Alvarado Score Research Articles

Imaging of acute appendicitis: Advances.

We read with interest the review by Teng et al, who summarized the current approach to the diagnosis and treatment of acute appendicitis (AA). Also, the article summarizes the clinical scoring systems very effectively. In one of the previous studies conducted by our research group, we showed that the use of the Alvarado score, ultrasound and C-reactive protein values in combination provides a safe confirmation or exclusion of the diagnosis of AA. Computed tomography is particularly sensitive in detecting periappendiceal abscess, peritonitis and gangrenous changes. Computed tomography is not a good diagnostic tool in pediatric patients because of the ionizing radiation it produces. Ultrasound is a valuable diagnostic tool to differentiate AA from lymphoid hyperplasia. Presence of fluid collection in the periappendiceal and lamina propria thickness less than 1 mm are the most effective parameters in differentiating appendicitis from lymphoid hyperplasia. Although AA is the most common cause of surgical acute abdomen, it remains an important diagnostic and clinical challenge. By combining clinical scoring systems, laboratory data and appropriate imaging methods, diagnostic accuracy and adherence to treatment can be increased. Lymphoid hyperplasia and perforated appendicitis present significant diagnostic challenges in children. Additional ultrasound findings are increasingly defined to differentiate AA from these conditions.

The Role of Neutrophil Lymphocyte Ratio in Predicting Acute Appendicitis in Adult

Introduction: Acute appendicitis is one of the most common causes of acute abdomen with lifetime occurrence of approximately 7% and with perforation of 17-20%. There are various scoring systems and investigations which are used to ruling in the conditions but none of these are 100% accurate. The aim of this study was to observe relationship between neutrophil lymphocyte ratio (NLR) and simple and complicated acute appendicitis. Methods: This is a prospective observational study conducted for a period of 12 months. Clinical, laboratory and USG parameters were used to diagnose acute. HPE findings were taken as final diagnosis and the objective of the study compared. Results: Total of 100 patients were evaluated in this study. The mean age of the patients with acute appendicitis in this study was 30 years .The mean Alvarado score in this study was 7 and the mean NLR was 6.6. In this study, 24% of case who had TLC of more than 10000 per cubic millimeter had complicated appendicitis (p=0.685). 16% of total cases had complicated acute appendicitis with neutrophil percentage between 81%-90%, 20% with NLR >8 had complicated acute appendicitis and 20% with NLR >8 had HPE proven complicated acute appendicitis (p=0.001) Conclusion: Both neutrophil percentage and NLR were statistically significant in differentiating complicated acute appendicitis from simple acute appendicitis than total leucocyte count alone as shown by study.

Study to evaluate the effectiveness of Alvarado scoring system in diagnosis of acute appendicitis

Acute appendicitis stays a typical careful crisis all through the world. Regardless of the steadily developing headways in the field of diagnostics the recognizing acute appendicitis stays a mystery for the specialists all throughout the planet. Specialists utilize distinctive scoring frameworks and clinical models to diagnose acute appendicitis and reduction the negative appendectomy rates. The Alvarado scoring system (Alvarado 1989) which was adjusted by Kalan et at 1994 is an easy to utilize and simple to apply scoring framework since it depends on history, clinical assessment and an essential lab examination.

Comparison of scoring systems regarding the gender as a parameter with the traditional scoring systems for predicting appendicitis.

