Modified Alvarado Scoring Research Articles

A Combination of Clinical Examination with Specific Biomarkers and Judicious Use of Imaging Modality can Reduce the Rates of Negative Appendicectomy.

Background: Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis ofacute appendicitis is based on careful history, physical examination and laboratory and imaging findings.Objective: The primary aim is the correlation between clinical, biochemical and radiological assessment inpatients of appendicitis and also to reduce the rates of negative appendicectomy.Method: The study was carried out in Department of General Surgery, Sir Sunderlal Hospital, IMS and BHUfrom September 2015 to July 2017. Total 61 patients of age group 16-65 years and either sex were evaluatedon the basis of predetermined proforma, which included a detailed history, clinical examination, laboratoryinvestigations and high resolution sonography or CT and histopathology. Sensitivities, specificities, positiveand negative predictive values of TLC, neutrophil percentage, Modified Alvarado Score, CRP, D-dimer,USG and CT scan were calculated in respect to histopathology finding as a gold standard.Results: Modified Alvarado scoring (MAS 7-9:Appendicitis definitive) was present in 24 (39.3%) patients.Raised leucocyte count was present in 49 (80.32%) patients, while neutrophil count above 75% waspresent in 47 (77%) patients. Raised CRP was present in 55 (90.16%) patients with cut-off of >3 mg/l(normal range 1-3 mg/l) while D-dimer was elevated in 44 (72.13%) patients with cut-off of >5 mg/l. Onultrasonography,(77%) patients were diagnosed as acute appendicitis whereas (83.3%) had diagnosis ofacute appendicitis in CECT abdomen. Histopathological examination was positive in 60 (98.4%) patients.Conclusion: We concluded that combination of thorough clinical evaluation along with certain routinebiochemical & specific markers and ultrasonography as the primary imaging modality is sufficient inestablishing a diagnosis of acute appendicitis in more than 90% cases.

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis

Background: Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. Methods: This study included 90 patients who underwent appendectomies and were documented as having “acute appendicitis” or “abdominal pain” in the operating theatre register from June 2014 to May 2018. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. Results: A total of 68 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specificity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modified Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a significant difference (P<0.001) for both scoring systems. Conclusion: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modified Alvarado scoring system for Kuwait population.

Augmentation of modified Alvarado score with abdominal ultrasound in diagnosis of acute appendicitis

Background: Acute appendicitis is one of the commonest surgical emergencies. But confirming the diagnosis of acute appendicitis is still a subjective issue for clnicians. Modified Alvarado score is based on clinical and laboratory findings which is scored upto. Management of 5 to 7 modified Alvarado score came under equivocal. Either may be conservative or operative.Methods: We augmented the modified alvarado score with abdominal ultrasound in diagnosis of acute appendicitis.Results: Outcomes were evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and negative appendicectomy rate, results of our study are sensitivity 95.7%, specificity is 76.92%, PPV 93.75% and NPV 33.34%.Conclusions: Overall increased sensitivity, specificity, NPV and PPV of the augmented approach is useful for diagnosis of acute appendicitis which scored under 5-7 of modified alvarado scoring system.

EVALUATION OF MODIFIED ALVARADO SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS AT TERTIARY CARE HOSPITAL IN WESTERN RAJASTHAN

Background: Acute abdominal pain is a common complaint among emergency department patients.&#x0D; Methods: A 100 consecutive patients suspected of acute appendicitis who were admitted in department of surgery. They were prospectively evaluated using the modified Alvarado scoring (MAS) to determine whether or not they had acute appendicitis.&#x0D; Result: In present study, out of total 100 patients 78(78%) were have MAS score 7-9, 20% were have 5-6 and 2% have MAS score 1-4.&#x0D; Conclusion: The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy.&#x0D; Keywords: Modified Alvarado Score (MAS), acute appendicitis, Patients.

Comparison of Raja Isteri Pengiran Anak Saleha Appendicitis and modified Alvarado scoring systems in the diagnosis of acute appendicitis.

