Alvarado Score Research Articles

Clinico-pathological profile of schistosomal appendicitis detected in surgically resected appendices: A retrospective study

BackgroundAppendicular schistosomiasis (AS) is an uncommon cause of acute appendicitis that can only be diagnosed histopathologically. There are few reports of AS and its histopathological profile is unclear in Egypt. Therefore, we aimed to evaluate the prevalence and clinicopathological, profile of AS among patients presented with acute appendicitis for proper management and to reduce the health burden of the disease. MethodsThis is a retrospective study performed at a university hospital comprising all patients with pathological confirmation of appendiceal Schistosomiasis after appendectomies between 2017 and 2021. All data were extracted from patient's files including age, sex, residence, main patient's complaint, Alvarado scores, and laboratory data. The histopathological specimens were reviewed by the histopathologist in this study and special stains were done when indicated. ResultsThe prevalence of AS was 1.07% (20/1870), all of them were adults or old age with a mean age of 39.25, 80% of cases were males. The most frequent clinical presentation in our patients was abdominal pain in the right iliac fossa (96%) with a mean duration of symptoms of 2.5 days. At the time of the operation, two patients had perforations, with no recorded mortality. Only 20% showed gross unusual foci, and lymphoplasmacytic infiltration was seen in 90% of cases. All patients were advised to postoperative praziquantel therapy. ConclusionHistopathological evaluation for schistosomiasis in all surgically removed appendix is recommended in endemic areas for middle and old ages and comprehensive postoperative follow-up with praziquantel therapy is required to ensure disease eradication and prevent further complications.

The diagnostic value of the systemic immune-inflammatory index in acute appendicitis cases in the emergency department.

Acute appendicitis (AA) is one of the most common causes of acute abdomen conditions and continues to cause mortality and morbidity despite all the improvements. There is still a necessity for inexpensive and easily calculable index and scoring systems with fewer side effects for the diagnosis of AA and the detection of complications. Since the systemic immune-inflammation index (SIII) is an index that could be used in this context, we aimed to measure the success and reliability of SIII for the diagnosis of AA and related complications and to contribute to the literature. Our study was carried out retrospectively in a tertiary care hospital and conducted with 180 AA patients (study group-SG) and 180 control group (CG) patients. Demographic data, laboratory data, and clinical data of the cases, as well as the Alvarado score (AS), adult appendicitis score (AAS), and SIII and neutrophil/lymphocyte ratio (NLR) values calculated from laboratory data, were recorded in the previously created study form. p<0.05 was accepted as the significance level for the study. In this study, age and gender were similar in the SG and CG groups. SIII and NLR levels calculated in SG cases were found to be significantly higher than CG. In addition, SIII and NLR levels were found to be significantly higher in complicated AA cases than in complicated cases. Although SIII was more significant in the diagnosis of AA, NLR was more successful than SIII in detecting the presence of complications. SIII, NLR, AAS, and AS were significantly positively correlated in the diagnosis of AA. In the presence of peritonitis, SIII and NLR were also found to be significantly higher when compared to cases without peritonitis. We found that SIII is a usable index in the diagnosis of AA and the prediction of complicated AA. However, NLR was found to be more significant than SIII in estimating complicated AA. In addition, it is recommended to be careful in terms of peritonitis in cases with high SIII and NLR levels.

Clinical scores (Alvarado and AIR scores) versus imaging (ultrasound and CT scan) in the diagnosis of equivocal cases of acute appendicitis: a randomized controlled study.

