Tool For Acute Appendicitis Research Articles

The Study of Accuracy of Alvarado Score, CRP, Bilirubin Level and Mean Platelet Volume in the Diagnosis of Acute Appendicitis in a Tertiary Care Centre

Acute appendicitis is one of the common surgical emergencies and when it progresses to appendicular perforation, morbidity and mortality becomes much higher. Nearly 6% of the population is expected to have appendicitis in their lifetime. Though absolute diagnosis is only possible at operation and histopathological examination of the specimen, many scoring systems are available for the diagnosis of acute appendicitis. Among them Alvarado scoring system is an important one which is based on history, clinical examinations and few laboratory tests. Recent studies have shown the association of hyperbilirubinemia with acute appendicitis and appendicular perforation. Many reports have investigated the value of raised C reactive protein (CRP) and reduced mean platelet volume (MPV) in improving the diagnosis of acute appendicitis. The objective of our study was to evaluate the accuracy of Alvarado scoring system and CRP as a preoperative diagnostic tool in acute appendicitis and to evaluate whether hyperbilirubinemia and reduced MPV has a predictive potential for its diagnosis. A total of one hundred one patients coming to our emergency in a study period of one year were included. It was observed that the sensitivity, specificity, positive predictive value of Alvarado score was 82.7%, 70% and 96%, CRP level- 96.5%, 63.6%, 95.4%, total bilirubin level- 96.4%, 19%, 60.91%, MPV level- 95.7%, 16%, 51.72% respectively and the P value was clinically significant for Alvarado score, CRP level, total bilirubin level but not for MPV. We conclude that Alvarado score, raised total bilirubin level and CRP level are very effective in the diagnosis of acute appendicitis in both men and women but some other diagnostic modality may be necessary to ascertain the diagnosis in females to rule out pelvic pathology and to reduce negative appendicectomy rate.

To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis in relation to operative and histopathological findings

Background: Appendicitis is expected to occur in about 6% of people during their lifetime. The most useful diagnostic techniques are still routine medical history and examination; Post surgery, after the specimen has been examined histopathologically, the final diagnosis is achievable. Systems of scoring are useful and valid for separating acute appendicitis from generalized abdominal pain and can help reduce unwanted surgery, particularly in remote areas. Aims: 1. To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis, in relation to operative and histopathological findings. 2. To determine the role of the Alvarado scoring system in cutting down the rate of negative appendicectomy without increasing morbidity and mortality. 3. To know the specificity and sensitivity of the Alvarado scoring system in the diagnosis of acute appendicitis. Methods: A prospective study of 50 patients who presented with symptoms and signs of acute appendicitis and suspected enough to warrant surgery for acute appendicitis admitted in DR. PSIMS & RF under various surgical units from November 2018 to October 2020 were selected. Results: In our study, migratory pain was noted in 80% of patients in this study. In this study, anorexia was noted in 60% of cases, rebound tenderness was found in 82% of cases, 37% of cases with a fever over 99°F had appendicitis, 80% of patients had leukocytosis, and leukocyte shift to the left was observed. Sensitivity, specificity, and positive predictive value (PPV) were 77.2%, 66.6%, and 94.4% in this study. Conclusion: This study concluded that the Alvarado score is a reliable, cheap, and reproducible tool for the diagnosis of acute appendicitis in the emergency room.

TP6.2.3 Abnormal liver function tests: A helpful diagnostic test and a predictor of severity in acute appendicitis

