Diagnosis Of Acute Appendicitis Research Articles

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

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

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

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

Post-Operative Increase in Serum Interleukin-6 Is Associated With Longer Hospital Stay in Children Operated on for Acute Appendicitis: A Pilot Study.

Background: Pediatric acute appendicitis (PAA) involves a substantial consumption of health and economic resources. The identification of serum biomarkers that may help predict the post-surgical evolution of these patients is a field of great interest. Patients and Methods: This was a prospective, observational substudy within the Biomarkers for the Diagnosis of Appendicitis in Pediatrics (BIDIAP) cohort aimed at evaluating the association between post-surgical increase in serum IL-6 and different outcomes related to the clinical evolution of children operated on for PAA. Sixty-nine children with a confirmed diagnosis of acute appendicitis and both pre-operative and post-operative serum IL-6 were included in the study. Three multivariable-adjusted linear regression models were fitted to analyze the association between an increase of >10% in post-operative serum IL-6 level with the length of stay, the number of post-operative emetic episodes, and the onset of oral feeding. Two multivariable-adjusted logistic regression models were fitted to assess the association of the same exposure with the indication of antibiotherapy at discharge and with positivity in peritoneal fluid culture. Results: Thirteen children showed an increase of >10% in the post-operative serum IL-6 value (group 1) whereas 56 showed only a minor increase, or no change (group 2). After accounting for potential confounders, children in group 1 had a mean of three-day longer hospital stay (difference, 3.33; 95% confidence interval [CI], 0.57-6.09) and higher odds of a positive result in peritoneal fluid culture (odds ratio [OR], 37.43; 95% CI, 1.02-1361.28) than children in group 2. Conclusions: An increase of >10% in post-operative serum IL-6 value could predict longer hospital stay and higher odds of positive peritoneal fluid culture. Future prospective studies are needed to replicate these findings and to broaden the range of biomarkers that could predict the post-operative evolution of children operated on for PAA.

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.

1148 A Rare Case of Loose Right Medial Umbilical Ligament Found During Laparoscopic Appendectomy

Abstract Aim We report this extremely rare variation of loose medial umbilical ligament discovered incidentally during laparoscopic appendectomy. This can be a potential cause of bowel obstruction and internal herniation or cause technical difficulty during laparoscopic surgery. Method A 29-year-old man presented to the emergency department with one day history of central abdominal pain that shifted to right iliac fossa associated with nausea and vomiting. He has no significant past medical history. His abdominal examination revealed tenderness and guarding in the right iliac fossa and his inflammatory markers were elevated. A clinical diagnosis of acute appendicitis was made. Results The patient was brought to the operating theatre for laparoscopic appendectomy. Laparoscopy revealed acutely inflamed appendix and also a completely redundant rounded structure extending from the anterior abdominal wall just to the right side of the umbilicus to the small bowel mesentery consistent with right medial umbilical ligament. The left medial umbilical ligament was entirely normal. Excision of right medial umbilical ligament was done using LigaSure laparoscopic instrument and was sent for histology. Laparoscopic appendectomy was also performed. The patient recovered well with no complications. Conclusions The medial umbilical ligament is the obliterated umbilical artery. This anatomical variation of the medial umbilical ligament is extremely rare. Surgeons should be aware of anatomical variations of medial umbilical ligament especially during laparoscopic surgeries at it may affect the surgeon’s preference for trocar locations.

The role of blood inflammatory markers in the preoperative diagnosis of acute appendicitis.

Acute appendicitis (AA) requires a prompt diagnosis. According to postoperative pathological results, a significant number of appendectomies are performed on a normal appendix (NA). The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting and improving the clinical diagnosis of AA, extracting more information from CBC parameters. The study is a retrospective one. The histopathological results of operated appendix from 102 patients, who underwent appendectomy for clinically suspected AA, were extracted from the Galilee Medical Center systems. Two patient groups (NA and true AA) were compared for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and mean platelet volume (MPV). The obtained data were statistically analyzed, using the independent sample t test and Mann-Whitney test. Category data have been compared among groups with the chi-squared test. The primary endpoint of our research was to assess the predictive power of blood biomarkers. Patients with suspected AA, based on clinical picture and contrast enhanced computed tomography (CECT), and with MLR-value ≥0.3357 were 5.25 times more likely than normal to have AA. Patients with NLR-value ≥3.2223 were 7 times more likely than normal to have AA. The differences in PLR and MPV values were not statistically significant. The NLR and MLR biomarkers can assist in diagnosis of AA. This can be particularly helpful in cases where CECT is contraindicated, as in pregnant women or children.