A total of 286 consecutive adult patients with suspected acute appendicitis were included. The clinical scores, including Alvarado and AIR scores and ultrasound, were done for all patients. Abdominal and pelvic CT scans were done for 192 patients to resolve the diagnosis of acute appendicitis. The sensitivity, specificity, positive and negative predictive values, and accuracy rate of both clinical scores and imaging (ultrasound and CT scan) were compared. The final histopathology was used as the gold standard for which the diagnostic feasibility of the clinical score and imaging were compared. Out of 286 total patients who presented with right lower quadrant abdominal pain, a presumptive diagnosis of acute appendicitis was made in 211 patients (123 males and 88 females) after thorough clinical evaluation, clinical scores, and imaging, and they were submitted to appendicectomy. The overall prevalence of acute appendicitis proved by histopathology as a gold standard was 89.1% (188 patients) with a negative appendectomy rate of 10.9%. Simple acute appendicitis was reported in 165 (78.2%) patients and perforated appendicitis in 23 (10.9%) patients. For patients with equivocal clinical scores (≥4 to ≤6), the sensitivity, specificity, predictive values, and accuracy rate of CT scan were significantly higher than those of Alvarado and AIR scores. Patients with low clinical scores (≤4) and high clinical scores (≥7), the sensitivity, specificity, predictive values, and accuracy rate of clinical scores and imaging were comparable. The diagnostic feasibility of AIR scores was significantly higher than the Alvarado score, and the clinical scores were associated with significantly higher diagnostic accuracy than ultrasound. CT scan is unlikely to be needed and will add little to the diagnosis of acute appendicitis for patients with high clinical scores (≥7). The sensitivity of the CT scan for perforated appendicitis was lower than that for nonperforated appendicitis. The use of CT scans for query cases did not change the negative appendectomy rate. CT scan evaluation is beneficial only for patients with equivocal clinical scores. For patients with high clinical scores, surgery is recommended. AIR score was superior to the Alvarado score in terms of sensitivity, specificity, and predictive values. A CT scan is usually not required for patients with low scores since acute appendicitis is unlikely; in such cases, ultrasound could be of help to exclude other diagnoses.

Normal Total Leukocyte Count in Patients Despite Acute Appendicitis Clinically and Preoperatively

Background: The main objective of this study was to ascertain the proportion of individuals diagnosed with acute appendicitis who exhibited clinically and preoperatively normal levels of total leukocyte count. Methodology: During the months of June 2021 and March 2022, researchers from the Department of Surgery at Jinnah Postgraduate Medical Center in Karachi, Pakistan, conducted a prospective observational study. All the patients presented with an impression of acute appendicitis above the age of twelve were included. Complete history, clinical examination, emergency investigations including CBC, UCEs, Ultrasound, X-Rays, Alvarado score were recorded in a predefined pro forma. Patients with low ALVARADO score and normal TLC with signs and symptoms of acute appendicitis were compared with CRP levels which directed the decision of appendectomy rather than conservative management. Per operative findings of stages of acute appendicitis such as acute inflamed, suppurative, gangrenous and perforated appendix were also noted. Appendix was sent to the laboratory and histopathological reports of the specimen were assessed. Results: Patients diagnosed with acute appendicitis and subsequently operated on totaled 270 in the study, 156 (57.78%) were having and ALVARADO score of less than 7 mostly due to normal TLC, while 114 patients (42.22%) were having ≥ 7 ALVARADO score. Preoperatively and histopathological reports of 270 patients of appendicitis 25% patents were acutely inflamed/catarrhal stage , 15.5% gangrenous, 20.59% perforated, while higher number of patients i.e. 38.91 were suppurative appendicitis. Conclusion: Most patients presenting with symptoms of acute appendicitis have normal TLC, meaning low TLC. This needs to be confirmed by caring out by proper examinations and getting inflammatory markers or in cases confirmatory CT if diagnosis can not be made clinically or by lab investigations. Keywords: Appendicitis, ALVARADO score, C-reactive protein, total leukocyte count

New Score (Muzammil-Mudassar appendicitis severity score-an effective tool for conservative management of acute appendicitis.