Abstract Aim: Acute appendicitis (AA) is the commonest surgical emergency worldwide. The diagnosis usually is clinical but imaging and bloods tests are helpful. The study aims to establish the role of abnormalities in liver function tests (LFTs) in the diagnosis and in predicting the severity of AA. Methods Retrospective, observational study performed in district general hospital between June 2018 and June 2019. Patients with abdominal pain and appendicectomy (excluding children <16 years with isolated ALP rise) were categorized into two groups based on presence (Group-A) or absence (Group-B) of abnormal LFTs. Demographics data, diagnosis and severity of appendicitis, hospital stay and postoperative complications were analysed. Results Two hundred and seventy nine patients were included: Group-A (n = 146, mean age 37.5 years, M: F 1.3/1.0) and Group-B (n = 133, mean age 29.7 years, M:F 1.0/1.8). Appendicitis occurred in 85.6% of Group-A (125/146) and in 62.4% (83/133) of Group-B with positive predictive value 85.6%. The appendix was normal in 14.4% of Group-A (21/146) and in 37.6% of Group-B (50/133) with specificity of 70%. Laparotomy was required in 6.1% in Group-A (9/146) compared to 1.5% in Group-B (2/133). Average hospital stay was 4.7 days (range: 1-21) in Group-A versus 2.7 days (range 1-14) in Group-B. Readmission rate due to a postoperative complication was 16.4% in Group-A (24/146) compared to 6% in Group-B (8/ 133). Conclusion: Deranged LFTs is an additional diagnostic tool in AA and a good predictor of its severity. This may help to decrease the negative appendicectomy rate and guide surgeon in the decision-making process.

Role of alvarado score in diagnosis of acute appendicitis

Background: Appendicitis may be associated with morbidity and occasionally mortality. If failed to diagnose early, the situation may become more complicated.
 Objective: To validate the role of Alvarado score in diagnosis of acute appendicitis.
 Methods: A total of 282 patients with clinically diagnosed acute appendicitis were included in this study. Patients were examined thoroughly, investigated and managed accordingly. The relevant data collected and analyzed. Results: Out of 282 patients, surgical procedures were performed in 59.57% of the patients. The overall negative Appendectomy rate was 9.52%, and the percentage of Positive Predictive Value (PPV) for Alvarado score was 92.26%.
 Conclusion: Our study validates the Alvarado score as fast, simple and reliable diagnostic tool for acute appendicitis.
 Journal of Surgical Sciences (2017) Vol. 21 (2): 94-98

C-reactive protein as a diagnostic tool in acute appendicitis

Background: Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a ruptured appendix include widespread, painful inflammation of the inner lining of the abdominal wall and sepsis. The main objective is to compare C-reactive levels in diagnosis of acute appendicitis.Methods: In this study patients coming to General Surgery Department of ESIC Medical college, Rajajinagar, Bengaluru, from January 2017 to December 2017, who are diagnosed clinically as to have acute appendicitis form the source of study.Results: In the present study, maximum number of cases belongs to 21-30 year age group (22 cases) and male female ratio is 1.07:1. Most common site of pain being right iliac fossa (52 cases), vomiting as presenting complaint was seen in 51 cases, fever as a presenting complaint was present in 31 cases, Mc-Burneys point tenderness noted in 49 cases, rebound tenderness noted in 46 cases. In present series 53 patients had elevated serum CRP level (>2.5 mg/dl) which is 89% of total study group. In these patients only one patient had high serum CRP level in spite of normal appendix.Conclusions: An elevated serum CRP level supports the surgeon’s diagnosis and hence avoids chances of error in diagnosis, due to atypical presentations. Similarly a normal preoperative serum CRP level in patients with suspected acute appendicitis is most likely to be associated with a normal appendix on histo-pathological examination.

Whether Alvarado scoring system is A Reliable Diagnostic Tool for Acute Appendicitis.

Objective: to evaluate the diagnostic accuracy (discrimination) and implementation performance of Alvarado score. Methodology: This cross sectional study was done in Surgerical unit of Bahawal Victoria hospital Bahawalpur under supervision of consultant Surgeons of department. Study duration was 1 year from March 2018 to March 2019. For quantitative variables like age of patients Mean and SD was calculated, and frequency percentages were calculated for categorical data like gender. Negative appendectomy rate, positive predictive value, negative predictive value, sensitivity, specificity was calculated by using 2-2 contingency table. Results: Total 300patients enrolled in this study, both genders. Alvarado scoring at presentation, 15% (n=45) patients were categorized into Group I. 13% (n=39) patients were included in Group II. While, 72% (n=216) were enrolled in Group III. Diagnostic test was positive in 223 patients. While, acute appendicitis was confirmed histo-pathologically in 160 patients. Gangrenous appendicitis observed in 3 patients. Chronic appendicitis, perforated appendicitis, appendicular abscess, no specific pathology, gangrenous intestine and salpingo-oophoritis was observed as 31, 6, 9, 6,3 and 5 respectively. There were 174 patients true positive, 49 were false positive, 59 were false negative and 18 were true negative. Sensitivity, specificity, negative predictive value and negative predictive value were 74.68% 26.87%, 78.02% and 23.37% respectively. Conclusion: Alvarado scoring system is useful tool in diagnosis of appendicitis in pre-operative period which can be useful for surgeons at any level of health care. According to our study observations Alvarado scoring system has better sensitivity 74.68% but specificity 26.87% which shows that Alvarado scoring system is helpful in diagnosis of appendicitis but not much helpful in preventing negative laparotomies. Keywords: Right lower quadrant pain, Appendicitis scoring, Faecal peritonitis, Ultrasound abdomen, Perforated appendix. DOI : 10.7176/JMPB/55-15 Publication date :May 31 st 2019

