Appendicitis Score Research Articles

The Variable Definition of "Negative Appendicitis" Remains a Surgical Challenge.

Acute appendicitis (AA) is treated primarily surgically with histopathology being the gold standard for confirmation of appendicitis and reported rates of negative appendicectomies (NA) ranging between 3.2% and 19% worldwide and 15.9-20.6% in the UK. NA rates are frequently used to identify poor performing centers as part of a Model Health System and form an integral part of appendicitis scoring systems. This study aims to evaluate the prevalence of negative appendicectomies within our institution and critically analyze the appropriateness of its use as a quality metric and its impact on clinical practice and research. Data analysis from a prospective dataset of pediatric appendicitis patients between 2015 and 2021 in a tertiary center in the UK was performed. Detailed analysis of negative appendicectomies was performed and further stratified by two distinct age and gender groups looking at the incidence of NA and the classification of non-histologically normal appendix specimens. In our series, 819 patients met inclusion criteria, 736 (89.9%) had acute appendicitis. Our overall institutional negative appendicectomy rate was 10.1% (83 patients) with the breakdown as follows: 65 histologically normal appendix (7.9%), 10 Enterobius vermicularis, 3 eosinophilic appendicitis, 2 neoplasms, 1 isolated faecolith, 1 fibrous obliteration of the lumen, and 1 peri-appendiceal inflammation. Our negative appendicectomy rate is below established UK pediatric NA rates. This rate ranges from 7.9% to 10.1% depending on the definition of NA utilized. A single standard pathological definition for histological acute appendicitis is required when being used as a comparative quality metric. Centers engaged in clinical research should be aware of variations in NA definitions both in scoring systems and individual centers to avoid skewing derived results.

Apendiks mukoselini akut apandisitten ayırmada klinik, radyolojik ve laboratuvar belirteçlerin rolü

ABSTRACT AIM: This study aims to assist the surgical treatment plan by increasing the rate of correct preoperative diagnoses through comparing the clinical, radiological, and laboratory findings of appendiceal mucocele (AM) and acute appendicitis (AA) before surgery. MATERIALS AND METHODS: The study included 63 patients with a histopathologic diagnosis of AM and AA among 4867 patients who underwent appendectomy with the diagnosis of acute appendicitis in the general surgery clinic between 2009 and 2020. The patients were separated into two groups: those with AM (21 patients) and those with AA (42 patients). Age, gender, physical examination (PE), Alvarado appendicitis score, ultrasonography (USG), computed tomography (CT), laboratory, preoperative diagnosis, intraoperative diagnosis, and pathological diagnosis results of both groups were compared. RESULTS: PE, abdominal pain, nausea, vomiting, fever symptoms, and Alvarado score were found to be significant between the two groups (p<0.05). In addition, WBC, NE, LYM %, and CRP were found to be high in group 2 (p<0.05), while there was no difference in radiological diagnosis (USG/CT) between the two groups (p<0.05). However, the appendix diameter was larger in group 1 (p<0.05). Patients with AM in 80% preoperatively, and 52% intraoperatively were operated on with a provisional diagnosis of AA. The second surgery was performed in Group 1 with a rate of 9.5% (2/21). CONCLUSION: In our study, patients with AM who underwent surgery with a diagnosis of AA were found to differ in radiological, clinical, and laboratory findings from patients with AA. KEYWORDS: Appendiceal Mucocele, Acute Appendicitis, Differential Diagnosis

Evaluating the Diagnostic Accuracy of the Alvarado Score and Abdominal Ultrasound for Acute Appendicitis: A Retrospective Single-Center Study.