Objective: To determine the frequency of conservatively managed patients of acute appendicitis by using new (Muzammil-Mudassar appendicitis severity score) scoring system. Study Design: Cross Sectional Observational study. Setting: Government Teaching Hospital, Shahdara. Period: October 2021 to April 2022. Material &amp; Methods: 267 patients diagnosed with acute appendicitis by ALVARADO score were enrolled. New appendicitis severity score was devised by searching online literature. A cut off value of 11 was defined after conducting a pilot study. Patients having score of &lt; 11 were eligible for conservative management. All patients undergoing conservative treatment were receiving nothing per oral and given intravenous antibiotics (ciprofloxacin and metronidazole), intravenous fluids and infusion Paracetamol three times a day for at least 24-48 hours. Surgery was done in failed or unsatisfied cases. Weekly follow-up for first two weeks and then monthly for three months was done. Results: In our study mean age of the patients was 46.23±19.33 years, 187(70.04%) patients had age ≤60 years. The conservative management was successful in 214(80.15%) patients. Recurrence after three months was noted in 13(4.87%) patients. After 3 month follow up the anorexia was found in 4(1.5%) patients, nausea/vomiting in 5(1.9%) patients and pain was noted in 7(2.6%) patients. Conclusion: new score (Muzammil-Mudassar appendicitis severity score) is highly effective in predicting patients who will benefit from conservative management in terms of recurrence.

PRIMARY TUBERCULAR APPENDICITIS – A RARE CASE.

Introduction- Tuberculosis of appendix is clinical rarity among extrapulmonary tuberculosis and has similar presentation as acute appendicitis. Case Report- a 28 year old male with Rt iliac fossa pain and Modied Alvarado score of 8 was taken up for Open appendectomy in emergency. Histo- pathological ndings were suggestive of Tubercular appendectomy. Very few c Discussion- ases of appendicular tuberculosis have been previously Reported in literature. The diagnosis is one which can only be conrmed on histopatholgy. - primary tubercular appendicitis Conclusion is difcult to diagnose clinically and with USG ndings alone. Once the diagnosis is made with histopathology, patient should be started on ATT for a full course.

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.

Pediatric Appendicitis Transfers From Adult Centers: Can Alvarado Scores Help Determine Which Patients Need a CT?

Acute appendicitis is possible for any pediatric patient with abdominal pain. At our tertiary care center, patients are transferred for surgical management with unnecessary or excessive imaging. We hypothesize that using the Alvarado score (AS) to clinically stage patients will identify patient groups that could be transferred prior to imaging. Retrospective review of pediatric patients transferred to our hospital for suspected appendicitis between 11/2020 and 3/2022 was performed. Variables collected included AS, imaging, and pathology. Alvarado score was calculated for each patient, and patients were grouped into low score, intermediate score, and high score groups. Positive predictive values (PPVs) were calculated for patients who underwent CT. 196 patients (age 2-17, 58% male) were transferred with suspected appendicitis. CT was obtained in 67% of patients and was not significantly different between groups. The low-score group (n=35) had a rate of appendicitis of 14% and the PPV of CT was 33%. The intermediate-score group (n = 74) had a rate of appendicitis of 62% and the PPV of CT was 88%. In the high-score group (n = 87), the rate of appendicitis was 92% and PPV of CT was 98%. Our data show that patients with low, intermediate, and high AS undergo CT at similar rates. We suggest that patients in the low score and high score groups may not benefit from reflexive CT given the likelihood of appendicitis based on the Alvarado score. We propose that CT in these groups be performed at the discretion of the pediatric center in order to expedite transfer and spare children excess radiation.

