Evaluation Of Suspected Appendicitis Research Articles

A Study of Efficacy of Alvarado Score vs Ultrasonography in Evaluation of Suspected Appendicitis

A Study of Efficacy of Alvarado Score vs Ultrasonography in Evaluation of Suspected Appendicitis

Prospective Comparison of the Alvarado Score and CT Scan in the Evaluation of Suspected Appendicitis: A Proposed Algorithm to Guide CT Use

Although computed tomography (CT) has reduced negative appendectomy rates, its radiation risk remains a concern. We compared the performance statistics of the Alvarado Score (AS) with those of CT scan in the evaluation of suspected appendicitis, with the aim of identifying a subset of patients who will benefit from CT evaluation. We performed prospective data collection on 350 consecutive patients with suspected appendicitis who were evaluated with CT scans. The AS for each patient was scored at admission and correlated with eventual histology and CT findings. The sensitivity, specificity, and positive likelihood ratios were determined for various AS and for CT scan. The AS ranges that benefitted most from CT evaluation were determined by comparing the positive likelihood ratios of CT scan with each of the AS cutoff values. The study included 134 males (38.3%) and 216 females (61.7%). The overall prevalence of appendicitis was 44.3% in the total study population; 37.5% in females and 55.2% in males. There were 168 patients (48%) who underwent surgery, with a negative appendectomy rate of 7.7%. Positive likelihood ratio of disease was significantly greater than 1 only in patients with an AS of 4 and above. An AS of 7 and above in males and 9 and above in females has a positive likelihood ratio comparable to that of CT scan. Evaluation by CT is beneficial mainly in patients with AS of 6 and below in males and 8 and below in females. We propose an objective management algorithm with the AS guiding subsequent evaluation.

Efficacy of Ultrasonography in the Evaluation of Suspected Appendicitis in a Pediatric Population

Background The purpose of this study was to evaluate the efficacy of ultrasound (US) for the diagnosis of acute appendicitis in children. Patients and methods We reviewed all sonograms for acute appendicitis in children suspected of having appendicitis from January 2009 to December 2012. Sonographic findings were positive when the largest axial diameters were >6 mm. The sonograms that were unable to find the appendix were classified into an other group and were considered separately. Sonographic findings were compared with surgical pathological findings or discharge diagnoses in cases of no surgery. Subgroup analysis in the surgical group, including patient age ( Results The appendix was identified in 270/428 cases (63.1%). The overall sensitivity was 71.2% [95% confidence interval (CI): 56.9–82.9%], specificity 97.7% (95% CI: 94.7–99.3%), positive predictive value 88.1% (95% CI: 74.4–96.0%), negative predictive value 93.4% (95% CI: 89.4–96.3%), accuracy 92.6%, and receiver operating characteristic = 0.84. The specificity (47.1%), negative predictive value (61.5%), and accuracy (76.3%) were significantly lower in the surgical group. The efficacy of US between the sexes and age groups showed no significant difference, except the lower positive predictive values in the younger age group. Conclusion US efficacy for the diagnosis of appendicitis in children is high enough to use as an imaging modality of first choice to reduce complications, hospital stay, and negative appendectomy rate.

Evaluation of suspected appendicitis in children and young adults: helical CT.

To evaluate the accuracy of helical computed tomography (CT) for the diagnosis of appendicitis in children and to assess the utility of CT in establishing alternative diagnoses. The medical records of 154 children (median age, 12 years; age range, 1-20 years) who were suspected to have appendicitis and who underwent CT were reviewed. The gastrointestinal tract was opacified in 151 of 154 patients: Only orally administered contrast material was used in 126 patients; only rectally administered contrast material, in 21 patients; and both oral and rectal contrast material, in four patients. CT findings were correlated with surgical and histopathologic findings or with clinical follow-up findings. Sixty-four CT scans were interpreted as positive for appendicitis and included 58 true-positive and six false-positive scans. Ninety scans were interpreted as negative and included 87 true-negative and three false-negative scans. CT had a sensitivity of 95% and a specificity of 94% for the diagnosis of appendicitis. In addition, in 32 (34%) of 93 patients without appendicitis, an alternative diagnosis was established on the basis of CT findings. Helical CT is useful in a pediatric population to diagnose or exclude appendicitis and to establish an alternative diagnosis.