Acute appendicitis is a complex diagnosis that often requires both clinical and radiological evaluation. Significant variations in diagnostic approaches are evident among clinicians and healthcare institutions. While certain guidelines advocate for risk stratification based on clinical characteristics, others emphasize the importance of pre-operative imaging. This study seeks to explore the accuracy of the Alvarado Score and abdominal ultrasound (AUS) in diagnosing acute appendicitis. Suspected cases of appendicitis admitted to Al-Thora Hospital in Ibb, Yemen, from Jan 2021 to July 2022 were evaluated. The demographics, clinical, and laboratory data were collected and analyzed. This study assessed Alvarado scores (calculated based on clinical evaluation and laboratory data) and pre-operative AUS findings, correlating them with post-operative and histopathology findings. The Alvarado scores and AUS sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were assessed using the ROC curve. Out of 1021 cases of acute abdomen, 171 patients were suspected of appendicitis. Using AUS along with the Alvarado score, appendicitis was presumed in 137 patients who underwent appendectomy. 130 (94.9%) patients had positive intraoperative and histopathology findings while 7 (5.1%) had negative findings. The Alvarado Score had a sensitivity and specificity of 94.62% and 87.80% at cutoffs of 6, respectively [Area under the curve (AUC): 0.985; 95% confidence interval (CI), 0.954 to 0.998; p < 0.0001]. Abdominal US showed a sensitivity of 98.46% and specificity of 82.93% (AUC:0.907; 95% CI, 0.853 to 0.946; p < 0.0001). Alvarado's score and AUS exhibited high sensitivity and specificity in diagnosing acute appendicitis. The substantial accuracy and efficacy of both the Alvarado score and AUS support their utilization as primary investigative tools in resource-limited settings. This approach can help avoid unnecessary appendectomies and minimize the financial burden on patients.

Diagnostic scales for acute appendicitis in children

Acute appendicitis, a common medical emergency, primarily affects children, and its diagnosis can be challenging. In addition to methods such as abdominal ultrasound, predictive clinical scales are used, such as the Alvarado scale and others, which categorize risk in pediatric patients. Given the lack of consensus on exact criteria, this review seeks to identify and analyze 22 prediction scales used in the diagnosis of acute appendicitis in children. The search was carried out according to the PRISMA guide, resulting in 73 articles selected from a total of 1521, with inclusion criteria focused on the pediatric population and integrated scales. The importance of predictive scales for appendicitis in children is highlighted, which incorporate clinical history, physical examination, laboratory and images to guide surgical intervention decisions. Among the most used worldwide were the Alvarado and Tzanakis scales, PAS and Heidelberg Appendicitis Score (HAS), designed specifically for pediatric patients.

Importance of Pediatric Appendicitis Scoring System and Ultrasonography in the Diagnosis of Acute Appendicitis in Children

Importance of Pediatric Appendicitis Scoring System and Ultrasonography in the Diagnosis of Acute Appendicitis in Children

The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children

BackgroundAcute appendicitis is a common cause of abdominal pain leading to emergent abdominal surgery in children. C-reactive protein (CRP), an inflammatory marker typically elevated in acute appendicitis, and Pediatric Appendicitis Score (PAS), a clinical scoring system used for the diagnosis of appendicitis, have the potential to predict the severity of inflammation of the appendix. This may be useful in helping the physician make a treatment plan prior to surgery. ObjectiveThe purpose of this study was to assess whether CRP value and PAS differ with the extent of inflammation of the appendix seen on histologic examination. MethodsThis was a prospective observational study of patients diagnosed with acute appendicitis via computed tomography or ultrasound. Enrolled patients had CRP levels drawn, PAS calculated, and appendix pathology reviewed. Appendix pathology was categorized by the pathologist on the basis of the level of inflammation: simple, suppurative, gangrenous, and perforated. ResultsOne hundred sixty-three patients were enrolled. CRP levels and PAS were statistically different (p < 0.002) among the four pathology classifications. Patients with simple appendicitis (n = 3) had a mean CRP of 2.95 mg/L and PAS of 3.9, patients with suppurative appendicitis (n = 99) had a mean CRP of 26.89 mg/L and PAS of 6.5, patients with gangrenous appendicitis (n = 56) had a mean CRP of 91.11 mg/L and PAS of 7.5, and patients with perforated appendicitis (n = 6) had a mean CRP of 154.17 mg/L and PAS of 7. The results remained statistically significant (p < 0.002) after adjusting for age, race, and sex. When combined—PAS ≥ 8 and CRP level > 40 mg/L—the specificity of complicated appendicitis was 91.2% and positive predictive value was 72.7%. ConclusionsHigher CRP levels and PAS were associated with increased histologic inflammation of the appendix. This study provides preliminary evidence that CRP and PAS could potentially assist in treatment decisions for appendicitis.

