Early Diagnosis Of Acute Appendicitis Research Articles

An observational comparative study between RIPASA & modified Alvarado scoring in the diagnosis of acute appendicitis

Background: Acute appendicitis is one of the most common surgical emergencies. Different techniques and number of scoring systems have been used for aiding in early diagnosis of acute appendicitis and its prompt management of which Alvarado score is the most popular. So we retrospectively applied and compared Alvarado and RIPASA score in the diagnosis of acute appendicitis in Indian population. Materials and Methods: We compared retrospectively RIPASA and Alvarado scoring system by applying them to 85 patients in between June 2018 to November 2019. Both scores were calculated for patients who presented with right iliac fossa pain during the study period. Sensitivity, specificity, positive predictive value (PPV), negative predictive (NPV), diagnostic accuracy for RIPASA & Alvarado system was done. Results: The sensitivity and specificity of RIPASA score were 91.78% and 66.66% respectively. The sensitivity and specificity of Alvarado score were 64.38% and 58.33% respectively. The diagnostic accuracy of RIPASA scoring system is 88.23% and that of Alvarado scoring system is 63.52%. The results indicate that the RIPASA scoring system is a better diagnostic tool for the diagnosis of acute appendicitis (p

Diagnostic efficacy of serum procalcitonin, IL-6, IL-2, and D-dimer levels in an experimental acute appendicitis model.

Acute appendicitis is the most frequent cause of acute abdomen emergency surgery. It continues to be a problem today due to delayed diagnosis and its high perforation rate. For this reason, diagnostic tests continue to be developed. In this experimental study, the diagnostic significance of blood procalcitonin (PCT), interleukin (IL)-6, IL-2, and D-dimer levels in an acute appendicitis model in rabbits was investigated. A total of five groups were included: control group, sham group, and three different acute appendicitis groups. In the appendicitis groups, the appendix was ligated by laparotomy, and the blood PCT, IL-6, IL-2, and D-dimer levels were measured at 12 (group 3), 24 (group 4), and 48 h (group 5). Then, an appendectomy was performed. In the present study, PCT and IL-6 levels increased in parallel with the inflammation of the appendix in all groups and were found to be statistically significant. IL-2 and D-dimer values were higher in the groups diagnosed with appendicitis but were not statistically significant. In our experimental study, PCT and IL-6 levels were determined to be important in the early diagnosis of acute appendicitis, especially IL-6, and that these two parameters are more important markers than IL-2 and D-dimer.

Clinicopathological evaluation of acute appendicitis and the role of ultrasound in diagnosis: a prospective study

Background: Acute appendicitis is the most common acute surgical condition of the abdomen. Delay in treatment of acute appendicitis causes lot of complication. Study was done with the objective to study the clinical and pathological presentations of acute appendicitis, to evaluate the role of ultrasound in early diagnosis of acute appendicitis and to reduce negative appendicectomy in patients.Methods: This is a prospective study done on 100 patients with acute right lower abdominal pain clinically presumed to be of appendicular origin. A thorough history, clinical examination and ultrasound scan, was done for all cases. All ultrasound positive cases were subjected to surgery and some negative cases were also taken for surgery based on clinical suspicion. The ultrasound diagnosis was compared with clinical findings, operative findings and histopathological examination reports.Results: The overall accuracy of clinical diagnosis (Alvarado scoring system) with histopathology findings was 72%. The overall sensitivity and specificity was 70.3% and 81.3% respectively and positive predictive value of was 95.2% whereas the negative predictive value was 34.2%. The overall accuracy of ultrasound with histopathology report was 93%, with a sensitivity of 96.4%, specificity of 75%, and a positive predictive value of 95% and a negative predictive value of 80%. Negative appendicectomy rate was 8.82% in females and 3.63% in males.Conclusions: The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and inexpensive way of confirming acute appendicitis thus reducing negative appendicectomy rate.