CONSERVATIVE MANAGEMENT OF ACUTE APPENDICITIS IN BHUJ, KUTCH: A PROSPECTIVE STUDY

Objective: The current research was performed to know the outcome of conservative treatment in acute appendicitis using antibiotic therapy. Methods: The present and prospective research performed at Department of Surgery, Gujarat Adani Institute of Medical Science, Bhuj, Kutch for a duration of 2 years. All subjects diagnosed as acute appendicitis radiologically were enrolled into the research considering inclusion and exclusion criteria. Modified Alvarado score (MAS) was calculated based on clinical symptoms, signs, and laboratory investigations. Injection ceftriaxone and injection metronidazole were given for 48–72 h. Subjects who responded for i.v. antibiotics were switched to tablet ciprofloxacin and tablet metronidazole for 7 days and followed for 6 months. Subjects who did not respond to conservative treatment or had recurrence were classified as treatment failure/recurrence. Results: In the present research, total of 300 subjects were incorporated that comprise of 140 males and 160 females. Tenderness in the right inguinal fossa was observed in all the Subjects. MAS were in between 4 and 6 in 84 subjects and were 7–9 in 216 subjects with an average of 7.30. Thirty-six subjects had complicated acute appendicitis and 264 had uncomplicated acute appendicitis. Conclusion: In general, achievement rate of conservative management according to the present research was 82%. On the other hand, there were 12% failures and 6% recurrences in the current research. One of the major future goals will be to recover diagnosis of appendicitis, particularly the diagnostic capability to distinguish among the various forms of appendicitis.

CLINICOPATHOLOGICAL STUDY OF ACUTE APPENDICITIS – CORRELATION OF ALVARADO SCORING SYSTEM WITH INTRA OPERATIVE AND HISTOPATHOLOGICAL FINDINGS

BACKGROUND/ OBJECTIVE- Acute appendicitis (AA) is one of the most common surgical emergencies that require a proper diagnosis to avoid a negative outcome in the case of missed or delayed diagnosis. Our study aims to assess the diagnostic power of the Alvarado score and the prediction of the severity of acute appendicitis in correlation to intraoperative ndings and the nal histopathology (HP) result. METHODSPatients with suspicion of acute appendicitis were selected for the study, which were divided into 3 groups based on their ALVARADO scoring system after routine blood investigations and ultrasonography. Out of the 100 patients RESULTS- 53 were male and 47 were females.The number of patients were highest in the age group 21- 30 years [45%] indicating predominance in younger age group. Amongst them, 81 were operated and 19 were managed conservatively. Out of 81 patients operated, intra operatively 8 patients were found to have appendicular abscess and 7 patients had a perforated appendix, rest of the 66 patients had features of inamed appendix. These ndings were further conrmed on histopathological reporting. Only 2 cases were missed by Alvarado scoring, but both patients had increased scores on reassessment and they were operated. Complex or more advanced disease was encountered in patients with higher Alvarado score. In this study the sensitivity, specicity, positive predictive value and negative predictive value were 97.5%, 68.4%, 92.94% and 86.6% respectively. Alvarado Scoring Sy CONCLUSION- stem has a high sensitivity. The Alvarado scoring system in patients with pre- operative clinical diagnosis of appendicitis has been useful in the early diagnosis of acute appendicitis as demonstrated by various studies and was helpful in reducing the incidence of negative appendicectomies without increasing the morbidity and mortality. Difculty in surgery can be anticipated in patients with high Alvarado scores.

Diagnostic value of systemic immune inflammation index in acute appendicitis.

Clinical diagnosis of acute appendicitis is often difficult and involves a synthesis of clinical, laboratory, and radiological findings. The aim of this study was to investigate whether the systemic immune inflammation index can be used as an effective parameter in the diagnosis of acute appendicitis and its reliability in the differentiation of complicated vs. non-complicated appendicitis. The study was conducted retrospectively with patients admitted to the emergency department with abdominal pain and diagnosed with acute appendicitis. In total, 150 patients and 150 control cases were included in the study. Demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune inflammation index values, Alvarado score, adult appendicitis score, and pathology result of appendectomy material were retrieved from the hospital automation system and recorded in the data form. Neutrophil-lymphocyte ratio and systemic immune inflammation index were significantly higher, and platelet-neutrophil ratio and lymphocyte-neutrophil ratio were significantly lower in the patient group compared to the control group (p<0.001). Receiver operating characteristic analysis revealed that the sensitivity and specificity of systemic immune inflammation index with a cutoff value of 840.13 was 82 and 66.7%, respectively, for the diagnosis of acute appendicitis. Correlation analysis revealed that systemic immune inflammation index, Alvarado score, and adult appendicitis score were positively correlated, and this correlation was statistically significant. Systemic immune inflammation index may be used to promote the diagnosis of acute appendicitis and may reduce the need for radiation exposure and diagnostic imaging tests such as contrast-enhanced abdominal computed tomography. It can also be used to differentiate between complicated and non-complicated acute appendicitis cases.