Although acute appendicitis remains the most common cause of acute abdomen in General Surgery practice, negative appendectomy rates are still high in particularly female patients. Appendicitis scoring systems considering gender can help the clinician to reduce negative appendectomy rates in females. This present study aims to compare the Lintula, Ripasa, Fenyo-Lindberg scoring systems, which use gender as a variable, with the Alvarado, Karaman, scoring systems to evaluate which CSS is more successful in the differential diagnosis of appendicitis in females. We analyzed the records of the patients operated on with a prediagnosis of acute appendicitis in our clinic between 2020 and 2021, retrospectively. Alvarado, adult appendicitis score (AAS), appendicitis inflammatory response score (AIRS), Ripasa, Karaman, Lintula, and Fenyo Lindberg scores were calculated for each patient. The patients were divided into two groups as male and female, according to gender. Receiver operator characteristic (ROC) curve analysis was used to identify the best cut-off value and assess the performance of the test score for appendicitis. Three hundred and sixty-three patients were included in the study. One hundred seventy-two (47.4%) of the patients were male, and 191 (52.6%) were female. Alvarado and AAS were the most valuable score in female (AUC: 0.805, sensitivity: 0.63, specificity: 0.83; and area under curve (AUC): 0.794, Sensitivity 0.71, Specificity: 0.76, respectively), male group (AUC: 0.828, Sensitivity: 0.71, Specificity: 0.83; and AUC: 0.834, Sensitivity 0.74, Specificity: 0.77, respectively), and when patients were not categorized by gender (AUC: 0.818, Sensitivity: 0.67 Specificity: 0.83; and AUC: 0.794, Sensitivity 0.71, Specificity: 0.76, respectively). Although the Alvarado scoring system is the first defined appendicitis scoring system, it seems as superior to the many scoring systems defined after it in predicting appendicitis, even in female patients.

Value of Alvarado scoring system in diagnosis of acute appendicitis

Introductionand importance: Acute appendicitis is one of the most common causes of acute abdomen in surgical patients. The objectives of the study were to evaluate efficacy of Alvarado scoring system in preoperative diagnosis of acute appendicitis and correlating it with postoperative findings. MethodsThe present study was a prospective study of 208 patients presenting with symptoms and signs of acute appendicitis to the emergency department during a period of 10 months. Patients who met the inclusion criteria were evaluated using Alvarado scoring system. The efficacy of Alvarado scoring system was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value and negative appendectomy rate. ResultsTotal 208 patients were included in the study, which included 142 males and 66 females, at score of 7 or more, appendicitis was confirmed in 187/190 patients, while at scores <7 appendicitis was confirmed in 10/18 patients. The sensitivity was 94.9%, the specificity was 72.7%, the positive predictive value was 98.4% and the negative predictive value was 44.4%. In the present study, negative appendectomy rate was 4.8% ConclusionClinical experience remains of major importance in diagnosing acute appendicitis. The Alvarado score is a simple, easy scoring system at both end of scale.

A new approach to the management of acute appendicitis: Decision tree method.

It is important to distinguish between complicated acute appendicitis (CAA) and noncomplicated acute appendicitis (NCAA) because the treatment methods are different. We aimed to create an algorithm that determines the severity of acute appendicitis (AA) without the need for imaging methods, using the decision tree method. The patients were analyzed retrospectively and divided into two groups as CAA and NCAA. Age, gender, Alvarado scores, white blood cell values (WBC), neutrophil/lymphocyte ratios (NLR), C-reactive protein value (CRP), albumin value and CRP/Albumin ratios of the patients were recorded. In the algorithm we created, the most important parameter in the distinction between CAA and NCAA is CRP. NLR is predictive in patients with a CRP value of ≤107.565 mg/L, and the critical value is NLR 2.165. In patients with a CRP value of >107.565 mg/L, albumin is the determinant and the critical value is 2.85 g/dL. Age, gender, alvarado score and CRP/albumin ratio have no significance in distinguishing between CAA and NCAA. In the statistical analysis, there were significant differences between NCAA and CAA groups in terms of age (39.56 years vs 13,675 years), gender (48.1% male vs 71.4% male), WBC (13,891.10/mL vs 11,614.76/mL), CRP (27 mg/L vs 127 mg/L), albumin (3 g/dL vs 3 g/dL) and CRP/albumin (9.50 vs. 41). Thanks to the algorithm we created, CAA and NCAA distinction can be made quickly. In addition, by avoiding unnecessary surgical procedures in NCAA cases, patients' quality of life can be increased and morbidity rates can be minimized.

Heart Rate Variability May Predict the Severity of Appendicitis: A Cross-Sectional Study.

Objective:To evaluate the role of heart rate variability (HRV) in predicting pre-operative severity of appendicitis.Methods:In this cross-sectional study, 171 cases of acute appendicitis who underwent appendectomy were enrolled. Pre-anesthetic pulse rate of included patients were documented while the severity of appendicitis was determined by intra-operative evidences reported by two independent surgeons. Demographic characteristics, laboratory variables, and Alvarado criteria were recorded. Results:The mean age of patients was 28.75±4.21 years; 54% were men. HRV negatively associated the severity of appendix inflammation. A positive association was found between HRV and omental wrapping and Alvarado score (p<0.01). The receiver operating characteristic (ROC) curve analysis demonstrated that HRV could differentiate simple and complicated appendicitis with a sensitivity of 78.5% and specificity of 97.2%.Conclusion:The present findings revealed that HRV may predict the pre-operative severity of appendicitis and help differentiate simple and complicated appendicitis.