Improved Alvarado Score (MANTRELS) for the Early Diagnosis of Acute Appendicitis

Improved Alvarado Score (MANTRELS) for the Early Diagnosis of Acute Appendicitis

A study to compare RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) and Alvarado scores in diagnosing acute appendicitis in Indian population

Background: Acute appendicitis is one of the most common surgical emergencies. Various clinical scoring systems have been used for early diagnosis of acute appendicitis, of which Alvarado score is the most popular but it is found to be less accurate when applied to Asian population compared to RIPASA score. Radiological modalities such as computed tomography (CT) imaging may aid in making a definite diagnosis but will inflate the cost of treatment. This study aims to compare RIPASA and Alvarado scoring system in the diagnosis of acute appendicitis in our population.Methods: It was a comparative cross-sectional study done in 100 patients. RIPASA and Alvarado scores were applied to each patient. Our inclusion criteria were patients presenting with Right iliac fossa pain who subsequently underwent Appendicectomy in the same admission. Exclusion criteria included patients admitted under other specialties, those who underwent previous appendicectomy, elective appendicectomy and those not willing for the study. Results: The sensitivity and specificity of RIPASA score was 95.12% and 66.67% and that of ALVARADO score was 64.63% and 77.78%. The positive predictive value (PPV) and negative predictive value (NPV) of RIPASA score was 92.86% and 75% and that of Alvarado score was 92.98% and 32.5%. The diagnostic accuracy of Alvarado and RIPASA scores were 67.0% and 90.0% respectively.Conclusions: RIPASA scoring system is more accurate and specific scoring system for our population than Alvarado in diagnosing acute appendicitis.

Evaluation of Alvarado score in the Early Diagnosis of Acute Appendicitis: A Prospective Study

Evaluation of Alvarado score in the Early Diagnosis of Acute Appendicitis: A Prospective Study

Acute appendicitis: implementing low-dose CT in clinical practice

Acute appendicitis: implementing low-dose CT in clinical practice

Comparison between Modified Alvardo Score & Pediatric Appendicitis Score in the Early Diagnosis and Management of Acute Appendicitis in Children

Early diagnosis of acute appendicitis in children is a challenge for the pediatric surgeons. The objectives of this study were to compare the accuracy of Modified Alvardo Score (MAS) & Pediatric appendicitis Score (PAS) in the management of acute appendicitis in children, to make early diagnosis & treatment of acute appendicitis and to reduce morbidity of negative appendectomy or delayed appendectomy. It was a comparative prospective study. This study was carried out in Dhaka Shishu (Children) Hospital from January' 2004 to April '2005, a period of 16 months in the department of Pediatric Surgery. During this 16 months period, 106 patients with suspected acute appendicitis were admitted. Among these, 97 patients underwent surgery and 9 patients treated conservatively. Out of 97 patients, 90 specimens were sent for histological examination. Positive histological (Positive appendix) criteria of acute appendicitis required demonstration of acute inflammatory cells infiltration of the appendix wall. Only 85 histological reports were available finally & were included in this study. The sensitivity, specificity and diagnostic accuracy of MAS are 92.42%, 84.21% & 90.59% respectively. The sensitivity, specificity and diagnostic accuracy of PAS are 90.91%, 100% & 92.94% respectively. In these two scoring systems, the sensitivity, specificity and diagnostic accuracy are high. But in our study, PAS is better than the MAS regarding specificity & diagnostic accuracy.Medicine Today 2017 Vol.29(1): 19-22

Evaluation of proadrenomedullin as a diagnostic or prognostic biomarker of acute appendicitis in children

Evaluation of proadrenomedullin as a diagnostic or prognostic biomarker of acute appendicitis in children