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.

Clinical, laboratory and ultrasonographic criteria for reveaing inflammation of the appendix and its regression in children

Introduction. Because of the numerous studies on a possible regression of inflammation in the cecum appendix, the question of finding reliable criteria for preoperative verification of inflammation and of assessing its dynamics in children is relevant.Material and methods. In January 2017 – December 2021, case-histories of 92 children aged from 3 to 18 years – (Me (age median) = 12; Q1 (lower quartile) = 9; Q2 (upper quartile) = 14.5 – were analyzed in the Yaroslavl Children's Clinical Hospital. The researchers assessed diagnostic and management algorithms. All children had a high risk of appendicitis (PAS (Pediatrics appendicitis score) ≥ 6 points) because of changes in the appendix and findings of ultrasound examination, but due to the symptoms relief, no surgical interventions were performed.Results. 78 (84.8%) children were prescribed antibacterial therapy. The median duration of symptom regression was 2 days (Q1 = 1 day; Q2 =4 days). On days 5–8 (Q1–Q2) (Me = 6 days), relief of all symptoms of the disease was recorded. The average diameter dimensions of the vermiform process, by ultrasound findings at the initial examination, were 8.6 ± 1.47 (95% CI 8.31–8.92), wall thickness – 3.2 ± 0.39 (95% CI 3.12–3.28). After the symptom relief , these indicators were 6.3 ± 1.29 (95% CI 5.95–6.58) and 2.0 ± 0.63 (95% CI 1.18–1.88), respectively. The decrease in size was statistically significant (p 0.001), signs regressed in parallel (r = 0.63; p 0.0001).95% CI lower limit of ultrasonographic parameters at the initial examination exceeded the threshold values indicating inflammatory changes (8 mm and 2.7 mm, respectively). After regression of the disease symptoms, 95% CI upper limit returned to the normal state.Conclusion. The presented clinical observations may be considered as cases of appendix inflammation with regression. The selected clinical and ultrasonographic criteria can be used both for verifying inflammation and for assessing the regression of inflammatory process.

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.

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 &lt;4), G2 (≥4 score &lt;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.

Pediatric Ultrasound Appendicitis Score for the Diagnosis of Acute Appendicitis to Reduce Computed Tomography Scan Utilization.

Acute appendicitis is one of the most common reasons for pediatric surgical consultation in the emergency room. Although acute appendicitis is a clinical diagnosis, the use of imaging in the emergency department to assist with the diagnosis is very common. Ultrasound is frequently utilized in pediatrics because of the radiation risks associated with computed tomography (CT) scan. The risks of radiation in the pediatric population are much more significant than in adults. Reasons for this include smaller size so there is a relative higher radiation dose than for larger adults, radiosensitive organs such as thyroid, bone marrow, and gonads, and radiation exposure earlier in life allows for more time that a radiation induced cancer could develop. The risks of radiation from imaging are increased with cumulative dosing. The purpose of this study was to incorporate the pediatric appendicitis score (PAS) and standardized ultrasound scoring system to provide a combined score that would assist with the clinical diagnosis of acute appendicitis and avoid the need for a CT scan. The presented data shows that for scores of 7 or more, the specificity and sensitivity is 90% and 90.2%, respectively for the diagnosis of acute appendicitis. This study validates the combined score, shows the specific cutoffs, and initiates the discussion that CT scan may not always be required for diagnosing acute appendicitis if this scoring system is used.