Caecal Gurgling - A new sign in the diagnosis of acute appendicitis and its correlation with intra operative findings

Background: Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. The incidence is 1.5–1.9/1,000 in the male and female population and is approximately 1.4 times greater in men than in women. The diagnosis of acute appendicitis is based purely on clinical history andexamination combined with laboratory investigations such as elevated white cell count. Aims and Objectives: To examine clinical and laboratory findings of patients with right iliac fossa pain attending general surgery outdoor, indoor, and emergency of BSMCH and the relation between caecal gurgling with acute appendicitis andits correlation with intraoperative findings. Materials and Methods: This study was a hospital-based cross-sectional analytical study. It was conducted in rural-based tertiary care hospital and medical college with a time frame of about 1½years from acceptance of synopsis. The period of study was from January 2019 to May 2020, in the Department of general surgery, Bankura Sammilani Medical College and Hospital, Bankura. Results: In Acute Appendicitis, 188(68.1%) patients were APL, and 88(31.9%) patients were BPL. In Normal Appendix, 85(68.5%) patients were APL and 39(31.5%) patient were BPL. Association of SES versusThe final diagnosis was not statistically significant (P=0.9315). Conclusion: Diagnosis of acute appendicitis is mainly clinical. Keeping in view the results of the present study, we conclude that caecal gurgling is an important positive clinical finding in the diagnosis of acute appendicitis. Incorporating caecal gurgling into Modified Alvarado Scoring System,especially in the patients with a MAS of 5–6 where there is a dilemma whether to operate the patient or not, it aids in our decision-making and thus helps to reduce the rate of negative appendectomies.

Determine the Accuracy &amp; Use of Ultrasound Guidance and Alvarado Score for Diagnosing Acute Appendicitis

Background: Appendicitis is one of the most common and frequently encountered operations in surgical emergencies. It is the most frequent cause of acute abdominal pain. Early and accurate diagnosis can reduce the rate of negative appendectomy (surgical removal of appendix) and helps to provide better treatment with no extra cost and complications. Aim: The objective of this study was to examine the accuracy and use of ultrasonography and Alvarado score system for diagnosing Acute Appendicitis. Place and Duration of Study: Radiology Department Hayatabad Medical Complex, Peshawarfor duration of six months from January 2021 to June 2021. Methods: In this cross-sectional observational study, 130 patients of abdominal pain having ages of 10 years to 70 years were included. All patients had diagnosis with Alvarado scoring system and ultrasound for identifying Acute Appendicitis. Patients’ detailed history including age, sex and histopathology and ultrasonographic results were recorded. All statistically data was analyzed by SPSS version 17. P-value &lt;0.05 was considered as significant. Results: Out of 130 patients, 95 (73.08%) patients were men and 35 (26.92%) patients were women. 15 (11.54%) patients were ages less than 20 years, 75 (57.70%) patients having ages between 20 to 39 years, 32 (24.62%) patients were aged between 40 to 59 years and 8 (6.15%) patients were ages of &gt;59 years. Symptoms observed in all patients such as anorexia, nausea and vomiting, tenderness in right iliac fossa, rebound tenderness, elevated temperature as 71.54%, 53.85%, 100%, 95.39% and 84.62% respectively. In all 130 patients 122 (93.85%) had found acute appendicitis by using ultrasound. As per histopathology results 95 % had acute appendicitis and 5 % had chronic or normal appendicitis. Conclusion: It is concluded that Alvarado Score system along with noninvasive ultrasound guidance resulted accurately and helps to reduce the rate of negative appendectomy, complications and infections with no extra cost. The combine role of Alvarado score and ultrasonography can helps to provide better treatment in acute appendicitis. Keywords: Alvarado score system, Histopathology findings, ultrasound results, Appendicitis.