EVALUATION OF OHMANN SCORE AND CORRELATION WITH ULTRASOUND FOR DIAGNOSING ACUTE APPENDICITIS

Acute appendicitis is a common surgical condition that requires prompt diagnosis. However adecision to operate based on the clinical suspicion alone can lead to removal of the normalappendix in 15-30% cases. Besides the modern imaging techniques, scoring systems, based onclinical signs and symptoms and routine laboratory assessments, have been used as a diagnosticaid. However, differences in sensitivities and specificities were observed if the scores were appliedto various populations and clinical settings. The purpose of this paper is to assess the validity of theOhmann score and the correlation of ultrasound in diagnosis of acute appendicitis. A total of 80patients were enrolled in this study, 52 male patients and 28 females patients suspected of acuteappendicitis that were admitted, investigated and treated. After detailed examination andinvestigations, the Ohmann score was applied to these patients. A cut off point of 9 was taken.Patients were divided into two groups, group I score of ≥ 9 and group 2 score of < 9. This studywas conducted at SDM College of Medical Sciences and Hospital Dharwad.Proportion of truepositive for score ≥ 9 is 86.9%, Proportion of true negatives for score <9 is 87.1%. Sensitivity andspecificity of this study being 96% and 66.7%, positive predictive value and negative predictivevalue being 82.8 % and 90.9% respectively. Diagnostic odds ratio being 48 and P value of <0.005.The high scores in Ohmann scoring system is dependable aid in the early diagnosis of acuteappendicitis. Combined with ultrasound, the Ohmann scoring system has high sensitivity andspecificity, in the prediction of acute appendicitis.

How to improve the clinical diagnosis of acute appendicitis in resource limited settings.

This article is a general review of the diagnostic tools that the clinician can use for the early diagnosis of acute appendicitis with emphasis on the Alvarado Score, and it is aimed principally to the medical practitioners in different parts of the world where the diagnostic facilities and technological resources are limited.

How much Reliable Is Alvarado Scoring System in Reducing Negative Appendectomy?

There is still an ongoing debate, especially regarding early diagnosis of acute appendicitis. Early surgery leads to inadequate evaluation of acute abdominal pain and negative appendectomy, whereas delayed surgery leads to appendicitis perforation complications. The diagnosis of this condition is considerably difficult, especially due to subtle early symptoms and clinical condition. The aim of the present study was to identify whether the Alvarado scoring system could reduce the incidence of negative appendectomy in patients who will undergo surgery for acute appendicitis. Patients who underwent surgery with acute appendicitis prediagnosis were retrospectively classified as negative appendectomies (group A) and positive appendectomies (group B) according to histological diagnosis. All groups were evaluated for age, gender, Alvarado scores, and parameters. Two hundred eighty-one patients were included in the study. Group A contained 71 (25.3%) patients, and group B contained 210 (74.7%) patients. There was a significant difference in WBC, left shift, rebound, and change of pain localization between the groups (p = 0.002, p < 0.001, p < 0.001, and p = 0.023, respectively). Alvarado scores were significantly different between the groups (p < 0.001). In logistic model examination, the major factor was the Alvarado score (7 or above) and the minor factor was spreading pain. The Alvarado scoring system can be used to reduce negative appendectomy in patients who will undergo surgery with acute appendicitis.

Dilemma of Acute Appendicitis

Acute appendicitis is one of a relatively dwindling number of conditions in which a decision to operate may be based solely on clinical findings. Regular re-assessment of patients and making use of the investigative options available will meet the standard of care expected by patients with acute abdominal pain. In this chapter, the greater importance of history and examination over investigations in the early diagnosis of acute appendicitis is emphasized. The ability to identify the presence of peritoneal inflammation probably has the greatest influence on the final surgical decision.

A Comparative Study of RIPASA Score and ALVARADO Score in the Diagnosis of Acute Appendicitis.

Acute appendicitis is one of the most common surgical emergencies. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendicectomy rates. A number of scoring systems have been used for aiding in early diagnosis of acute appendicitis and its prompt management of which Alvarado score is the most popular. The accuracy of Alvarado score in the diagnosis of acute appendicitis is disappointingly low in Asian population and RIPASA scoring has been designed for the diagnosis of acute appendicitis in the Asian population. So we prospectively applied and compared Alvarado and RIPASA score in the diagnosis of acute appendicitis in Indian population. We compared prospectively RIPASA and Alvarado scoring system by applying them to 206 patients. Both scores were calculated for patients who presented with right iliac fossa pain during the study period. Depending on clinical judgment appendicectomy was done. Post operative histopathology report was correlated with the scores. A score of 7.5 is the optimal cut off threshold for RIPASA and 7 for Alvarado scoring system. Sensitivity, specificity, positive predictive value (PPV) and negative predictive (NPV) for RIPASA & Alvarado system was done. The sensitivity and specificity of RIPASA score were 96.2% and 90.5% respectively. The sensitivity and specificity of Alvarado score were 58.9% and 85.7% respectively. RIPASA score correctly classified 96 percent of all patients confirmed with histological acute appendicitis to the high probability group (RIPASA score greater than 7.5) compared with 58.9% with Alvarado score (Alvarado score greater than 7.0; p-value less than 0.001). RIPASA scoring system is more convenient, accurate, and specific scoring system for Indian population than Alvarado scoring system.