Adult appendicitis score versus Alvarado score: A comparative study in the diagnosis of acute appendicitis

BackgroundAcute Appendicitis (AA) is the most common abdominal surgical emergency. It requires proper management to decrease mortality and morbidity. Clinical scoring systems for diagnosing AA aimed to decrease the use of radiological scans and the rate of negative appendectomies (NA). We aim to assess the adult appendicitis score (AAS) in the diagnosis prediction of AA. MethodA retrospective study with 1303 cases of AA is performed. We compared the correlation of AAS and Alvarado scores to postoperative histopathology. Specificity, sensitivity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were assessed. ROC was used. ResultsAAS risk stratification was applied to the study population. Group I for a low probability, and groups II and III for an intermediate and high probability of AA. We found that 159 patients were matched in group I, 505, and 639 were in groups II and III of AAS, respectively. The correlation between Alvarado and AAS with HP was significant. AAS ≥ 16 presented sensitivity and specificity of 50 % and 75.47 %, respectively, with PPV of 97.96 % and NPV of 6.02 %, with an accuracy of 51.04 %. Regarding AAS ≥ 11, the sensitivity was 88.96 %, specificity was 39.62 %, PPV was 97.2 %, NPV was 13.21 %, and accuracy was 86.95 %. ConclusionAAS is relatively more accurate than Alvarado's score, especially in selecting a safe candidate for discharge from an emergency. In addition, AAS is found to decrease the need for radiological images and NA rate more than Alvarado.

Diagnostic performance of the classic symptom “abdominal pain before vomiting” for pediatric acute appendicitis

Acute appendicitis is the most common type of acute abdomen that requires surgical intervention in children. According to general pediatric textbooks, the presence of vomiting before abdominal pain is considered a classic patient history item for excluding acute appendicitis. However, its diagnostic performance in the pediatric population has yet to be investigated. This was a single-center retrospective observational study involving 134 children who were admitted to the hospital with both abdominal pain and vomiting. The reference standard for appendicitis was defined by computed tomography scanning. The diagnostic performance of "abdominal pain before vomiting" was calculated and compared to those of the Alvarado score and pediatric appendicitis score. The diagnostic performance of "abdominal pain before vomiting" was as follows: sensitivity of 75.3% (95% confidence interval [CI], 64.7-83.6), specificity of 25.0% (95% CI, 15.5-36.7), positive likelihood ratio of 1.00 (95% CI, 0.82-1.22), negative likelihood ratio of 0.99 (95% CI, 0.54-1.79), and diagnostic odds ratio of 1.02 (95% CI, 0.46-2.25). In contrast, the Alvarado score and pediatric appendicitis score (with a threshold of 4 points) demonstrated favorable sensitivity (98.3% [95% CI, 92.4-99.6]), negative predictive value (94.6% [95% CI, 78.4-98.8]), negative likelihood ratio (0.04 [95% CI, 0.01-0.23]), and diagnostic odds ratio (49.9 [95% CI, 6.88-243.2]). In this study, "abdominal pain before vomiting" was associated with poor diagnostic performance for ruling out acute pediatric appendicitis. Thus, the diagnosis of acute appendicitis in the pediatric population should be made based on existing validated scoring systems such as the Alvarado score and pediatric appendicitis score.

Performance and diagnostic accuracy of scoring systems in adult patients with suspected appendicitis.

