (AA), evoke significant concern due to the challenges associated with its diagnosis. Objectives This study aimed to evaluate the contribution of modified Alvarado and Samuel scores (pediatric appendicitis scoring systems) to the diagnosis of AA in children who attended our acute and emergency department. Study Population and Methods Children aged 3 to 16 years who presented to the acute and emergency department with acute abdominal pain were included after obtaining parental consent and Ethics Committee approval. Data on the patient’s age, sex, body temperature, history of bowel habits, trauma, weight loss, chronic gastrointestinal disease, etc., were collected. The modified Alvarado and Samuel scores were calculated, and children were classified into three groups: G1 (score <4), G2 (≥4 score <7), and G3 (score ≥7). The diagnostic value of both scores was assessed by calculating their positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR). Children with known chronic inflammatory bowel disease, obvious sepsis, and incomplete case records were excluded. Results Of the 90 children recruited for this study, only 87 were included (49 boys, 38 girls, sex ratio: 1.3:1). The overall mean age of the study population was 9.3 years, and the mean ages per group were 9.25 years (G1), 10.3 years (G3), 9.5 years (G3-1), and 7.25 years (G3-2). Of the 87 children, 69 (79%) experienced abdominal pain attributed to a medical cause, and 18 (21%) required surgery [of whom 16 received early intervention, while 2 (G3-1 subgroup) received the intervention after 24 hours of observation]. Of the 16 patients who received early intervention, 6 (38%) who underwent immediate surgery had perforated appendicitis, 4 had suppurated appendicitis, and 6 had simple inflammatory appendicitis. For G3 patients, Alvarado score showed a PPV, an NPV, a sensitivity, a specificity, a PLR, and a NLR of 91.7%, 98%, 91.7%, 98%, 45.5, and 0.09, respectively. For Samuel score, the values were 93%, 98%, 93%, 98%, 46, and 0.08, respectively. The majority of patients with purulent and perforated appendicitis (except 1, score 3) belonged to G3, of whom 1 had a false-positive score (score ≥7) and another had a false-negative score (score 3). Four patients in G3 required abdominal tomodensitometry. Conclusion The modified Alvarado and Samuel scoring system is a valuable tool for diagnosing AA in children seeking care at the acute and emergency department.

Clinical effectiveness study of the new diagnostic score of acute appendicitis in the elderly

Introduction. Acute appendicitis is among the three most frequent surgical diseases. The lifetime likelihood of developing acute appendicitis is around 7%. The incidence of acute appendicitis reduces with age after adolescence. Several studies evaluated the relevance of the current scores to the general population, mostly children, but a limited number of studies have studied the elderly population. This study aims to assess the clinical effectiveness of the new diagnostic score for the elderly population in comparison to both the Alvarado score and the non-standardized score. Material and methods. In order to evaluate the effectiveness of the diagnostic score of acute appendicitis, we examined 78 patients who were admitted to emergency unit of the Saint Archangel Michael Municipal Clinical Hospital during 20182021 with the presumptive diagnosis of acute appendicitis. Of all patients admitted, Acute Appendicitis was confirmed on pathological examination in 22 (28.2%) patients. The average age of patients was 73.5±13.5 years (minimum - 60 years, maximum - 87 years). The ratio of males to females was 1:1.6. Results. Comparative evaluation of the new diagnostic score of acute appendicitis and the non-standardized clinical-echographic examination for acute appendicitis diagnosis showed better performance indicators of the new diagnostic score of acute appendicitis compared to the non-standardized clinical method for acute appendicitis diagnosis. The high sensitivity of the new diagnostic score of acute appendicitis was statistically demonstrated (ƛ2 = 4.32; p < 0.05), a lower rate of missed acute appendicitis cases in the new diagnostic score of acute appendicitis (ƛ2 = 4.32; p < 0.05), the „grey area” is lower in the new diagnostic score of acute appendicitis (ƛ2 = 5.28; p < 0.05), than in the non-standardized diagnosis. It was shown to have a lower rate of acute appendicitis cases in the „grey area” of the total number of acute appendicitis cases (ƛ2 = 4.9; p < 0.05). Benchmarking indicators such as specificity and diagnostic accuracy showed no statistically significant differences. At the same time, a definite increase in specificity and accuracy was observed for the new diagnostic score of acute appendicitis compared to non-standardized clinical diagnosis. Conclusions. Diagnosing acute appendicitis in elderly patients remains challenging due to the numerous potential diagnoses with similar clinical manifestations that are observed in this patient population. It was necessary to utilize clinical risk-scoring systems that could aid in the prompt identification of patients with acute appendicitis. This study concludes that the New diagnostic score has higher clinical efficiency in diagnosing acute appendicitis in elderly patients. It has a sensitivity of up to 93.15%, compared to the unstandardized clinical method and the Alvarado diagnostic score, and is independent of „risk factors” such as obesity and atypical vermiform appendix localization.