English

BACKGROUND AND OBJECTIVES: Decision making in case of acute appendicitis may be difficult, especially for junior surgeon. Radiological investigations do not appear to be helpful sometime. A decision to operate based on clinical suspicion alone can lead to removal of normal appendix in 1530% cases. In some studies Modified Alvarado Scoring System (MASS) was helpful in minimizing unnecessary appendectomies. The present study aims to evaluate the efficiency of Modified Alvarado scoring in preoperative diagnosis of acute appendicitis. METHODS: A 100 consecutive patients suspected of acute appendicitis who were admitted, investigated and treated were taken for the study. They were prospectively evaluated using the modified Alvarado scoring (MAS) to determine whether or not they had acute appendicitis they were assigned in three groups they were treated accordingly. The MAS was correlated with operative and histopathological findings. RESULTS: The results of the study showed that high score in men and children (7-9) had a sensitivity of 95.45% and 87.50& respectively, where in females it had a sensitivity of 76%. The score (5-6) in men and females had a sensitivity of 57.14% and 75% respectively. INTERPRETATION AND CONCLUSION: the high score in Modified Alvarado Score Is dependable aid in the early diagnosis of acute appendicitis in men and children but is a less dependable aid as far as women are concerned.

Multi-slice CT diagnosis of early acute appendicitis

Objective To investigate the value of multi-slice CT (MSCT) in diagnosing early acute appendicitis (AA).Methods From June 2008 to June 2011,abdomen MSCT images of 41 patients with acute simple appendicitis confirmed by surgery and pathology were evaluated retrospectively. Thirty-six patients with clinically confirmed normal appendix served as the control groups with 18 patients in complicated-normal-appendix (CNA) group and 18 patients in noncomplicated-normal-appendix (NCNA)group. The appendix was reconstructed by using multiplanar reformation (MPR) and curved planar reformation (CPR) techniques. The differences between early AA and normal appendix in appendiceal diameter,thickness of the appendiceal wall, maximum depth of the intraluminal appendiceal fluid (MDIAF), abnormal enhancement of the appendiceal wall, appendicolith and the periappendiceal abnormalities were evaluated and compared by using analysis of variance,R test and Chi-square test.Results The mean thickness of the appendiceal wall was (2.88 ±0.62),(2.58 -±0.50) and (2.73 ±0.53) mm in early AA,CNA and NCNA groups respectively,with no statistically significant difference among them ( F =1.73,P=0.19).The nean appendiceal diameter was (11.37 ± 1.94),(7.03 -±0.89),(6.75 ±0.63) mm,and median MDIAF was 4.05 (2.65-8.50),1.68 (0-.40),0 (0-1.90) mm in early AA,CNA and NCNA groups respectively,with statistically significant differences between early AA and the two normal appendix groups ( Z =7.02,7.24 ; P =0.00 ).The abnormal enhancement of appendiceal wall was found in 61.1％ (11/18) of early AA,16.7％ (3/18) of CNA and 11.1％ (2/18) of NCNA groups respectively,with statistically significant differences between early AA and the two normal appendix groups (x2 =12.83,P =0.00). Using a cutoff value of 7.8 mm of the appendiceal diameter and 2.6 mm of MDIAF for the early AA,the sensitivity,specificity and accuracy were 97.6％ (40/41),91.7％ (33/36) and 94.8％ (73/77),and 100.0％ (36/36),88.9％ (32/36) and 94.4％ (68/72),respectively.Conclusions MSCT is particularly useful for the diagnosis of early AA. When appendiceal diameter is greater than 7.8 mm,and MDIAF greater than 2.6mm,early AA can be diagnosed with confidence. Key words: Appendicitis; Tomography,X-ray computed