The diagnosis of acute appendicitis (AA) is mainly dependent on clinical evaluation. There are several scoring systems developed for an accurate and early diagnosis of AA. Modified Alvarado score is one of the most common systems. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was developed in 2010. The aim of this study is to evaluate and compare the accuracy of modified Alvarado and RIPASA scoring systems for the diagnosis of AA. A total of 100 cases with the clinical diagnosis of AA were included in the study. All the cases were treated surgically. For all cases, modified Alvarado and RIPASA scores were calculated and recorded. According to the calculated cut-off values, sensitivity, specificity, negative and positive predictive values and total accuracy were calculated for each scoring systems. According to the receiver operating characteristic curve. the optimal score of modified Alvarado score for AA was found to be 5.5 with a sensitivity of 88% and specificity of 69%. According to the receiver operating characteristic curve, the optimal score of RIPASA score for AA was found to be 8.75 with a sensitivity of 94% and specificity of 88%. With the cut-off value of 8.75, total accuracy of RIPASA scoring was found to be 85.2%. Although there is no significant difference in negative appendicectomy rate, both sensitivity and the specificity of the RIPASA were found to be significantly higher than the modified Alvarado. According to the current study, RIPASA scoring system was found to be superior to modified Alvarado in the prediction of cases with AA.

Evaluation of modified alvarado scoring system regarding early diagnosis of acute appendicitis and in reduction of negative appendicectomies

Aim: To compare and evaluate diagnostic accuracy of Modified Alvarado score in co-relation to histopathology report for diagnosis of acute appendicitis.Materials and methodsStudy Design: A Cross Sectional Study of 100 patients with complaint of Lower Abdominal pain.Place of Study: Trichy SRM medical hospital and research centre period of study – Janaury 2017 to January 2019.Inclusion criteriaPatients hospitalized with abdominal pain suggestive of acute appendicitis.Age range of 15 - 50 yearsBoth males and femalesAbility to understand and give consentExclusion criteriaPatients less than 15 years of age and older than 50 years.Patients who have underwent Appendicectomy previously.Chronic/Subacute/Recurrent AppendicitisResults1.Histopathological diagnosis was accepted as the final confirmation of the diagnosis.2.Though large number of consultants were involved in clinical diagnosis of acute appendicitis, no significance was attached to the inter observer variation.Conclusion: The study concludes that establishing diagnosis in cases of suspected acute appendicitis might require a combination of different diagnostic tools such as modified Alvarado score, investigative modalities such as ultrasonography and the indispensible clinical judgment.

The Validity of Modified Alvarado Scoring System as a Predictor Tool for Diagnosis of Acute Appendicitis in a Low- Country; a Comparative Prospective Study

Background: Acute appendicitis is a disease with a well-known long history. The final diagnosis of acute appendicitis is only accurate with histopathological findings after appendectomy. However, the choice to carry out surgical treatment is based exclusively on clinical assessment which does not reach the precise diagnosis of appendicitis. Therefore, Different scoring systems have emerged in order to help physicians in decision making and diagnosis of suspicious individuals. Aim: To determine the diagnostic accuracy of the Modified Alvarado Scoring System in a low-income country in the diagnosis of appendicitis. Patients and Methods: This was a cross-sectional study that included 200 patients with right iliac fossa pain, suggestive of acute appendicitis. The patients were examined clinically and randomly allocated into 2 groups. The Modified Alvarado Scoring System (MASS) was calculated for the case group and listed and compared to another control group for which the operative decision was based on the clinical evaluation without relying on a scoring system. All the studied patients went through appendectomy according to overall clinical judgment and never based on MASS only. Specimens were sent to histopathological examination to verify the diagnosis. Results: The results showed that MASS at the cut-off value of ≥ 7 has a sensitivity of 93.33%, a specificity of 52.94%, and accuracy of 84.42%, and a negative appendectomy rate of 17 out of 95 patients (17.8%). Conclusion: MASS is a safe tool in the diagnosis of acute appendicitis due to its accepted sensitivity and higher specificity. It could be helpful in low-income countries, where resources are limited.

Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p&lt;0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

Use and relevance of modified alvarado scoring system in diagnosis of acute appendicitis: a cross sectional study from West Bengal, India

Background: For successful management of acute appendicitis, early diagnosis and intervention is needed. Incorrect diagnosis may allow significantly increased morbidity and mortality. Several studies across the globe shows that Modified Alvarado Scoring System (MASS) does not need high end instrument and can be done in emergency situation for accessing acute appendicitis and reducing the chances of unnecessary surgery. To access the efficacy of MASS for diagnosis of acute appendicitis in remote areas with primary health care facilities, present study was done at Siliguri of Darjeeling district of West Bengal which was 580 km distant from state capital (Kolkata).Methods: A cross sectional study over a period of 16 months was conducted among the patients admitted at North Bengal Medical College and Hospital suspected to have acute appendicitis. The diagnosis was confirmed by histopathological examination. Written consent was obtained from the patients before commencement of the study. MASS was applied to the patients and the results were compared with histopathological findings. Appropriate statistical analysis has been done by SPSS (version 16.0).Results: A total of 75 patients (44 males and 31 females) were considered. The sensitivity and specificity of MASS in this study were 75.86% (71.43% for males and 80% for females) and 82.61% (80% for males and 87.5% for females) respectively. Study revealed statistically significant (p&lt;0.000) association between Histopathological report and MASS.Conclusions: To reduce the chances of negative appendectomy and for better diagnosis of appendicitis, MASS may be more useful at primary health care centres those are located in remote areas as it was very simple, easy and cost effective.

The modified alvarado score versus alvarado score in the diagnosis of acute appendicitis

Background: Appendicitis is the most common surgical emergency presented daily to emergency surgical department. The Modified Alvarado Scoring System (MASS) is easier and applicable in the diagnosis of acute appendicitis using extra signs instead of neutrophilic left shift. Objective: The aim of this study is to compare and evaluate the diagnostic accuracy of MASS versus the Alvarado scoring system. This study was carried out in Duhok Emergency Teaching Hospital, Iraq, over the period of 12 months, from October 2017 to October 2018. Materials and Methods: A cross-sectional study including 200 patients, diagnosed with acute appendicitis by the senior surgeon on call and underwent conventional open appendicectomy. MASS were applied to all patients preoperatively by author and results of both scores compared to operative and histopathological findings of excised appendix to analyze the efficacy of both scores in the diagnosis of acute appendicitis. Results: Of 200 patients who underwent operation those with Alvarado score of 9–10 had sensitivity of 88% and specificity of 100%. Those with a score of 7–8 had sensitivity of 63% and specificity of 68%. For MASS patients with score of 9–10 had sensitivity of 96% and specificity of 100%, and those with a score of 7–8 had sensitivity of 77% and specificity of 86%. The higher the score, the sensitivity and specificity increased. Positive predictive value and accuracy of neutrophilic left shift of Alvarado were 95% and 65%, positive predictive value and accuracy of extra signs of modified Alvarado score were 97% and 84% respectively. Conclusion: Both Alvarado and MASS are fast, simple, and repeatable systems in the diagnosis of acute appendicitis. This study reveals that accuracy of MASS is higher than Alvarado score, and the rate of negative appendicectomy can be reduced using this system.

RIPASA vs Modified Alvarado Scoring System for diagnosis of Appendicitis

INTRODUCTION: Acute appendicitis is the most common surgical condition presented to the emergency department. Clinical scoring systems such as the Alvarado and modified&#x0D; Alvarado scoring system were developed with the goal of reducing the negative appendectomy rate to 5%–10%. In the other hand the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian population. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in the Nepalese population.&#x0D; METHODS: This study included 125 patients who had undergone appendectomies &#x0D; from March of 2017 to January 2018. The sensitivity, specificity, positive predictive value (PPV),&#x0D; negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software.&#x0D; RESULTS: A total of 125 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 68.64% and a specificity of 28.57%. The PPV was 95% and the NPV was 5.12%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded 88.13% sensitivity and 28.57% specificity. The PPV was 95.41% and the NPV was 12.5%. &#x0D; CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity similar to the modified Alvarado scoring system.&#x0D; KEYWORDS: Acute appendicitis, Modified Alvarado Score, RIPASA score.