Comparative Analysis of Clinical – sonoscopic Scale of Acute Destructive Appendicitis and Alvarado Diagnostic Score

The goal of this work was the comparison of the diagnostic eff ectiveness of the Alvarado score and the clinicosonoscopic&#x0D; acute destructive appendicitis score (CSADA score) in a prospective-retrospective study of 336 patients. CSADA score showed statistically signifi cant better sensitivity 96,9 %, specifi city 80 % and accuracy 88,2 %. It has lower «grey zone» (3,6 %) and less cases of missed destructive appendicitis (2,5 %).

Nigam’s scoring system for acute appendicitis with high accuracy surpassing Alvarado scoring system

Background: Acute appendicitis is one of the most common surgical emergencies. Delay in the treatment of acute appendicitis can result in complications, may be lethal. That’s why the early diagnosis and quick treatment is essential. The diagnosis of acute appendicitis is still a clinical one. Alvarado scoring system is the commonest scoring system but it has many lacunae. Nigam’s scoring system (NSS) is invented to deal with drawbacks of Alvarado scoring system and improve accuracy.Methods: NSS has 17 scoring points. This scoring system can be divided into three parts, 6 and below 6, 7 to 10, and 11 and above. This study includes 36 patients of acute abdomen during a period of 8 years from Jan 2012 to Jan 2020. The diagnosis of acute appendicitis by NSS was compared with the ultrasonography findings, operation findings, and histopathological results.Results: Out of 36 patients 2 patients scored 6 and below, 3 patients scored 7 to 10 and 31 patients scored 11 and above. Accuracy of NSS resulted in 100%. No negative appendicectomy was recorded.Conclusions: NSS has better accuracy than Alvarado scoring system in diagnosing acute appendicitis. NSS is an easy, economical, simple, accurate, fast and dependable scoring system. NSS is best suited for small hospitals which lack advance investigative techniques such as ultrasound, CT scan and MRI.

Comparison of Diagnostic Accuracy of Appendicitis Inflammatory Response Score and Alvarado Score in Diagnosis of Acute Appendicitis Taking Histopathology as Gold Standard

Objective: To compare the diagnostic accuracy of appendicitis inflammatory response score and Alvarado score in diagnosis of acute appendicitis taking histopathology as gold standard. Study Design: It is a Cross Sectional Study Study setting and Duration: This study conducted at the Department of General Surgery, Abbasi Shaheed Hospital, Karachi from September 2018 To March 2019. Methods: Alvarado and Appendicitis inflammatory response scores were used to evaluate all patients. For the Alvarado scoring system, a score of 7 or more was considered a high chance of acute appendicitis, while the AIR scoring system required a score of 9 or higher. The findings of the histopathology lab were compared to the test results. Both tests' results were analysed to determine their sensitivity, specificity, and diagnostic accuracy. Results: For Alvarado score Sensitivity (80.1%), Specificity (92.3%) and accuracy was 81.7%. For AIR score Sensitivity (72.6%), Specificity (94.2%), and accuracy was 75.5%. There were 66.9% male and 33.1% female patients. Right iliac fossa pain was 76.8%, pain migration to right iliac fossa was 63.5%, anorexia was 90.9%. Conclusion: Higher sensitivity and specificity of the Appendicitis inflammatory response score and the Alvarado score were found to outperform the histological findings in appendicitis. Keywords: Appendicitis, Appendicitis Inflammatory Response Score, Diagnostic Accuracy, Acute Appendicitis, Histopathology, Alvarado Score,

Keep it Simple, Laboratory Parameters to Predict Complicated Acute Appendicitis in Children Younger Than Five Years.

The clinical presentation of acute appendicitis in the youngest age lacks specific signs and symptoms, and it is difficult to obtain an accurate clinical diagnosis. Once the diagnosis is made, it is necessary to determine if the appendicitis is simple and able to be managed non-surgically, or complicated, therefore requiring surgery. Together with the clinical picture and imaging, routine laboratory values play a vital role in this decision. The aim of this study is to evaluate routine blood in their ability to differentiate between complicated and uncomplicated acute appendicitis. A retrospective analysis was conducted from a single pediatric surgery department of all children 5years of age or younger who underwent surgery for acute appendicitis between the years 2010-2020. 728 children were diagnosed with acute appendicitis, and 42 children were under the age of 5years. There was a significant difference in the C-reactive protein, white blood cell count, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio in the complicated group versus the uncomplicated group. The value of these together for prediction complicated appendicitis were 84.8% sensitivity, 80.9% specificity, 82.8% positive predictive value, and 72.8% negative predictive value. These values were all higher than both the Alvarado score and the PAS (P < .05). C-reactive protein, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio are simple laboratory parameters that can help identify complicated versus uncomplicated appendicitis in children 5years old or younger. These universal parameters may help guide the treatment and decision to operate on a difficult to diagnose population.