Oxidative stress in diagnosis of acute appendicitis patients

The most common acute surgical infection seen in emergency department is acute appendicitis (AA). Although many advances in diagnostic system, the diagnosis of AA is not always straight forward. Early diagnosis of AA is important for reducing morbidity rates. The objective of the current study was to investigate the value of oxidative stress in the accuracy of preoperative AA diagnosis. A total of thirty consecutive patients with histopathologically confirmed AA were retrospectively included in the study. Thirty volunteers were included as control group. Serum antioxidative status was evaluated by measuring total antioxidant status (TAS) levels in patients with AA and in healthy individuals. Serum oxidative status was evaluated by measuring total oxidant status (TOS). Then also oxidative stress index (OSI) was calculated. The male/female ratio of patients was 22/8. Mean age: 31.83±1.06. TOS and OSI levels increased in patient group compared to control group (respectively, 22.71±24.82 μmol H2O2 equivalent/L vs 8.34±2.26μmol H2O2 equivalent/L, p = 0.003; 1.05±1.10 arbitrary unit vs 0.40±0.09 arbitrary unit, p = 0.002). But there were no differences in TAS levels of both groups, p>0.05. Oxidative stress parameters beside other diagnostic tools should be considered as a diagnostic marker in AA. Key words: Acute appendicitis, diagnosis, oxidative stress, total oxidant status, total antioxidant status.

Preoperative Diagnostic Role of Hyperbilirubinaemia as a Marker of Appendix Perforation

This retrospective study investigated preoperative markers of appendix perforation in 351 acute appendicitis cases: group 1, appendicitis not histologically confirmed; group 2, appendicitis without perforation or gangrenous changes; and group 3, histologically confirmed perforated appendicitis with gangrenous changes. In group 3, symptom duration was significantly longer, and white blood cell (WBC) and bilirubin values significantly higher, than for the other groups. Symptom duration, gender, bilirubin and elevated WBC were significantly associated with early diagnosis of acute appendicitis in univariate analysis. Multivariate analysis identified increased WBC counts and male gender as independent variables for the early diagnosis of acute suppurative appendicitis, and symptom duration, total bilirubin and elevated WBC as independent variables for identifying appendix perforation amongst acute suppurative appendicitis patients. Receiver operating characteristic curve analysis showed good discrimination of bilirubin and moderate discrimination of WBC as markers of appendix perforation. It is concluded that assessment of preoperative total bilirubin is useful for the differential diagnosis of perforated versus acute suppurative appendicitis, whereas WBC assessment is effective for diagnosing the presence versus absence of appendicitis. Symptom duration, WBC and total bilirubin should be used as independent parameters in the early diagnosis of appendix perforation.

Is urinary 5-hydroxyindoleacetic acid helpful for early diagnosis of acute appendicitis?

Is urinary 5-hydroxyindoleacetic acid helpful for early diagnosis of acute appendicitis?

Is C-reactive Protein Helpful for Early Diagnosis of Acute Appendicitis ?

Purpose : Appendectomy is one of the most common surgical procedures all over the world. Although various laboratory tests and imaging studies are available to improve the accuracy of diagnosis, the rate of negative appendectomy is still about 15–30%. This study was designed to assess the diagnostic value of quantitative C-reactive protein (CRP) in patients suspected to acute appendicitis.Materials and methods : In a prospective study, blood samples of 102 patients were collected before appendectomy. CRP was measured by immunoturbidimetry and the data were compared with the final histopathologic reports. Diagnostic accuracy of the CRP test was analyzed by ROC curve.Results : In histopathology, 83 patients (81/4%) had acute appendicitis and 19 (18/6%) had normal appendices. Considering 14 mg/lit as the cut-off point, this test shows 59% (95% CI, 48–69%) sensitivity and 68% (95% CI, 47–88%) specificity. The positive and negative predictive values were 89% (95% CI, 80–97%) and 27% (95% CI, 14–39%), respectively. Conclusions : The measurement of CRP levels is not an ideal diagnostic tool for ruling out or determination of acute appendicitis.