scholarly journals Alvarado Score: still relevant in diagnosis of acute appendicitis: a prospective study with histopathological correlation

2017 ◽  
Vol 4 (7) ◽  
pp. 2123
Author(s):  
Rushil Jain ◽  
Vimal Jain ◽  
Shalit Jolly
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Imaging Techniques ◽  
Clinical History ◽  
Negative Appendectomy ◽  
Emergency Setting ◽  
Likelihood Ratios ◽  
Alvarado Score ◽  
Predictive Values ◽  
Negative Appendectomy Rate

Background: Acute appendicitis is the most common abdominal emergency. Although abdominal surgeons have been encountering the acute appendicitis for more than 100 years, prompt diagnosis is still elusive in order to reduce morbidity and to avoid serious complications. Present study was conducted to evaluate the usefulness of Alvarado score in diagnosing acute appendicitis and its role in minimizing the negative appendectomy rate and correlating the same with histopathological findings of appendectomy specimens.Methods: This prospective correlational study was conducted in the Department of General Surgery, Mata Chanan Devi Hospital, New Delhi for a period of one year from January 2014 to December2014.Complete clinical history of the patients was collected in a predesigned proforma.  A complete physical and systemic examination was done for all patients. Based on the Alvarado scoring system the patients were divided into three categories. Category 1 (score ranging from 1-4), Category 2 (score ranging from 5-6), Category 3 (score ranging from 7-10). Specimen of removed appendix was sent for histopathological examination and clinically correlated those findings with Alvarado score. Sensitivity, specificity, positive negative likelihood ratios, positive and negative predictive values and negative appendectomy rate were calculated.Results: Out of 100 cases (56 males and 44 females) 15 belonged to category-I, 30 belonged to category-II and 55 belonged to category-III. Surgical procedures were done in 67 patients along with conservative management. Final diagnosis by histopathology was found in 58 cases. The sensitivity and specificity of Alvarado score was found to be 89.66% and 92.86% respectively. PPV and NPV of Alvarado score is 94.55% and 86.67% respectively. The negative appendectomy rate was 13.4%.Conclusions: Alvarado score is a simple non-invasive diagnostic procedure, which is reliable, safe, repeatable and economical, easy and can be used in emergency setting, without expensive and complicated supportive diagnostic tool in diagnosing acute appendicitis and thus still very much relevant in today’s modern era with availability of gamut of expensive imaging techniques.

scholarly journals A study on the clinical and sonological correlation in the diagnosis and management of acute appendicitis in a tertiary care centre

2019 ◽  
Vol 6 (6) ◽  
pp. 2053
Author(s):  
Keerthi Mudavath ◽  
Thinagaran K.
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Histopathological Examination ◽  
Iliac Fossa ◽  
Tertiary Care ◽  
Negative Appendectomy ◽  
Common Symptom ◽  
Emergency Setting ◽  
Alvarado Score ◽  
Histopathological Findings

Background: Acute appendicitis is the most common acute surgical condition of the abdomen requiring early intervention. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. Alvarado score for diagnosis of acute appendicitis is easy and additional tools like sonography results in accurate diagnosis. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological findings and histopathological examination for the diagnosis of acute appendicitis.Methods: 100 cases of acute abdomen admitted in PES institute of medical sciences and research, Kuppam from December 2016 to June 2018 were included. Clinical examination was done and all patients were subjected to ultrasound abdomen examination and other relevant blood and imaging investigations.Results: Out of 100 patients 62 were males and 38 were Females. Most common symptom was pain in the right iliac fossa and patients with Alvarado Score 7 or > 7 subjected to USG followed by emergency appendectomy showed positive operative findings and histopathological findings. The overall specificity of abdominal USG in the diagnosis of acute appendicitis was 88.09% and sensitivity was 95.37%.Conclusions:The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and less expensive useful, reliable and non invasive way of confirming acute appendicitis thus helps in reducing negative appendectomy rate. The overall accuracy of diagnosis of acute appendicitis goes up to 90% with positive histopathological findings. 

scholarly journals Negative Appendectomy Rate in Urban Referral Hospitals in Tanzania: A Cross-sectional Analysis of Associated Factors

2021 ◽  
Vol 18 (2) ◽  
pp. 109-114
Author(s):  
Masawa Klint Nyamuryekung’E ◽  
Ali Athar ◽  
Miten Ramesh Patel ◽  
Aidan Njau ◽  
Omar Sherman ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Associated Factors ◽  
Lifetime Risk ◽  
Histological Evaluation ◽  
Negative Appendectomy ◽  
Perforation Rate ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Referral Hospitals ◽  
Negative Appendectomy Rate