This study aims to determine the most accurate appendicitis scoring system and optimal cut-off points for each scoring system. This single-centred prospective cohort study was conducted from January-to-June 2021, involving all patients admitted on suspicion of appendicitis. All patients were scored according to the Alvarado score, Appendicitis Inflammatory Response (AIR) score, Raja Isteri Pengiran Anak Saleha (RIPASA) score and Adult Appendicitis score (AAS). The final diagnosis for each patient was recorded. Sensitivity and specificity were calculated for each system. Receiver operating characteristic (ROC) curve was constructed for each scoring system, and the area under the curve (AUC) was calculated. Optimal cut-off scores were calculated using Youden's Index. A total of 245 patients were recruited with 198 (80.8%) patients underwent surgery. RIPASA score had higher sensitivity and specificity than other scoring systems without being statistically significant (sensitivity 72.7%, specificity 62.3%, optimal score 8.5, AUC 0.724), followed by the AAS (sensitivity 60.2%, specificity 75.4%, optimal score 14, AUC 0.719), AIR score (sensitivity 76.7%, specificity 52.2%, optimal score 5, AUC 0.688) and Alvarado score (sensitivity 69.9%, specificity 62.3%, optimal score 5, AUC 0.681). Multiple logistic regression revealed anorexia (p-value 0.018), right iliac fossa tenderness (p-value 0.005) and guarding (p-value 0.047) as significant clinical factors independently associated with appendicitis. Appendicitis scoring systems have shown moderate sensitivity and specificity in our population. The RIPASA scoring system has shown to be the most sensitive, specific and easy-to-use scoring system in the Malaysian population whereas the AAS is most accurate in excluding low-risk patients.

Predicting Complicated Appendicitis in Children: Pros and Cons of a New Score Combining Clinical Signs, Laboratory Values, and Ultrasound Images (CLU Score).

This retrospective study aimed to combine the clinical signs, laboratory values, and ultrasound images of 199 children with acute appendicitis in order to create a new predictive score for complicated appendicitis in children. The study included children who had clinical examination of abdominal pain (description of pain, anorexia, body temperature, nausea or vomiting, duration of symptoms), laboratory findings on admission (white blood cell, platelets, neutrophils, C-reactive protein), preoperative abdominal ultrasound, and histopathological report after an operation for appendicitis in their records during the period from January 2016 to February 2022. According to the statistical analysis of the values using multivariate logistic regression models, the patients with appendiceal diameter ≥ 8.45 mm, no target sign appearance, appendicolith, abscess, peritonitis, neutrophils ≥ 78.95%, C-reactive protein ≥ 1.99 mg/dL, body temperature ≥ 38 °C, pain migration to right lower quadrant, and duration of symptoms < 24 h were more likely to suffer from complicated appendicitis. The new score was comprised of the 10 variables that were found statistically significant in the multivariate logistic model. Each of these variables was assigned a score of 1 due to the values that were associated with complicated appendicitis. A cutoff value of ≥4 has been a good indicator of the final score. The sensitivity with the usage of this score is 81.1%, the specificity 82.4%, the PPV 73.2%, the NPV approaches 88% and finally the accuracy is 81.9%. Also, the pros and cons of this score are discussed in this study.

A prospective comparative study among Alvarado score, appendicitis inflammatory response (AIR) score, and adult appendicitis score (AAS) in the diagnosis of acute appendicitis in adults

Background Acute appendicitis (AA) is the most common condition presenting with acute abdomen requiring emergency surgery. Several clinical scores were developed to diagnose AA. Aim This study aimed to compare the diagnostic accuracy of three clinical scores (Alvarado score, appendicitis inflammatory response (AIR) score, and adult appendicitis score (AAS)) in the diagnosis of AA. Methods This prospective study was conducted on 100 adult patients (aged ≥ 18 years) presenting with acute abdomen suspicious of noncomplicated AA. Patients with complicated AA (abscess, mass, or diffuse peritonitis) and patients with uncomplicated AA subjected to nonoperative management (NOM) were excluded from our study. The histopathological results were used as the gold standard for diagnosis of AA to which the three clinical scores results were compared. Results Our study included 100 patients (60 males and 40 females), all of whom, had histopathologically proven AA. Due to this outcome, we could only conclude and compare the sensitivities of the three scores. Alvarado score had the highest overall sensitivity (91% at cut-off value &gt; 4 points), followed by AAS (80% at cut-off value &gt; 10 points), then AIR score (71% at cut-off value &gt; 4 points) however, the difference between Alvarado score and AAS was not statistically significant. In males, the Alvarado score had the highest sensitivity (88.3%), followed by AAS (86.7%), then the AIR score (71.7%) at the same cut-off values however, the difference between the Alvarado score and AAS was also not statistically significant. In females, Alvarado score had the highest sensitivity (95%) followed by AAS and AIR scores (70% for both) with a statistically significant difference. Obesity did not influence the outcome of the three scores. Conclusions Alvarado score and AAS are more sensitive than the AIR score. In relation to sex, Alvarado’s score is the most sensitive in females.