A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis.

A systematic review was performed as per the PRISMA guidelines using search engines like Ovid, PubMed, and Google Scholar with predefined, strict inclusion and exclusion criteria. The quality assessment of included studies was performed using the QUADAS 2 tool. Summary statistics were performed for all variables. A linear regression model was performed between dependent and independent variables using STATA software. Heterogeneity testing showed significant heterogeneity within the included studies; hence, a forest plot with pooled estimates could not be constructed, and therefore a meta-regression was performed. Seventeen full-text articles met inclusion and exclusion criteria. Ten of which were identified as low-risk studies. Five studies were included in final data pooling with total patients being 2239 and mean age of 31.9 years. (1) Linear regression demonstrated an association between 'histological appendicitis' and 'AS 7-0' with patients receiving intervention, with a significant P value of less than 0.005. (2) Meta-regression demonstrated a positive coefficient (0.298), a positive Z score of 2.20 with a significant P value of 0.028 for patients with 'high AS' who received interventions that were significantly proven to be 'histologically appendicitis', indicating a cause-and-effect relationship. High AS (7 and above) is a significant predictor of acute appendicitis. The authors recommend further prospective randomized clinical trials to establish a cause-and-effect relationship.

COMPARISON OF ULTRASOUND AND THE ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS : A PROSPECTIVE COMPARATIVE STUDY IN A TERTIARY CARE CENTRE IN WESTERN MAHARASHTRA

Background :Acute appendicitis is one of the most common surgical emergencies with a lifetime prevalence of approximately 1 in 7. The Alvarado scoring system and ultrasonography play a definite role in diagnosis of acute appendicitis, because of the easy availability, cost effectiveness and being radiation free. According to the analysis, the percentage of Appendicectomies done for a normal appendix mistaken to be Acute Appendicitis was found to be as high as 20%.The following study compares the accuracy of the Alvorado scoring system and Ultrasonography in the diagnosis of Acute appendicitis and examines the value of using both modalities together. Materials and Methods :In this study 100 patients were included with provisional diagnosis of acute appendicitis and admitted and operated in the Department of General Surgery, MGM Medical College, Navi Mumbai between January 2021 to November 2022. Alvarado score was applied and ultra sound abdomen was done pre operatively. The decision for surgery was made independent of the score and ultra sound finding. Diagnosis of patients who underwent appendicectomy was confirmed by histopathology report. Results :In the present study, 100 cases were provisionally diagnosed of having acute appendicitis and were operated during the study period.Itwas seen that 95.52% of patients who were thought to be positive by Alvarado score &gt;=7 usually had appendicitis by histopathology where as 4.08% of the patients were normal by histopathological examination. This accounted for 47.96% and 33.33% of the total patients respectively. From this the sensitivity of the Alvarado score is calculated to be 47.96%. Ultrasound alone showed a PPV of 67% and a NPV of 66.7%. Conclusion :In our study, Alvarado score had better sensitivity than ultrasonography. Alvarado score has a high diagnostic value (97.7%). USG has role in ruling out normal appendix and other pathology, with a specificity of 66.67% When we diagnose acute appendicitis based on the individual results of Alvarado score and USG, we get a statistically significant value. Hence as a conclusion of this study, alvaradoscore and USG together could be applied in the diagnosis of acute appendicitis for better outcomes and decision making.