Ruling out Appendicitis in Children: Can We Use Clinical Prediction Rules?

PurposeTo identify available clinical prediction rules (CPRs) and investigate their ability to rule out appendicitis in children presenting with abdominal pain at the emergency department, and accordingly select CPRs that could be useful in a future prospective cohort study. MethodsA literature search was conducted to identify available CPRs. These were subsequently tested in a historical cohort from a general teaching hospital, comprising all children (< 18 years) that visited the emergency department between 2012 and 2015 with abdominal pain. Data were extracted from the electronic patient files and scores of the identified CPRs were calculated for each patient. The negative likelihood ratios were only calculated for those CPRs that could be calculated for at least 50% of patients. ResultsTwelve CPRs were tested in a cohort of 291 patients, of whom 87 (29.9%) suffered from acute appendicitis. The Ohmann score, Alvarado score, modified Alvarado score, Pediatric Appendicitis score, Low-Risk Appendicitis Rule Refinement, Christian score, and Low Risk Appendicitis Rule had a negative likelihood ratio < 0.1. The Modified Alvarado Scoring System and Lintula score had a negative likelihood ratio > 0.1. Three CPRs were excluded because the score could not be calculated for at least 50% of patients. ConclusionThis study identified seven CPRs that could be used in a prospective cohort study to compare their ability to rule out appendicitis in children and investigate if clinical monitoring and re-evaluation instead of performing additional investigations (i.e., ultrasound) is a safe treatment strategy in case there is low suspicion of appendicitis.

Clinical and histopathological analysis of the patients undergoing appendectomy

Background: Acute appendicitis is one of the most common surgical emergencies, but the diagnosis is difficult even with the sophisticated diagnostic tools. The aim of this study is to analyze the clinical and histopathological features of acute appendicitis and to see how reliable the clinical scoring system modified Alvarado score in our setup.Materials and Methods: This was a retrospective observational study of patients who underwent appendectomy at KIST Medical College and Teaching Hospital during two years. The clinical characteristics of the patients in terms of modified Alvarado scoring were outlined. The diagnosis of acute appendicitis was confirmed by histopathological examination. The data were tabulated in MS-Excel and statistically analyzed using SPSS statistics software, version 21.Results: Among 118 patients, who underwent appendectomy, 69 were male and 49 were female with male to female ratio of 1.41:1 and mean age of 27.46±12.724 years.The clinical diagnosis of acute appendicitis was more likely (MAS 7-9) in 56 patients, less likely (4–6) in 44 patients and unlikely (MAS 1-3) in 18 patients. The highest incidence of acute appendicitis was observed in 19-40 years and the lowest incidence in 61 years or above. After histopathological examination, 52 patients out of 56 in the more likely group had acute appendicitis and 4 patients had non-inflamed appendices. 7 patients out of 62 in the less likely and unlikely groups had acute appendicitis and 55 patients had non-inflamed appendices. The overall negative appendectomy rate was 9.32 percent.Conclusion: Our clinical practice of using modified Alvarado score in the diagnosis of acute appendicitis is effective, easy and non-invasive.

Modified alvarado score in diagnosis of acute appendicitis: a clinicopathological study

Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies.Methods: A total 100 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of modified Alvarado scoring system and were subsequently operated, were included in the present study in our institute for period of 20 Months.Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients. Fever seen in 87% of patients and vomiting in78%. Modified Alvarado score of 9 had positive predictive value of 100% while negative predictive value 8.9%, while score between 7-8 had positive predictive value of 98.9% and negative predictive value 27.8%. The sensitivity was 86.1% and specificity was 83.3%. The ultrasonography showed a sensitivity of 94.68%. In present study rate of total white appendectomy was 6%. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.