Prediction of acute appendicitis using ultrasonography and modified Alvarado score — A prospective comparative study

Acute appendicitis is not uncommon pathology but clinical diagnosis depends on skills of treating health officer. Now advancement in technology and easy availability of USG and CT scan centers make the easy diagnosis. Some time atypical presentation of acute appendicitis makes delay in diagnosis clinically. But, the modified Alvarado score make easy diagnosis of acute appendicitis and compatible to USG. This is a prospective comparative study conducted at RNT Medical College, Udaipur. This study was done in 50 patients, who were presented with pain right lower abdomen. to compare the sensitivity and specificity of modified Alvarado score and USG in diagnosis of acute appendicitis. there were 28 male and 22 female in this study. Age of Youngest patient in the study was 17 years and elder most was 57 years old. Anorexia was common symptoms after pain at right iliac fossa. Appendicectomy was done in 48 cases (96%) and taw cases were managed conservative. There were 34 (68%) patients who had modified Alvarado score more than 7. Modified Alvarado Score is a simple, practical and quick tool in securing diagnosis of acute appendicitis when score is &amp;#62;7. Its results are similar to USG finding. It also helps to reduce the rate of negative appendicectomy. This study recommend appendicectomy in patients presenting with right iliac fossa pain in whom modified Alvarado score is 7 or more.

Retrospective Evaluation of the Effectiveness of Alvarado and RIPASA Scoring Systems in the Diagnosis of Acute Appendicitis

Amaç: Bu çalışmanın amacı acil servise başvuran ve akut apandisit tanısı ile apendektomi yapılan hastalarda Alvarado ve RIPASA skorlarının etkinliğini incelemektir. Gereç ve Yöntemler: Akut apandisit tanısı alan hastaların incelendiği tek merkezli, retrospektif bir çalışma olarak planlandı. Çalışmamızda, hastaların post-operatif histopataolojik tanıları altın standart kabul edilerek, hastalardan başlangıç muayenelerinde bakılan Alvarado ve RIPASA klinik skorlar ile karşılaştırılması planlandı. Bulgular: Akut apandisit tanısı ile opere edilen 125 hastanın; 81’i erkek (%64,8) 44’ü kadındı (%35,2). Hastaların 95’inde (%76) non-komplike apandisit, 21’inde (%16,8) reaktif lenfoid hiperplazi, 9’unda (%7,2) komplike apandisit tanısı konulmuştur. Alvarado ve RIPASA skorlarının ROC eğrisi ve eğri altında kalan alanı değerlendirildiğinde RIPASA skoru AUC=0.811 iken Alvarado için AUC=0.762 idi. Cut-off değer olarak her iki skorda da en iyi değer ≥7 olarak belirlendi. Alvarado ve RIPASA skorları arasındaki karşılaştırmada istatistiksel olarak anlamlı bir fark bulunmadı. Sonuç: Akut apandisit kesin tanısı histopatolojik olarak konulabilen bir cerrahi acildir. Hızlı ve doğru teşhisini sağlamak için çeşitli skorlama sistemleri acil hekimleri tarafından daha sık kullanılmalıdır Acil serviste skorlama sistemleri tanı koymada faydalı olup birbirlerine üstünlükleri bulunmamıştır. Hem RIPASA hem de Alvarado skorlama sistemlerinin daha sık kullanılması ile negatif apendektomi oranı azaltılabilir.