Background: Acute appendicitis (AA) has a lifetime risk of 8.3% with a consequent 23% lifetime risk of emergency appendectomy. In atypical presentation, making a clinical diagnosis is difficult, leading to a high perforation rate (PR) or misdiagnoses and high negativeappendectomy rates (NAR). This study aimed to establish NAR and explore the associated factors and possible attainable solutions to reduce it in urban referral hospitals in Tanzania. Methods: This was a crosssectional study with 91 consecutive patients, aged 10 years and older undergoing appendectomy for  suspected AA with histological evaluation of specimens. The study was powered to detect the NAR at 95% confidence level and 80% power. Results: The histological NAR was 38.5% and the perforation rate was 25.3%. The Alvarado score (AS) was rarely applied (6%), despite ademonstrated ability in this study to decrease the NAR by half. Females were four times more likely to undergo negative appendectomy than males. Conclusion: The NAR is clinically significant as about two out of every five patients undergoing emergency appendectomy for suspected AA do not require the procedure. The AS is underutilized despite a demonstrated ability to decrease the NAR. We recommend that the AS be incorporated in the management of patients with suspected appendicitis. Keywords: Negative appendectomy rate, SubSaharan Africa, Alvarado score, Appendectomy, Suspected acute appendicitis

scholarly journals A study of correlation between clinical, radiological and pathological diagnosis of appendicitis: a retrospective analytic study

2018 ◽  
Vol 5 (9) ◽  
pp. 3011
Author(s):  
Prabhu R. ◽  
Vijayakumar C. ◽  
Balagurunathan K. ◽  
Senthil Velan M. ◽  
Kalaiarasi R. ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Scoring System ◽  
Acute Abdominal Pain ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Radiological Finding ◽  
Clinical Signs ◽  
Emergency Setting ◽  
Alvarado Score

Background: Acute appendicitis is the most common cause of acute abdominal pain in young adults requiring emergency surgery. Appendicectomy is the most frequently performed surgery. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. A combination of clinical signs and symptoms with laboratory findings in many scoring systems are suggesting the probability of appendicitis and the possible subsequent management pathway. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological finding and histopathological examination for the diagnosis of acute appendicitis.Methods: A retrospective study was conducted in the department of general surgery in a tertiary care centre in South India. Total of 237 patients with acute abdominal pain were included and evaluated with the clinical Alvarado scoring system, radiological finding with (USG/CT abdomen) and histopathological examination for the diagnosis of acute appendicitis. The data was collected and analyzed retrospectively.Results: Of the 237 patients, 164 patients were male (69.1%) and rest is female. The correlation of the Alvaroda score with histopathological findings in groups with score > 7 and ≤7 the correlation of Alvarado score and the ultrasound findings were comparable between the study groups. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score >7 was 72.99%. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score ≤7 was decreased to 27%.Conclusions: The diagnostic accuracy of clinical features is far better than radiological investigations in the diagnosis of acute appendicitis. Therefore, it is concluded that it is better to use radiological investigations only to confirm the diagnosis of acute appendicitis rather to diagnose it.

scholarly journals Alvarado score and computerized tomography scan as impact indicator in intervening negative appendectomy rate

2020 ◽  
Vol 7 (4) ◽  
pp. 1223
Author(s):  
Braja Mohan Mishra ◽  
Pramit Ballav Panigrahi ◽  
Sandeep Mishra ◽  
Abinasha Mohapatra
Keyword(s):  
Ct Scan ◽  
Histopathological Examination ◽  
Length Of Hospital Stay ◽  
Negative Appendectomy ◽  
Impact Indicator ◽  
Alvarado Score ◽  
Combined Use ◽  
Positive Score ◽  
Negative Appendectomy Rate ◽  
The Impact

Background: The objective of this study is to study the impact of combined use of Alvarado score and computed tomography (CT) scan on negative appendectomy rate.Methods: This prospective observational study comprising of patients presenting with clinical features of appendicitis admitted to department of general surgery, VIMSAR, Burla from November 2017 to October 2019, where Alvarado score and ultrasonography (USG) findings are mismatching each other. Alvarado scores calculated and categorized in 2 groups as negative (score <4) and positive (score ≥4). These patients were also subjected to USG and categorized as negative (USG -ve) and positive (USG +ve). Those patients having discrepancy in both the findings were subjected to CT scan. On histopathological examination, inflamed appendix in 63 (97%) patients and non-inflamed in 2 (3%). Rest patients were either discharged (both -ve) or operated (both +ve). Results: Total 84 patients showed discrepancy between Alvarado score and USG findings and are subjected to CT scan abdomen and pelvis. CT scan was positive for appendicitis in 65 cases (where appendectomy done) and negative for appendicitis in 19 cases (where the diagnosis is different). patient. Thus, negative appendectomy (NAR) is 3% in this study.Conclusions: Alvarado score and ultrasonography could not be used as absolute tool in doubtful and equivocal cases, where combined use of CT scan with Alvarado score and USG has definitely has an edge by diagnosing the differentials and reducing NAR followed by reduction in cost and length of hospital stay.

scholarly journals Clinical and histopathological analysis of the patients undergoing appendectomy