A prospective study of accuracy of modified Alvarado score in patients with acute appendicitis in tertiary care hospital

Background: Acute appendicitis is the most common acute emergency of the abdomen. Clinical diagnosis of acute appendicitis is challenging in most of situation. The present study was designed to evaluate the role of modified Alvarado scoring system in diagnosis of acute appendicitis.Methods: One hundred consecutive patients presenting in the department of surgery Geetanjali Medical College and Hospital from January 2014 to 2016 were included. Demographic characteristics, symptoms and signs, laboratory results were recorded. Data was collected using a pre-tested questionnaire and analyzed using statistical calculation.Results: In the present study 100 patients were studied in a period of two years. Maximum percentage of patients were in age group 20-30 years and males dominated the series. The sensitivity and specificity of modified Alvarado score was 91.57% and 76.47% respectively with positive predictive value 95% and negative predictive value 65% and diagnostic accuracy of 89%.Conclusions: This study shows that use of modified Alvarado scoring system in patients with acute appendicitis provides a high degree of diagnostic accuracy.

Evaluation of the diagnostic accuracy of Modified Alvarado scoring system in Comparison to Histopathological results in Acute appendicitis

Background: Acute appendicitis even today remains the commonest cause of acute abdomen needing surgical intervention. In developing countries the clinical diagnosis still poses a challenge to the surgeon and advanced radiological investigations are not cost effective while histopathological diagnosis remains the gold standard. The Modified Alvarado score augments the accuracy of diagnosis of appendicitis thus reducing the rate of negative appendicectomy.Methods: Patients admitted with clinical findings suggestive of Acute appendicitis were evaluated by applying Modified Alvarado scoring system.Those patients with Alvarado scores above 5 were subjected to appendicectomy.The Modified Alvarado score was correlated with that of histopathologial features of appendicectomy specimens.Results: The histopathological features of appendicitis was seen in 87.8% of the cases whose scores were more than 7 while negative appendicitis was seen in 38.1% whose scores were between 5-7.The sensitivity, specificity, positive predictive value and negative predictive value of Alvarado scores in our study were 87.80%, 38.01%, 73.50% and 61.50% respectively. Conclusions: The study concludes that the Modified Alvarado scoring system is more sensitive in diagnosing acute appendicitis with reference to the histopathological findings.DOI: 10.21276/APALM.1642

Using modified Alvarado score in conservative treatment of acute appendicitis

Background and objectives: Acute appendicitis is the most common and challenging surgical emergencies. The diagnosis is still based on the clinical examination. The modified alvarado score system isa safe diagnostic modality without extra expense and complications. Efficacy ofantibiotic treatment was often considered as a bridge to surgery inselectedpatients with acute appendicitis aided by using of Modified Alvarado scoring system. Methods: A prospective clinical trial comparing antibiotics with appendectomy, a total of 424 consecutive patients were enrolled, according to Modified Alvarado Scoring Systemwere divided into three groups: Group A: score between 8-10 (emergency surgery group),Group B: score between 5-7 (conservative group): these patients were subjected to repeated clinical examinations for 24 hours. Group C: scorebetween 1-4, the choice of antibiotic regimen was made by using an intravenous injection of (ceftriaxon 1g x2 and metronidazo l500mg x 3). Results: out of 424 patients, 206(48.6%) female and 218(51.4%) male. 156(36.8%) patients group A,148 (34.9%) group B, histopathology confirmed appendicitis in 128(82%). patients nine (5.8%) patient in group A revisiting hospital due to complications. Mean hospital stay in group A was lesser than group B. The antibiotic response rate was 91.3%, In group A 12(7.7%) patients had wound infection,while in group B and C seven (4.7%) had complications. Out Of 13 patients in the antibiotic group, nine (6%) underwent appendectomy during the initial hospitalization. Conclusions: Modified Alvaro Scoring System as a diagnostic tool,can be usedsafely for conservative treatment of patients with acute uncomplicated appendicitis by giving antibiotics only.