Comparative Study between RIPASA Scoring System and ALVARADO Scoring System in Diagnosing Acute Appendicitis in Adults

Background: Acute appendicitis is regarded as one of the most common inflammation that needs surgical intervention. Different scoring systems have been used for diagnosing of acute appendicitis. ALVARADO score is one of the most widely used score in diagnosing of acute appendicitis, but the accuracy of the latter is insufficiently low in Middle-East patients. Thus a new scoring system called RIPASA score has been designed for diagnosing of acute appendicitis in those patients. The aim of this study is to use RIPASA score and compare its result with ALVARADO score in diagnosing of acute appendicitis. Subjects and Methods: The study includes 200 patients with symptoms and signs of acute appendicitis in Al-Kindy Teaching Hospital/Baghdad/Iraq from 1st of November 2017 to 30th of November 2018. The variables of both scoring systems are registered for each patient included in this study and all patients who are underwent appendectomy their specimens are sent for histopathology. Results: The study includes 200 patients with suspicion of acute appendicitis. By applying both scores for each patient, then comparing the result of the two scores with the histopathology reports; RIPASA score has shown sensitivity, specificity, and diagnostic accuracy (93.6%, 74.4%, 89.5%) more than ALVARADO score (82.8%, 65.1%, 79%) respectively. The area under the receiver operating characteristic (ROC) curve of RIPASA score (0.957) is higher and significantly better than that of ALVARADO score (0.893) with P value <0.05. Conclusions: The RIPASA score is more sensitive, more specific, and has high diagnostic accuracy than ALVARADO score.

EVALUATING CLINICAL ALVARADO SCORING SYSTEM AND CT CRITERIA IN THE DIAGNOSIS OF ACUTE APPENDICITIS

The retrospective study was conducted in Combined Military Hospital from January 2021- January 2022 to assess the diagnostic value of CT and the clinical Alvarado scoring system for patients with acute appendicitis. A total of 200 participants were included in the study. Patient details were recorded, including demographic data, radiological findings, Alvarado clinical assessment scoring, and pathological findings. CT evaluation was based on the diameter of the Appendix, presence or absence of appendicolith, peri appendiceal inflammation, and free fluid. Results showed that there was a significant association between CT criteria (free fluid, peri appendiceal inflammation, and appendicolith) and the presence of appendicitis (P=.01). There also was a significant association between Alvarado score and appendicle diameter (P=.01), and also between WBC and appendicle diameter (P=.01). The cut-off value obtained for appendicle diameter was 6.4 mm. Computed tomography is an accurate modality for diagnosing acute appendicitis. CT and Alvarado score systems provide helpful insight for diagnostic workup of suspected cases of acute appendicitis.