Evaluation of Role of Laparoscopy in Diagnosis and Treatment of Non-Traumatic Acute Abdomen

Background: abdominal pain is a common complaint seen in emergency departments in United States. Abdominal pain is the leading reason for visits to the emergency department (ED), accounting for 6.8% of all visits in 2006. Aim of the Work: this study aimed to evaluate the diagnostic role of laparoscopy in acute abdominal conditions and its therapeutic role in perforated peptic ulcer, acute cholecystits and acute appendicitis. Patients and Methods: this study was conducted prospectively on 40 patients presented with acute abdomen to AlAzhar University hospitals from March 2018 till August 2018. 24 (60%) of patients were females and 16 (40%) were males. The age ranged from 20 to 60. Results: we accomplished complete laparoscopic diagnosis in 90% of cases, and avoided negative laparotomy in 5% of cases. We converted about 10% of laparoscopically diagnosed cases to open surgery for therapeutic purposes with significant reduction in complications in laparoscopic cases and mean hospital stay 2.6 days in laparoscopic cases vs. 5.3 days in open cases. Conclusion: laparoscopy was an excellent diagnostic tool. It was a very good therapeutic tool in acute appendicitis, acute cholecystitis and perforated peptic ulcer. It was also safe and satisfactory; also it saved more hospital beds.

Trends in diagnostic approaches for pediatric appendicitis: nationwide population-based study

BackgroundTo define the benefits of different methods for diagnosis of pediatric appendicitis in Taiwan, a nationwide cohort study was used for analysis.MethodsWe identified 44,529 patients under 18 years old who had been hospitalized with a diagnosis of acute appendicitis between 2003 and 2012. We analyzed the percentages of cases in which ultrasound (US) and/or computed tomography (CT) were performed and non-perforated and perforated appendicitis were diagnosed for each year. Multivariate logistic regression analyses were performed to evaluate risk factors for perforated appendicitis.ResultsThere were more cases of non-perforated appendicitis (N = 32,491) than perforated appendicitis (N = 12,038). The rate of non-perforated cases decreased from 0.068% in 2003 to 0.049% in 2012; perforated cases remained relatively stable at 0.024%~0.023% from 2003 to 2012. The percentage of CT evaluation increased from 3% in 2003 to 20% in 2012; the rates of US or both US and CT evaluations were similar annually. The percentage of neither CT nor US evaluation gradually decreased from 97% in 2003, to 79% in 2012. The odds ratios of a perforated appendix for those patients diagnosed by US, CT, or both US and CT were 1.227 (95% confidence interval (CI) 0.91, 1.65; p = 0.173), 2.744 (95% CI 2.55, 2.95; p < 0.001), and 5.062 (95% CI = 3.14, 8.17; p < 0.001), respectively, compared to patients who did not receive US or CT. The odd ratios of a perforated appendix for those patients 7–12 and ≤6 years old were 1.756 (95% CI 1.67, 1.84; p < 0.001) and 3.094 (95% CI 2.87, 3.34; p < 0.001), respectively, compared to those 13–18 years old.ConclusionsOur study demonstrated that using CT scan as a diagnostic tool for acute appendicitis increased annually; most patients especially those ≤6 years old who received CT evaluation had a greater risk of having perforated appendicitis. We recommend a prompt appendectomy in those pediatric patients with typical clinical symptoms and physical findings for non-complicated appendicitis to avoid the risk of appendiceal perforation.