Role of modified Alvarado scoring system and USG abdomen in acute appendicitis: an overview

Background: Acute appendicitis is the most common cause of an ‘acute abdomen’ in young adults and, as such, the associated symptoms and signs have become a paradigm for clinical teaching. Appendicitis is sufficiently common that appendicectomy (termed appendectomy in North America) is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. In this study we correlate the usefulness of Modified Alvarado scoring system(MASS) and ultrasonography(USG) in management of acute appendicitis.Methods: The study was done on 60 patients of symptomatic appendicitis, requiring management accordingly, attending surgical OPD of People’s College of Medical Sciences(PCMS) and Research Centre, Bhopal, India from 1st October 2011 to 30th August 2013. The study includes 60 patients between 5-60 yrs of age. They were prospectively evaluated on admission using the modified Alvarado Score to determine whether or not they had acute appendicitis, all equivocal cases were subjected to ultrasonography examination. The score and ultrasonography were correlated with the operative and histological findings.Results: All 60 patients underwent surgery. The sensitivity of the modified Alvarado score was 89.65% and sensitivity of USG was 91.37%, out of 60 cases of acute appendicitis male were 36 and remaining 24 cases were female. So, it showed sex ratio of 36:24, 3:2 which correlate with literature and other studies. With use of both MASS and USG as diagnostic tool, out of 60 cases 57 cases were positive and with the help of histopathology, it was confirmed in 58 cases.Conclusions: The modified Alvarado scoring system is a good diagnostic indicator for acute appendicitis. It helps in minimizing the rates of negative appendicectomy. It can be used as an adjunct to surgical decision-making along with ultrasonography in doubtful cases. When combined, modified Alvarado score and ultrasonography can work very effectively in diagnosing acute appendicitis(AA) correctly and in reducing the number of negative appendicectomy.

Comparison of Efficacy of Ripasa Scoring System with Modified Alvarado Scoring System in Diagnosing Acute Appendicitis

Comparison of Efficacy of Ripasa Scoring System with Modified Alvarado Scoring System in Diagnosing Acute Appendicitis

Assessment of the accuracy of using the combination of modified alvarado score and abdominal ultrasound in acute appendicitis

Background: Appendix is a worm shaped blind tube of varying length (2-25) cm opening into the caecum 2cm below the ileocaecal valve in posteromedial valve. It is the only organ in the body that has no constant position. Incidence of acute appendicitis parallels that of lymphoid development with peak incidence in early adulthood. It is rare before the age of two. Before puberty the incidence of acute appendicitis is equal in both sexes. But after puberty there is a slight male preponderance. The objective of this study was to evaluate assessment of accuracy of the combined use of modified Alvarado scoring system and ultrasound in the diagnosis of acute appendicitis.Methods: Around 136 patient’s acute appendicitis were subjected to estimation of total leucocyte count and plain x-ray abdomen after thorough history evaluation and clinical examination before surgery. Alvarado score was found in all cases. All of them were operated on the day of admission itself and preoperative findings were noted. All appendicectomy specimens were subjected to histopathological examination (HPE).Results: Acute appendicitis is the most common surgical abdominal emergency in our hospital. Acute appendicitis is more common in males and the commonest age group affected is 21 - 30 years. Right iliac fossa pain is the most common presenting symptom followed by nausea/vomiting. In diagnosis of acute appendicitis Alvarado score has a high diagnostic value (82.5%).Conclusions: The combined use of modified Alvarado score with ultrasonogram done in patients with equivocal or low Alvarado score is useful in identifying the missed-out cases thereby preventing diagnostic delay and its attendant complications. Appendices that appear to be normal on macroscopic inspection may show features of acute appendicitis on histopathologic examination.