Comparison of the Laparoscopic Appendicitis (LAPP) score with the Alvarado and Appendicitis Inflammatory Response(AIR) scores and computed tomography and pathology results

Background: Acute appendicitis is the most commonly encountered and operated group among general surgery emergency patients. Various scoring and algorithms are used in diagnosis and treatment. This study aimed to compare the Laparoscopic Appendicitis (LAPP) score, which is used to reduce negative appendectomy, according to the pathology and preoperative computed tomography results and investigate its correlation with other clinical scoring systems. Methods: Patients who underwent appendectomy in our clinic between June 2020 and March 2021 were retrospectively reviewed. The obtained LAPP scores were compared with the preoperative imaging results, Alvarado score, appendicitis inflammatory response (AIR) score, and pathology results. Results: The study included a total of 109 patients, of whom 22 (20.18%) had a pathology result that was not consistent with appendicitis. The LAPP score was determined as 1.41 for this 22 patients who underwent negative appendectomy (p&lt;0.001), 2.45 for 74 patients with suppurative appendicitis (p&lt;0.001), and 3.54 for 13 patients with gangrenous or perforated appendicitis (p&lt;0.001). Conclusions: The purpose of the LAPP score is to reduce the rate of negative appendectomy. Appendectomy is also performed in some patients who may have spontaneous resolution if they present to the hospital in the early period. We also consider that the frequency of familial Mediterranean fever in Turkey may be another reason for the high rate of negative appendectomy. In addition, the correlation of high Alvarado and AIR scores with a high LAPP score indicates that it is more reliable in the diagnosis of complicated appendicitis.

Efficacy in Predicting Negative Appendectomy Rates in Operated Acute Appendicitis Patients Using the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Score Versus Modified Alvarado Score.

Introduction Acute appendicitis is the commonest abdominal surgical emergency globally. The most accepted management of acute appendicitis is surgical, either open or laparoscopic appendectomy. Overlapping clinical presentations with many genitourinary and gynecological conditions lead to difficulty in accurate diagnosis, making negative appendectomies an unwanted reality. With the advancement in technology, there have been constant efforts to minimize negative appendectomy rates (NAR) using imaging modalities like USG of the abdomen and the gold-standard imaging test, the contrast-enhanced computed tomography of the abdomen. Due to the cost incurred and the lesser availability of such imaging modalities and needed expertise in resource-poor settings, various clinical scoring systems were devised to accurately diagnose acute appendicitis and thereby decrease NAR. We conducted our study to determine the NAR between the Raja Isteri Pengiran Anak Saleha Appendicitis score (RIPASA) and the modified Alvarado (MA) scoring methods. Methods A prospective observational analytical study was conducted, including 50 patients presenting to our hospital with acute appendicitis and who underwent emergency open appendectomy. The need to operate was decided by the treating surgeon. Patients were stratified by both scores; the pre-operative scores were noted and were later compared with the histopathological diagnosis. Results A total of 50 clinically diagnosed patients with acute appendicitis were evaluated utilizing the RIPASA and the MA scores. The NAR was 2% using the RIPASA score vs 10% with the MA score. The sensitivity was 94.11% vs70.58% (p<0.0001), the specificity was 93.75% vs 68.75% (p<0.0001), the positive predictive value (PPV) of 96.96% vs 82.75% (p<0.001), the negative predictive value (NPV) of 88.23% vs 52.38% (p<0.001), and NAR of 2% vs 10% (p<0.0001) in the RIPASA vs MA scoring method, respectively. Conclusions RIPASA score is highly efficacious and statistically significant in diagnosing acute appendicitis with higher PPV at higher scores and higher NPV with lower scores leading to decreased NAR compared with MA score.

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.

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.