Diagnostic accuracy of Alvarado score components in patients with appendicitis: Systematic review and meta-analysis approach

Appendicitis is a global disease with higher incidence in developing countries. Use of ultrasonography, and CT scan is very helpful for diagnosis. Meanwhile, health care providers in developing countries, especially in remote areas have difficulties to access these modalities. This report aimed to understand more about the diagnostic accuracy of Alvarado score and its components, and also some examinations (ex. Rovsing sign and local guarding). We collected data from studies in which patients with suspected appendicitis received examination or classification according to the Alvarado scoring system and their diagnostic test accuracy that were published from the last 10 years. We searched on ScienceDirect, Cochrane, ProQuest, PubMed, WorldWideScience and GoogleScholar. Data analysis conducted with RevMan5.4 with 95% Confidence Interval (CI). Total of 32 eligible studies were included. Studies were assessed for bias with QUADAS-2. High risk Alvarado score showed good odds ratio (8.21; 95%CI: 4.15–16.23, p < 0.000001) and low risk Alvarado score to rule out appendicitis (0.08; 95%CI: 0.02–0.32, p = 0.0004). Most sensitive tests are RLQ abdominal pain (83%; 95%CI: 81%-85%), anorexia (69%; 95%CI: 67%-71%), and nausea (66%; 95%CI: 64%-69%). Most specific are elevated temperature (74%; 95%CI:71%-76%), and rebound pain (72%; 95%CI:71%-74%). The use of Alvarado score for diagnosis and ruling out an appendicitis is useful in remote areas with limited radiology/laboratory examination, especially modified Alvarado score. Right lower quadrant abdominal pain, anorexia, and nausea have highest sensitivity respectively; and elevated temperature and rebound pain for specificity. Local guarding and Rovsing sign are also significant to diagnose appendicitis.

Comparison of Outcomes of Laparoscopic and Open Appendectomy in Management of Appendicitis

Objective: To compare the outcomes in relations to postoperative pain and complications, and hospital stay of laparoscopic versus open appendectomy in management of appendicitis.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: This study was conducted in department of surgery Unit III of PUMHS Nawabshah and Suleman Roshan Medical College Tando Adam, Sindh Pakistan, from January 2020 to December 2021.&#x0D; Methodology: This study consisted of 136 consecutive cases of either gender, aged between 13 to 60 years, that were enrolled during study period and matching with the inclusion and exclusion criteria. After the permission of ethical committee, a detailed history was taken from all the patients with special regard to the pain in RIF, Pain starting around umbilicus, nausea, vomiting, fever and altered bowel habits. All the cases were randomly divided into Group A comprising of 68 cases which were operated by conventional open appendectomy (OA) and other group B also comprising of 68 cases which were operated by laparoscopically appendectomy (LA). All the clinical and demographic data was collected on a proforma designed for the study, and analyzed by using Statistical Package for Social Science (SPSS) software version 22. Effect modifier like age, gender was controlled by stratification and chi-square test was applied to see the effect of these on both open versus laparoscopic appendectomy outcome variable. P &lt;0.05 was taken as significant.&#x0D; Results: In open appendectomy group male:female ratio of 1.2:1 and in laparoscopically appendectomy group male:female ratio of 1.5:1. The mean age was 31.28±4.30 years for OA group and 35.47±3.23 years for LA group (p 0.02).Alvarado score was showed &lt;4 Score 0% in both groups, where as 4-7 Score in 9(13.23%) patients of OA group and 8(11.76%) patients of LA group, and &gt; 7 Score was seen in 59(86.76%) patients of OA group and 60(83.23%) patients of LA group. The mean time in OA group was 45.21±12.1 minutes and LA group was 43.44±9.4 minutes (p 0.026).Mild pain was felt in 7(10.29%) patients of OA group and 39(57.35%) patients of LA group, Moderate pain was seen in 31(45.58%) patients of OA group and 26(38.23%) patients of LA group, severe pain was described by 30 (44.11%) patients in OA group and 3(4.41%) patients in LA group (p 0.005).The common complications seen in this study Ileus was 29(42.64%) patients in OA and 18(26.47%) patients in LA group) followed by wound infection 10(14.70%) patients in OA and 1(1.47%) patients in LA group. The duration of hospital stay was longer about 3-4 days in 58(85.29%) of OA patients as compared to LA cases where majority 65(95.58%) were discharged within 2 to 3 days. &#x0D; Conclusion: We conclude that laparoscopic appendectomy procedure has a low rate of complications, earlier mobilization, implies a shorter hospital stay and offers the patient a more comfortable postoperative period than open appendectomy procedure.