HUBUNGAN DIAMETER APENDIKS BERDASARKAN USG DENGAN SKOR ALVARADO PADA APENDISITIS AKUT

Appendicitis is the most common cause of acute abdomen and the most common surgical emergency. Signs and symptoms that are not always clear in every patient make it difficult to establish a diagnosis. This study aims to determine the relationship of the Alvarado score with the size of the diameter of the appendix based on ultrasound which can help in diagnosing cases of appendicitis. This research is an analytic observational study with a retrospective cohort study approach with a total sample of 52 people who have complied with the specified criteria and were selected by non-probability sampling technique. The data used for this study were the Alvarado score and the size of the diameter of the appendix based on the patient's ultrasound taken from secondary data. The Pearson correlation test conducted has shown a negative relationship between the Alvarado score and the size of the appendix diameter based on ultrasound with a p-value is 0,078&gt;0.05. Based on this study, it can be concluded that there is no corellation between the size of the appendix diameter based on ultrasound and the Alvarado score in appendicitis patients of RSUD Ulin Banjarmasin

Factors contributing to the late diagnosis of appendicitis in children: the results of a retrospective study

BACKGROUND: The diagnosis of acute appendicitis in children is often established late, which leads to complications, lethal outcomes are recorded.&#x0D; AIM: To identify and analyze the factors contributing to the late diagnosis of acute appendicitis in children.&#x0D; MATERIALS AND METHODS: A retrospective analysis of 279 case histories of children was carried out. The duration of symptoms is divided into time 1 (before hospitalization) and time 2 (from hospitalization to surgery). Patients were divided into two groups: 1st with destructive uncomplicated appendicitis (phlegmonous, gangrenous), 2nd with complicated appendicitis (unrestricted peritonitis, infiltrate, abscess). The causes of late hospitalization, symptoms indicated in the case histories, examinations performed, postoperative complications were analyzed. The diagnosis was established on the basis of intraoperative data, histological examination.&#x0D; RESULTS: In the 1st group, time 1 and time 2 were significantly less than in the 2nd (p 0.001; 0.028). Late presentation (24 hours) in 21.9%, misdiagnosis in 12.2% of cases. In the hospital, the observation of the patient 12 hours in 21.1% of patients. The frequency of presence / absence of a description of clinical and laboratory signs of acute appendicitis is from 100 to 19.7%. The 2nd group was characterized by: duration of symptoms 24 hours, repeated vomiting (p 0.001), febrile condition (p 0.001), increase in neutrophils 90% (8792%). Ultrasound examination with evaluation of the appendix in 20.1% of cases with a diagnostic accuracy of 89.3%. Laparoscopic appendectomy in 53.2% Alvarado scores are significantly higher in 2nd group (810) than in 1st group (79, p 0.001). In 1st group, complications were significantly less than 3.4% than in 2nd group 22.7 % (p 0.001).&#x0D; CONCLUSIONS: Factors contributing to the late diagnosis of appendicitis in children are: late treatment, diagnostic errors at the prehospital stage, incomplete clinical examination and observation, insufficient use of laboratory and instrumental methods.

Appendiceal wall thickness and Alvarado score are predictive of acute appendicitis in the patients with equivocal computed tomography findings

Around 8–13% of the patients who underwent CT scan for diagnosis of appendicitis had equivocal CT results. About one-third of these patients had acute appendicitis and this caused diagnostic challenge to the clinicians. This study was conducted to identify clinical and imaging features that were predictive of acute appendicitis in patients who had equivocal CT findings. During January 2015 to June 2021, we retrospectively included 103 consecutive CT scans of adult patients (22 men and 81 women; mean age, 39.1 ± 17.5 years) who had equivocal CT findings of acute appendicitis. Two readers, blinded to the clinical data, independently assessed CT images for the relevant CT findings of appendicitis. Any disagreement between the readers was solved by consensus. The clinical parameters and CT findings were analyzed and compared between the patients who had appendicitis and patients who did not have appendicitis. Thirty-one (30.1%) patients had appendicitis, all of which were non-complicated. The appendiceal wall thickness of ≥ 2 mm and the Alvarado score of ≥ 7 were independent predictors of appendicitis with adjusted odds ratios (ORs) of 2.76 (95% CI, 1.09–7.02) and 1.47 (95% CI, 1.12–1.94), respectively. The maximal appendiceal diameter was higher in the appendicitis group (7.2 ± 1.2 mm vs. 6.5 ± 1.0 mm), but not predictive of appendicitis. The rest of the clinical parameters and CT findings, including mucosal hyperenhancement, periappendiceal fat reticulation, thickening of peritoneal reflection, appendicolith, focal cecal thickening, and content in appendiceal lumen showed no significant difference between two groups. The appendiceal wall thickness and the Alvarado score were able to predict appendicitis in patients who had equivocal CT findings.

Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score in predicting acute appendicitis

IntroductionAcute Appendicitis is the most common surgical emergency encountered in emergency departments. To prevent the rate of negative appendectomies, different systems i.e. Alvarado score and Appendicitis Inflammatory Response Score (AIR) scores were used, but their diagnostic accuracy in Asian population is questionable. Raja Isteri Pengiran Anak Saleha (RIPASA) score has showed promising results in the recent literature. The purpose of this study is to compare the efficacy of Alvarado, AIR and RIPASA scores in the diagnosis of acute appendicitis. MethodsAlvarado, AIR and RIPASA scores were prospectively applied to 132 included patients that were admitted with provisional diagnosis of acute appendicitis and then their surgery was performed in General Surgery Unit, Hayatabad Medical Complex Peshawar, Pakistan from 1st January 2022 to 31st July 2022. Final diagnosis was confirmed by histopathology report and scores were correlated with final report. Cut off value of score >7, >5 and >7.5 were set for Alvarado, AIR and RIPASA score, respectively according to previous literature. Statistics analysis was done for all 3 scoring systems on SPSS version 23. ResultsOf 132 patients, there were n = 79(59.8%) males and n = 53(40.2%) females. Mean age was 24 years (SD ± 11.6) with youngest patient of 9 years and oldest one was 70 years old. Negative Appendectomy rate was 8.3%(n = 11). RIPASA score was superior to AIR and Alvarado score in Sensitivity, NLR, Accuracy and Area under the Curve. AIR score performed better in specificity, NPV, PLR compared to RIPASA and Alvarado score. ConclusionRIPASA score is an overall better scoring system in diagnosing acute appendicitis in compared to Alvarado and AIR score.

Alvarado or RIPASA? Which one do you use to diagnose acute appendicitis?: A cross-sectional study.

Acute appendicitis is one of the most common causes of lower abdominal pain, which is considered a general surgical emergency worldwide. The present study aimed to compare the diagnostic value of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado score systems in diagnosing acute appendicitis. A prospective cross-sectional study was conducted at Shahid Sadoughi and Shahid Rahnemoon Hospitals in Yazd between September 2020 and February 2020. The statistical population consisted of all of the patients referred to the Accident and Emergency department with right iliac fossa (RIF) pain. All patients were scored using Alvarado and RIPASA scoring system. sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed by using SPSS statistical software. An receiver operating characteristic curve were plotted. In present study, one hundred suspected patients with appendicitis who underwent appendectomy were evaluated. The mean age of our study population was 25.2 ± 12.1 years, and the gender distribution was 57% males and 43% females. The sensitivity, specificity, PPV and NPV of RIPASA were 86.6%, 66.7%, 92.2%, and 52.2%, respectively. The sensitivity, specificity, PPV and NPV of Alvarado score were 67.1%, 72.2%, 91.7%, 32.5%, respectively. The diagnostic accuracy was 68% for Alvarado score and 83% for RIPASA. The area under the curve for RIPASA (0.87) was more than that for Alvarado score (0.77). The RIPASA score system had higher sensitivity, PPV, NPV, and accuracy than the Alvarado one. It is recommended for the physician and surgeon to evaluate patients with RIF pain using the RIPASA score.