Comparative study of Alvarado score and RIPASA score in the diagnosis of acute appendicitis

Background: Acute appendicitis is one of the most common surgical emergencies. Immediate and accurate diagnosis, mainly based on clinical assessment and laboratory results, is of paramount importance in order to reduce complications and mortality rates. Challenging diagnosis and fears of missing an inflamed appendix may lead to a negative appendectomy. Many scoring systems have been developed to reduce ambiguities in the diagnosis of appendicitis. The aim of the present study was to compare the efficacy of Alvarado score and RIPASA score in the diagnosis of acute appendicitis. Methods: This study was conducted in the Department of Surgery, Nehru Hospital, BRD Medical College, over a period of 12 months. A total number of 50 cases with a clinical diagnosis of acute appendicitis were studied. Informed consent was obtained from all registered cases. Results: 48% were male and 52% were females in the study. 70% belonged to <40 years and 30% belonged to >40 years. Among 50 patients, in patients ≥40 years of age, appendicitis was diagnosed in 10 patients and in patients <40 years of age, 24 were diagnosed with appendicitis. Among 50 patients, 24 were males out of which 19 were diagnosed with appendicitis compared to 15 out of 26 females. Anorexia and tenderness in RLQ were present in 100% patients. 100% patients had anorexia, RIF pain and tenderness. Alvarado and RIPASA score showed sensitivity 64.7% and 88.2% respectively. Conclusions: The difference in the diagnostic accuracy between Alvarado and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.

Diagnostic Accuracy of Modified Alvarado Scoring System in Acute Appendicitis in the Egyptian Patients

Abstract Background Approximately 7% of population will suffer from acute appendicitis during their life time. In 1889 Mc Burney in New York pioneered early diagnosis of appendicitis and was the first to point out the importance of early surgical intervention. Objective To assess the diagnostic accuracy of modified Alvarado scoring system in acute appendicitis in the Egyptian patients correlated with the operative findings and histo-pathological results. Patients and Methods This was a prospective; was conducted in Ain Shams University Hospitals and Nasr City Police Hospital, over a period of 6 Months, from February 2019 to August 2019, the study was carried out on 40 cases of both genders presenting to the emergency department with suspected acute appendicitis. Results There was statistically significant association between Histo-pathological findings and MASS (p < 0.001). There was statistically significant association between MASS and US findings (p < 0.001). Modified Alvarado Scoring System (MASS) showed a very high diagnostic value (AUC = 0.84, specificity = 88.6%, sensitivity = 80%, PPV=96.9%, NPV=50.0%, p-value =0.0001. Conclusion The present study has shown that MASS provides high degree of sensitivity, specificity, PPV, NPV and accuracy in the diagnosis of acute appendicitis, Alvarado scoring system increases the sensitivity and specificity for diagnosis of acute appendicitis with the added advantages of being simple and easy to use. Moreover it is repeatable at no cost. Thus the application of this scoring system improves diagnostic accuracy and consequently reduces appendicectomy.

Validation of the modified Alvarado score on patients attending A&E units with suspected appendicitis

IntroductionThe aim of our prospective study was to confirm validity and diagnostic accuracy of the modified Alvarado score, which was developed at the Department of Surgery, University of Szeged, on patients presenting with symptoms suggestive of acute appendicitis (right lower quadrant complaints) at the A&E department.Patient population, methods138 patients were included in our study between 01.01.2019 and 01.01.2020. For patients attending A&E, the first medic calculated and recorded the modified Alvarado score before surgical consultation. The consulting surgeon decided on further treatment without knowing the score. Validation of the score was based on the pathology report of the removed appendix (whether the operation was warranted, and if the score also supported indication for surgery), if there was readmission or surgery due to worsening symptoms after discharge from A&E. We also examined if there was any connection between the value of the Alvarado score and the severity of inflammation. Our aim was to prove that using modified Alvarado score at the A&E Units helps to reduce patient’s waiting time and avoid unnecessary surgical consultations. Furthermore our study included measuring the diagnostic accuracy of the ultrasound examination (specificity, sensitivity).ResultsBased on the results, patients presenting at A&E had a mean modified Alvarado score of 6.5. Comparing the score to histological results showed that the specificity of the modified Alvarado score was 100%, and its sensitivity was 80.7%. Based on Spearman’s rank correlation (0.796) and ROC analysis (AUC 0.968), the modified Alvarado score has an excellent predictive value in diagnosing acute appendicitis. When comparing the patients’ waiting times with the use of modified Alvarado score and without it we found that there was a significant difference in group also in group under 4 points and in group over 7 points when using modified Alvarado score, so the diagnostic and therapeutic algorithm should be much quicker with the help of the score. We found a correlation between the severity of inflammation based on the Fisher’s exact test. Rank correlation of the same question also showed a significant connection. All patients had an US examination during their diagnostic course, its sensitivity was 82.6%, specificity was 87%. Based on this, we can conclude that the predictive value of the imaging method is good.ConclusionsWe can conclude according to our results that the predictive value of the modified score is excellent, and it can be safely applied by non-surgeons in urgent care in the differential diagnosis of acute appendicitis. The new score incorporates the results of an easily obtainable, ionising radiation free imaging method, the ultrasound, which was not included in previous scores. With the help of the new score, the number of unnecessary surgical referrals and waiting times for patients are reduced, excess examinations will become avoidable.