Ultrasonography as a diagnostic tool in acute appendicitis: Rural setup

Background: Despite technological advances the diagnosis of appendicitis is still based primarily clinical assessment. The diagnosis of atypical appendicitis remains clinically challenging and is one of the most commonly missed problems in the emergency department. Ultrasonography is highly operator dependent with a consequently wide reported sensitivity range.Methods: This is a prospective study conducted in the department of surgery. All patients with right lower abdominal pain, admitted to HSK hospital Bagalkot, in whom acute appendicitis was suspected were analysed from January 2013 to June 2014.Results: In the present study appendix was visualized in 85% of the patients and periappendiceal collection was found in 7% of patients. Faecolith was found only in 1 case. Out of these 74 cases were uncomplicated acute appendicitis. Perforated acute appendicitis was diagnosed in 6 cases. One case was diagnosed as appendicular abscess and 4 cases were diagnosed as chronic appendicitis. Based on clinical assessment 4 patients were subjected to surgery after 48hours.Conclusions: Graded compression US remains our first line method in rural setup in the evaluation of patients referred with clinically suspected acute appendicitis.

Diagnostic value of serum hyperbilirubinemia in acute appendicitis and its complications

Background: To increase diagnostic accuracy and to decrease complication rates secondary to acute appendicitis, a variety of different approaches have been described, including predictive scoring systems. To prevent the catastrophic effects of perforated appendix, a surgeon needs diagnostic tools which may signal perforation of appendix at earliest, as a result of which the delay in the management of perforated appendix will not be witnessed. Keeping in view the above facts, the diagnostic value of serum bilirubin in acute appendicitis and its complications has been evaluated.Methods: This prospective study was conducted on 100 patients who presented with clinical diagnosis of Acute Appendicitis. Role of serum bilirubin as a diagnostic tool in acute appendicitis and diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation was evaluated. . Estimation of serum bilirubin was done by Jendrassik and Gorf method using Hitachi – 912 automatic biochemistry analyzer. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the investigations in the diagnosis of the acute appendicitis were calculated.Results: Serum bilirubin levels had a sensitivity of 84.1% and specificity of 83.3% in the diagnosis of acute appendicitis. The mean bilirubin level of patients with gangrenous appendicitis (2.1±1.2mg/dl) was significantly higher than the mean bilirubin level of patients with simple acute appendicitis (1.5 ±0.6) (p1=0.030 sig). A statistically significant difference was also observed in the mean bilirubin level of patients with perforated appendicitis (mean=2.9±1.6mg/dl) and mean bilirubin level of patients with simple acute appendicitis (p2=&lt;0.0001 sig). However statistically non-significant difference was observed between the mean bilirubin level of patients with gangrenous and perforated appendicitis (p3=0.056 non- sig).Conclusions:Pre-operative assessment of serum bilirubin not only helps in acute appendicitis but also serves as a predictive factor for appendiceal perforation.

Validity of Serum Total Bilirubin as a Diagnostic Tool for Acute Appendicitis

Objective: To study the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis and to evaluate whether elevated serum total bilirubin levels have a predictive potential for the diagnosis of complicated appendicitis Background: In acute appendicitis occurs through bacterial invasion in appendix leads to transmigration of bacteria and release of TNF-alpha, IL6 and cytokines. These reach the liver through superior mesenteric vein and may produce inflammation or dysfunction of liver either directly or indirectly by altering hepatic blood flow with rising of total serum bilirubin. Methods: This is a prospective cohort study including Ninety four (94) of adult patients have right iliac fossa pain attending to the Emergency Department (ED) at Suez Canal university Hospital. All 94 patients undergo total serum bilirubin measuring and post-operative histopathological examination of removed appendix. Results: In this study population of 94 patients and found that thirty-six male patient (38 %) and fifty-eight female patient (62 %), 81 patients (86.2%) were diagnosed as acute appendicitis while 13 patients (13.8%) were normal post-operatively by histopathological reports. Amongst the patients diagnosed with Acute appendicitis post-operatively, 57 patients (70.4%) were found to have elevated serum total bilirubin (>1.2mg/dL) while 24 patients (29.6%) had normal serum total bilirubin levels (≤1.2 mg/dL). Conclusion: Serum total bilirubin level appears to be a promising new laboratory marker for diagnosing acute appendicitis and have a predictive potential for the diagnosis of complicated appendicitis.