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

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

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

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

Feasibility of nonoperative treatment of acute appendicitis in children: a prospective cohort study.

The management of acute appendicitis is a matter of debate even in contemporary era. Non-operative management is proposed as a valid treatment option for acute appendicitis in children. A prospective cohort study was conducted from April 2020 to September 2021 at the National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan, in children aged ≤ 12 years who were suspected of having acute appendicitis. Children with diffuse peritonitis and complex mass on ultrasonography were excluded. All children were kept nil per oral and started on intravenous fluid hydration and antibiotics. Statistical analyses were performed using IBM SPSS version 20. Chi-square test and Fisher's exact test were applied to determine the statistical significance. A total of 190 patients were admitted with a diagnosis of acute appendicitis. Thirty-two children with advanced disease underwent surgery. The remaining 158 patients were managed with nonoperative treatment. In 138 (87.3%) patients, resolution of symptoms occurred. Twenty (12.7%) patients underwent operation during the same admission (non-responders). Thirteen (9.4%) patients had recurrence of symptoms and underwent appendectomy. A total of 33 (20.9%) patients had appendectomy either at the primary admission or after discharge. Non-operative treatment was more likely to be successful in patients with symptoms of ≤ 24 h duration (P = 0.02), total leucocyte count of <12 × 109 cells/L (P = 0.005) and smaller size of the appendix on ultrasound (P = 0.001). Among children with uncomplicated acute appendicitis, a non-operative approach resulted in resolution of symptoms in 87.3% of patients at the initial admission. Failure of non-operative treatment and recurrence of disease after discharge from the hospital occurred in 9.4% of patients after successful initial treatment. Thus, the overall success rate at a mean follow-up of 3 months was about 78%.

Inequities in the Diagnosis of Pediatric Appendicitis in Tertiary Children's Hospitals and the Consequences of Delayed Diagnosis

IntroductionMissed diagnosis (MD) of acute appendicitis is associated with increased risk of appendiceal perforation. This study aimed to investigate whether racial/ethnic disparities exist in the diagnosis of pediatric appendicitis by comparing rates of MD versus single-encounter diagnosis (SED) between racial/ethnic groups. MethodsPatients 0-18 y-old admitted for acute appendicitis from February 2017 to December 2021 were identified in the Pediatric Health Information System (PHIS). International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes for Emergency Department visits within 7 d prior to diagnosis were evaluated to determine whether the encounter represented MD. Generalized mixed models were used to assess the association between MD and patient characteristics. A similar model assessed independent predictors of perforation. Results51,164 patients admitted for acute appendicitis were included; 50,239 (98.2%) had SED and 925 (1.8%) had MD. Compared to non-Hispanic White patients, patients of non-Hispanic Black (odds ratio 2.5, 95% confidence interval 2.0-3.1), Hispanic (2.1, 1.8-2.5), and other race/ethnicity (1.6, 1.2-2.1) had higher odds of MD. There was a significant interaction between race/ethnicity and imaging (P < 0.0001). Among patients with imaging, race/ethnicity was not significantly associated with MD. Among patients without imaging, there was an increase in strength of association between race/ethnicity and MD (non-Hispanic Black 3.6, 2.7-4.9; Hispanic 3.3, 2.6-4.1; other 2.0, 1.4-2.8). MD was associated with increased risk of perforation (2.5, 2.2-2.8). ConclusionsMinority children were more likely to have MD. Future efforts should aim to mitigate the risk of MD, including implementation of algorithms to standardize the workup of abdominal pain to reduce potential consequences of implicit bias.