Evaluation of Diagnostic Accuracy of Alvarado, Appendicitis Inflammatory Response and Adult Appendicitis Scoring System in Diagnosing Acute Appendicitis: A Prospective Cohort Study

Introduction: Appendicitis is one of the most common surgical emergencies, but its clinical diagnosis is still a big challenge for surgeons to decrease the negative appendectomy rate. Aim: To validate and compare alvarado, Appendicitis Inflammatory Response (AIR) score and adult appendicitis scoring system in diagnosing acute appendicitis. Materials and Methods: A prospective cohort study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, from December 2020 to May 2022 on 100 patients who were clinically suspected of acute appendicitis. All three scores {AIR, Adult Appendicitis Score (AAS), Alvarado} were calculated. Diagnostic tests were used to calculate sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV). DeLong test were used to compare the area under the curve of three scores with each other for predicting acute appendicitis and the final result was compared with the histopathological report. The data was presented as numbersvand percentage and the p-value &lt;0.05 was considered statistically significant. Results: The mean age of study subjects was 30.28±10.9 years. It was found that the AIR score had more sensitivity (92.55%), followed by the AAS (84.04%) score and Alvarado (60.64%) score for diagnosing acute appendicitis but the specificity of the Alvarado score was highest (100%), followed by AAS (83.33%) and AIR (66.67%) score. AIR score had more NPV (36.40%) as compared to AAS (25%) and Alvarado score (14%). The diagnostic accuracy of AIR (91%) was higher than AAS and Alvarado’s score 84% and 63%, respectively. Conclusion: Appendicitis Inflammatory Response (AIR) score and AAS can be used over Alvarado score for better diagnosis of acute appendicitis in emergency patients and to reduce the rate of negative appendectomy.

Diagnosis of Acute Appendicitis using Alvarado Score, Ultrasound Abdomen, and C-Reactive Protein in Different Combinations: A Prospective Observational Study

Introduction: Appendicitis is the most commonly encountered surgical emergency worldwide. Numerous diagnostic methods, including clinical scoring systems, radiological modalities, and laboratory markers have been suggested over time to diagnose appendicitis correctly, but a Negative Appendectomy Rate (NAR) of 20-30% is still maintained. Aim: To determine the effect of using all three modalities together i.e., a clinical modality {The Alvarado Score}, a radiological modality {Ultrasound (US)}, and a laboratory parameter {C-Reactive Protein (CRP)} in diagnosing acute appendicitis. Materials and Methods: This was a hospital-based, prospective observational study, carried out in the Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India, from March 2019 to June 2020. The three diagnostic modalities were arbitrarily categorised into different combinations: Combination 1: Alvarado score ≥5 with C-Reactive Protein (CRP) ≥0.8; Combination 2: Alvarado score ≥5 with US grade 4 with CRP ≥0.8; Combination 3: Alvarado score ≥5 with US grade 4 with CRP ≥4); and the individual modalities i.e., the alvarado score and the US abdomen were also categorised into four categories each. Each of the individual modalities along with their different combinations were tested for their sensitivities, specificities, Positive and Negative Predictive Values (PPV, NPV) etc. Chi-square and t-test, sensitivity test and Receiver Operating Characteristic curve (ROC) and, Analysis of Variance (ANOVA) was used. Results: Total 200 cases were analysed in this study with mean age 32.33±15.78 years. Alvarado score had a sensitivity and specificity of 95.83% and 75%, respectively. US had a sensitivity and specificity of 71.35% and 75%, respectively while CRP had the highest sensitivity with 98.96%, but very low specificity (37.5%). The sensitivity, specificity, PPV and NPV of the combination 1 were found to be 98.96, 37.50, 97.44, 60.00, and of combination 2 was found to be 70.83, 87.50, 99.27,11.11 and for combination 3 was 56.77, 100, 100, 8.79, respectively. Combination 2 also had the highest Area Under Curve (AUC) in Receiver Operating Characteristic (ROC) curve. (Combination 1- 0.661; combination 2- 0.742; combination 3- 0.727). Conclusion: The Combination 2 of three modalities proved to be the best diagnostic tool in the present study. It can pave the way, for a better diagnostic scoring system and future studies in this field.