EVALUATION OF MODIFIED ALVARDO SYSTEM IN ACUTE APPENDICITIS IN TRIBAL POPULATION OF GUJARAT

Clinical scoring systems, such as the Alvarado and modied Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specically for Asian populations. The aim of this study was to compare the modied Alvarado with the RIPASA scoring system.This study included 180 patients who underwent appendectomies and were documented as having “acute appendicitis” or “abdominal pain” in the operating theatre logbook (unit B).The sensitivity, specicity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modied Alvarado and RIPASA scoring systems were derived using SPSS statistical software.A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modied Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specicity of 56%. The PPVwas 89.3% and the NPVwas 42.4%. The cut-off threshold point of the RIPASAscore was set at 7.5, which yielded a 94.5% sensitivity and an 88% specicity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modied Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased signicantly, from 18.4% to 10.7% for the modied Alvarado, and to 2.2% for the RIPASA scoring system, which was a signicant difference (P&lt;0.001) for both scoring systems.Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specicity than the modied Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations.

Accuracy and diagnostic approach of combining multiple modalities for diagnosing appendicitis among non-pregnant female of reproductive age

Background: Appendicitis is notorious in its ability to simulate other conditions and in the frequency, it can be mimicked by other pathologies. The purpose of this study was to evaluate the accuracy of the diagnostic approach incorporating modified Alvarado score system (MASS) and ultrasonography with clinical findings. The aim of the study was to observe and evaluate different modalities of determining appendicitis among the non-pregnant female population of reproductive ageMethods: This prospective descriptive study was conducted at the department of surgery, Rajshahi College and Hospital, Rajshahi, Bangladesh. The study duration was 6 months, from February 2013 to July 2013. The study was conducted with a total of 101 women who were of reproductive age, presenting with right lower quadrant pain, who went through appendicectomy during the study period.Results: The incidence of negative appendicectomy was 4.95% in this study. Most of the patients having appendicitis were in second and third decades with a mean age of 24.79±10.11 years. The rate of perforation in our study was 5.94%. The overall post-operative complication rate was 13.86% with minor wound infection being the most common complication. The accuracy, sensitivity, specificity, PPV and NPV of the diagnostic approach in this study were 95.05%, 98.96%, 20.00%, 95.96% and 50.00% respectively. The accuracy, sensitivity and specificity of ultrasound were found to be 29.47%, 25.56% and 100% respectively.Conclusions: Combined use of clinical diagnosis incorporating modified Alvarado score and ultrasonography led to a significant reduction in the negative appendicectomy rate.

Acute appendicitis in pediatric patients with Coronavirus Disease 2019 (COVID-19): A case series from a developing country's tertiary hospital

Introductionand importance: A common gastrointestinal presentation of both COVID-19 and multisystem inflammatory syndrome in children (MIS-C) is acute abdominal pain, which sometimes mimics appendicitis. Literature describing children with COVID-19 infection and concurrent acute appendicitis is growing, and understanding these patients’ clinical picture is necessary for their proper treatment. Case presentationWe present a case series of six healthy children before they developed classic symptoms of appendicitis. At the same time, they were also found to have confirmed COVID-19. All patients had fever and right lower abdominal pain. Four of six children having Alvarado score above seven had surgical treatment, while the others only received systemic antibiotic and antiviral medication. Surgical results of two patients revealed perforated appendicitis. No mortality occurred among them. Clinical discussionThere is increasing recognition of gastrointestinal involvement in patients with COVID-19 and MIS-C. There are several postulates to explain appendicitis in COVID-19. First, inflammatory response is exaggerated in SARS-CoV-2 infected patients. Second, obstruction of the appendiceal lumen is caused by mesenteric adenopathy, which in turn, is caused by COVID-19 infection, not fecalith. Third, hyperinflammatory response in MIS-C triggers inflammation in appendix. ConclusionClinicians must recognize that abdominal pain with fever could be the presenting symptoms of COVID-19 with MIS-C. MIS-C, which has severe presentations with gastrointestinal manifestations and high mortality rate, should be considered as a differential diagnosis for a patient with appendicitis-like symptoms and a positive SARS-CoV-2 infection.