Evaluation of procalcitonin as a marker to predict antibiotic response in adult patients with acute appendicitis: a prospective observational study.

The aim of the study was to investigate the value of serum procalcitonin (PCT) as a predictor of early antibiotic treatment response in patients with acute appendicitis. Procalcitonin is a biochemical marker that increases rapidly in cases of bacterial infection and sepsis; however, the benefit of PCT as a diagnostic tool in acute appendicitis has not been confirmed. Observations of PCT dynamics were conducted as part of a prospective clinical trial at Sahlgrenska University Hospital between May 2009 and February 2010 on adult patients with acute appendicitis treated with antibiotics as first-line therapy. Procalcitonin, C-reactive protein (CRP), and white blood cell count (WBC) were measured before administration of antibiotics and subsequently between 4-24 h following treatment. Three hundred sixteen patients were included in the study. Almost 80% recovered on antibiotics without the need of surgery. Serum PCT concentrations before initiation of antibiotic therapy and during treatment did not differ significantly between antibiotic responders and non-responders (p<0.94). However, differences were observed for CRP (p<0.04) and WBC (p<0.001), with a trend for body temperature (p<0.06). Procalcitonin has limited additional value, compared with standard laboratory tests as CRP, WBC, and body temperature to predict antibiotic treatment response in adult patients with acute appendicitis.

Severity of appendicitis correlates with the pediatric appendicitis score

The pediatric appendicitis score (PAS) has been used as a diagnostic tool for the assessment of acute abdominal pain. Our institution has utilized this scoring system as part of a clinical pathway for acute appendicitis. We sought to discover if the PAS could also serve as a prognostic indicator. Patients treated within the clinical pathway were divided into three groups (A, B, and C) based on the PAS assigned on admission. Data pertaining to intraoperative findings and length of hospital stay were collected prospectively. In 4 months, 112 patients were enrolled in the study (median age 10.5, range 1-18). 69 of these patients underwent early laparoscopic appendectomy. For group A, 75% had simple appendicitis and 5% were complex. For group B, 68.4% patients had simple appendicitis and 26.3% were complex. For group C, 27.3% were simple and 63.6% were complex. Mean length of hospital stay increased from 1.63 ± 0.34 for patients in group A to 5.9 ± 1.37 for patients in group C. Our observational data suggests that the PAS may be a prognostic tool for acute appendicitis. It thereby may impact on preoperative management and postoperative clinical pathways. A larger cohort is necessary to validate our findings.

Sequential cytokine levels in the diagnosis of appendicitis

Objective. To determine the diagnostic value of sequential white blood cell count (WBC), tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6) in patients with abdominal pain. Material and methods. Tests were determined at hospital admission and 6 h later in 105 children. Patients who were non‐operatively followed and had a normal histopathology were classified as the non‐appendicitis (NA) group. Patients with symptoms consistent with appendicitis were classified as the appendicitis group (A). Data were analyzed as positive/negative predictive value, sensitivity, specificity and accuracy rate (AR). The global power of the variables in discriminating the patients between the two groups and advanced/simple appendicitis was assessed from the area under the receiver operating characteristic (ROC). Results. Initial measurements showed WBC to be a valuable diagnostic tool in acute appendicitis (AR = 74 %), whereas IL‐6 and TNF‐α were found not to be valuable. The second measurements revealed higher values, and IL‐6 reached its highest AR (89 %). When initial values were evaluated in combination, the highest AR of 73 % was observed with TNF‐α + WBC. The highest AR (90 %) was seen with IL‐6 + TNF‐α in the second measurements. ROC analysis showed WBC to be the most valuable parameter of the three. The area under the curve (AUC) was 0.750 for the initial measurement and 0.779 for the repeat measurement of WBC (p = 0.001). The most useful diagnostic parameter in discriminating between the simple and the advanced cases was IL‐6 as assessed with the ROC curve (p<0.01). Conclusions. WBC elevation in patients with suspected acute appendicitis is an important parameter supporting the diagnosis at initial admission, whereas IL‐6 is a more valuable tool in diagnosing advanced appendicitis.