Acute Appendicitis in Children: Evaluation of the Diagnostic Efficacy of Ultrasonography and Computed Tomography.

Acute appendicitis (AA), the most common cause of acute abdomen in childhood, can result in significant morbidity and mortality if not diagnosed and treated in a timely manner. Diagnosis of AA is more difficult in children due to the limited communication skills, in comparison to adults. The aim of this study is to evaluate the diagnostic accuracy of abdominal ultrasonography (US) and computed tomography (CT) in the diagnosis of AA in children. Pediatric patients who were operated on with the diagnosis of AA between January 2016 and December 2021 were retrospectively reviewed. Preoperative abdominal US and CT findings of the patients and postoperative pathology results were recorded. A total of 263 patients with a mean age of 11.3 years were included in the study. There were 164 (62.3%) males and 99 (37.7%) females. Histopathology revealed AA in 215 (81.7%) patients. Preoperatively, US and CT were performed in 139 (52.8%) and 137 (54.5%), respectively. Both imaging methods were applied to 13 (5.1%) patients. US had a sensitivity and specificity rate of 77.2% and 52.6%, respectively. Positive predictive value (PPV) was found to be 81.2%, whereas negative predictive value (NPV) was 46.5% for US. The diagnostic accuracy rate of US was found as 70.5%. CT had a sensitivity and specificity rate of 88.1% and 57.1%, respectively.PPV was found to be 88.8%, whereas NPV was 55.1% for CT. The diagnostic accuracy rate of CT was found as 81.8%. In case of suspicion of AA, US may be the first choice because it is inexpensiveand easily accessible. However, considering patient incompatibility and subjective factors in children, US may sometimes be insufficient. We think that CT should be performed as an advanced examination method in cases where US is not compatible with the patient's condition, not clinic.

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

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

Is It Worth Considering Colonic Evaluation After Appendicectomy?

Introduction The association of acute appendicitis with caecal or colorectal cancer is known. One of the proposed theories for acute appendicitis is luminal blockage by mass at the base of the appendix. There have been no national recommendations or guidelines for follow-up with patients aged 40 and older after an emergency appendicectomy. The purpose of this study was to evaluate the prevalence of caecal and colonic cancer or polyps in patients over the age of 40 who have undergone an appendicectomy. This shall enable us to develop the necessary strategies to investigate and diagnose associated caecal and colonic pathology in acute appendicitis to prevent delayed diagnosis of colon cancer. Methods All patients who underwent appendicectomy between October 2011 and October 31, 2021, and who were 40 years of age or older were included in this retrospective cohort study. Patients aged 40 to 54 years old and patients 55 years or older underwent subgroup analyses. We looked at any investigations of the colon (CT pneumocolon or colonoscopy) within three years before the appendicectomy or three years after an appendicectomy. All colorectal cancers diagnosed within five years of the index episode of appendicitis were included in the analysis. Results A total of 1076 appendicectomies were performed on patients aged 40 and older during the study period of 10 years. A total of 769 patients were confirmed to have appendicitis on histology. One hundred and fifty-seven patients had colonic investigations within three years of the diagnosis of acute appendicitis. In our study, 51 of the 769 patients (6.63%) were found to have colorectal neoplasms. Eight patients (8/769, 1.04%) were diagnosed with colorectal cancers, and the occurrence of caecal cancer was 0.26% (2/769). The mortality rate was 75% (6/8) in these patients diagnosed with colorectal cancer. Four out of six died due to advanced metastatic colonic cancer. In comparison to patients aged 40 to 54, patients over the age of 55 had a statistically significant increased risk of caecal pathology (polyp and cancer) (p = 0.07). Conclusion There seems to be an increased risk of significant colorectal neoplasm in patients over the age of 55 who are admitted with acute appendicitis, and there appears to be an increased severity with a poor prognosis of cancer in these individuals. We recommend the use of routine colonoscopy or CT pneumocolon, particularly for those over the age of 55 who present with acute appendicitis or the histology of appendicular neoplasms.

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

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

Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review.

Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric appendicitis during the COVID-19 era. This systematic literature search evaluated studies containing pediatric appendicitis patient data regarding outcomes, times to hospital admission or times from symptom onset to emergency department visit. Studies elucidating reasons for delays in the management of pediatric appendicitis were also reviewed. Ultimately, 42 studies were included. Several reasons for delayed diagnosis are analyzed such as changes to public health measures, fear of exposure to COVID-19, increased use of telemedicine, COVID-19 infection with concurrent acute appendicitis, recurrence of appendicitis after non-operative management and increased time to intraoperative diagnosis. Time to hospital admission in conjunction with patient outcomes was extracted and analyzed as an indicative measure of delayed management. Delayed diagnosis of acute appendicitis has been documented in many studies with various effects on outcomes. Suspicion of pediatric acute appendicitis must always lead to prompt medical examination, regardless of pandemic status. Telemedicine can be valuable if properly applied. Data from this era can guide future health system policies.

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

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

A case report of perforated appendicitis with pyoperitoneum in a tertiary care center

Acute appendicitis remains one of the most frequent reasons for emergency hospital admissions and the most common cause of an 'acute abdomen' in young adults. The risk of appendicitis is 8.6% for men and 6.7% for women throughout a lifetime, with the frequency peaking in the second decade of life. In 19% of acute appendicitis cases, there is perforation, and it has a bimodal distribution. Appendiceal gangrene and perforation appear to be caused by the appendiceal lumen being blocked. Gangrenous appendicitis and free bacterial contamination of the peritoneal cavity result from ischaemic necrosis of the appendix wall. Extreme ages, diabetes mellitus, immunosuppressive diseases, and obstruction of the appendix lumen are risk factors for appendix perforation. Advances in radiographic imaging have increased diagnostic accuracy, although the diagnosis of acute appendicitis remains primarily clinical. Ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans are the imaging modalities presently in use. Early appendectomy continues to be the best option and the least contentious treatment for acute appendicitis. The accepted standard of care for perforated appendicitis includes both open and laparoscopic procedures. Antibiotic prophylaxis responds effectively to complicated appendicitis.

Acute Appendicitis in Pregnancy-Current Management-Review Article

The management of acute appendicitis in pregnancy is considered controversial, as there is no consensus in terms of diagnosis, investigation, and treatment. Blood investigations like full blood count are of limited value due to the physiological changes that occur in pregnancy. The use of abdominal ultrasound has always been mandatory but magnetic resonance imaging (MRI) is slowly becoming an alternative in the investigation of this condition. Open appendectomy has always been the treatment of choice, but laparoscopic appendectomy is becoming an emerging trend in the management of acute appendicitis in pregnancy. We conducted this narrative review article to evaluate the diagnosis and management of acute appendicitis in pregnancy.

Implementation of ultrasound and fast magnetic resonance imaging pathway reduces computed tomography utilization in children with suspected appendicitis.

Computed tomography (CT) is still used in the imaging diagnosis of acute appendicitis in children at many hospitals. We implemented an ultrasound (US) and fast magnetic resonance imaging (MRI) pathway for suspected appendicitis at our institution with the goal of reducing radiation exposure in children. All children (< 18years old) who underwent appendectomy between January 2011 and July 2021 were reviewed. Data were collected on all imaging studies performed. In December 2015, we initiated an imaging pathway for suspected acute appendicitis. US was the initial imaging study, and a rapid protocol MRI was performed if US was equivocal. Those could not tolerate MRI underwent CT. We evaluated the difference in percentage of patients who underwent CT before and after pathway initiation. 554 patients who underwent appendectomy did not have prior imaging studies on presentation to our hospital and were included in analysis. After initiating the pathway, the use of abdominal US increased from 87% (220 of 254) to 97% (291 of 300, p < 0.0001) and the use of MRI increased by 100% (0 MRIs pre-protocol, 90 of 300 patients post-protocol, p < 0.0001). CT utilization decreased significantly from 32% (82 of 254) to 2% (6 of 300, p < 0.0001). Embracing a new US and rapid MRI pathway to evaluate pediatric patients with suspected acute appendicitis resulted in significant reduction in CT utilization and therefore radiation exposure.

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.