Clinical scoring systems in acute appendicitis-Current perspectives-Review article

Clinical scoring systems have been used in the diagnosis of acute appendicitis and they have had varying degrees of success. The most common scoring system is the Alvarado scoring system followed by other scoring systems like the RIPASA and AIR systems. Most of the scoring systems are good at ruling out appendicitis or selecting patients who may require further imaging like ultrasound or computerized tomography. On their own most clinical scoring systems are not used to solely diagnose acute appendicitis and we have conducted this review article to look at the common scoring systems that are being used and its sensitivity and specificity.

CLINICAL STUDY ON ACUTE APPENDICITIS INCORPORATING MODIFIED ALVARADO SCORE AND ABDOMINAL ULTRASOUND

Acute appendicitis is one of the most common acute abdominal surgical emergencies the diagnosis of which is often challenging. If there is a delay in the diagnosis and prompt action is not taken, it may lead to perforation and other complication. Many scoring systems have been devised for the diagnosis of appendicitis, among which Modified Alvarado score is being used widely. Ultrasound also has gained importance in recent years. Our study aims in combining the use of Modified Alvarado score and USG in the diagnosis to bring down the rate of negative appendicectomies. Aimof The Study 1. To evaluate the sensitivity of the use of modified Alvarado scoring system and ultrasound in the diagnosis of acute appendicitis 2. To reduce the rate of negative appendicectomy. Materials & Methods: This study was done in 100 patients admitted in Navodaya Medical College Hospital from November 2019 to May 2021. All patients chosen on purposive sampling basis who present with right lower quadrant pain. Preoperatively, modified Alvarado score and abdominal ultrasound are assigned to those included in the study. Intraoperative findings and histo-pathological reports are followed up and the results are compared with modified Alvarado score and abdominal ultrasound. Results 1. In our study, the sensitivity of Modified Alvarado score in diagnosing Acute Appendicitis in the score range of 1-4 is 60%, so 6 out of 10 patients were confirmed with Acute Appendicitis. 2. In the score range of 5-7, out of 26 patients, 24 patients were confirmed with Acute Appendicitis using HPE having 92.3% sensitivity. 3. In the score >7, out of 64 patients , 63 patients had Acute Appendicitis confirmed with HPE and the sensitivity of HPE was the highest among this score range and its found to be 98.43%.The remaining 7 patients had normal appendix. 4. In our study, the sensitivity of USG Abdomen in diagnosing Acute Appendicitis was 95.83% in the score range of 5-7, 71.42% in score range of >7 and 66.6% in score range of 1-4.Out of 100 patients, USG abdomen showed positive result for Acute Appendicitis in only 72 patients when compared to HPE which showed 93 patients with Acute Appendicitis. Interpretation & Conclusion: Modified Alvarado scoring system is the better indicator for confirmation of diagnosis of Acute Appendicitis in the clinical setting rather than relying on USG abdomen imaging modality of investigation for diagnosing and treating the patient with Acute Appendicitis. When we incorporate both Modified Alvarado Scoring system and USG abdomen then we can diagnose Acute Appendicitis with accuracy close to HPE diagnosis of Acute Appendictis.