2018 ◽  
Vol 8 (2) ◽  
pp. 1337-1340
Author(s):  
Kamal Koirala ◽  
Shiva Raj KC ◽  
Ganesh Simkhada ◽  
Rupesh Mukhiya ◽  
Nisheem Pokharel ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Diagnostic Tools ◽  
Histopathological Analysis ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Female Ratio ◽  
Medical College ◽  
Clinical Scoring ◽  
Modified Alvarado Score

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.

scholarly journals Accuracy of Ultrasound in the Diagnosis of Acute Appendicitis and Correlation with Histopathology

2018 ◽  
Vol 8 (2) ◽  
pp. 13-19
Author(s):  
Aimandu Shrestha ◽  
Hensan Khadka ◽  
Baburam Poudel ◽  
Ranga Bahadur Basnet ◽  
Siv Bahadur Basnet
Keyword(s):  
Acute Appendicitis ◽  
Leukocyte Count ◽  
Total Leukocyte Count ◽  
Radiology Department ◽  
Clinical Impression ◽  
Negative Appendectomy ◽  
Differential Leukocyte Count ◽  
Diagnostic Modality ◽  
Predictive Values ◽  
Negative Appendectomy Rate

Introduction: Acute appendicitis is a common surgical condition; yet its diagnosis can be elusive at times and missed diagnosis can lead to attendant complications of perforation and its sequelae. On the contrary, negative appendectomy subjects one to unnecessary surgery and its physiological and psychological consequences. Among the various available modalities of diagnosis of appendicitis, Ultrasonography(USG) is easily accessible, non invasive, less time consuming, low cost investigation no radiation hazards. So, USG is appropriate diagnostic modality in our country.Methods: This prospective observational study was carried out from January 2011 to June 2011, in the radiology department of Bir hospital. Total of 80 cases with clinical impression of acute appendicitis were enrolled. These patients underwent surgery for suspected acute appendicitis. Details of signs and symptoms, lab findings including Total Leukocyte count (TLC), Differential Leukocyte Count (DLC) and USG findings were recorded. Intra-operative and histopathology findings were also recorded. The findings were analyzed to assess accuracy of ultrasonography in acute appendicitis. Histopathological report was considered the goal standard.Results: A total of 93 cases clinically diagnosed as acute appendicitis were subjected for USG. Out of 93 cases, 80 cases underwent surgery. Among 80 cases, sonography showed acute appendicitis in 56 cases out of which 54 was proved by histopathology as well. However, ultrasonography was not able to detect appendicitis in 9 cases. The sensitivity and specificity of USG for acute appendicitis were 87.7% and 88.2% respectively. The positive and negative predictive values were 96.4% and 62.5% respectively. Overall negative appendectomy rate of 21.2% had been used a basis for decision making, the rate of error being 13.7%.Conclusion: Ultrasonography is a fairly accurate and safe modality in acute appendicitis. It can be useful in reducing negative appendectomy rate.

scholarly journals Acute Appendicitis in Children: Comparison of clinical diagnosis versus modified Alvarado score system

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Mukhtar Hussain ◽  
Muhammad Kashif ◽  
Shafiq Ahmad ◽  
Haroon Khurshid Pasha
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
False Positive ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Score System ◽  
Pain Abdomen ◽  
Group I ◽  
Negative Appendectomy Rate ◽  
Modified Alvarado Score

Objective: To compare the accuracy of clinical diagnosis of Acute Appendicitis with that of Alvarado Score System in Children. Design: A Prospective and Comparative Study. Patients and Duration of Study: Department of Pediatric Surgery, Nishtar Medical College & Hospital, Multan from January 200I to June 2002. All patients of pain abdomen with suspicion of acute appendicitis were included in study. Subjects and methods: 92 patients were admitted with pain abdomen, After preliminary history and examination sixty were suspected of acute appendicitis. A Detailed history, clinical examination and relevant investigations were done. These patients were divided in two equal groups of 30 each. In group-I all the findings were entered on Performa based on the indicants of modified Alvarado Score. Later on their Score was calculated according to the assigned weight-age of each indicant. Twenty-eight patients were submitted for Surgery having Alvarado Score of >7. In group-II patients were clinically evaluated by one of the consultant to declare the diagnosis of Acute Appendicitis or otherwise. Twenty-nine out of 30 were submitted for surgery in this group. Three cases turned out to be of mesenteric lymphadenitis confirmed on Ultrasonography. The diagnosis of Acute Appendicitis was further confirmed by Histopathology of appendix after removal. Hence the accuracy of both methods was compared. Results: The diagnostic accuracy of Alvarado Score was 85.71% with false positive or negative appendectomy rate of 14.29% while the accuracy of clinical diagnosis was 93.01% with false positive or negative appendectomy rate of 6.99%.

scholarly journals A Comparative Study of RIPASA Score and Modified Alvarado Score in Acute Appendicitis in Nepalese Population

2019 ◽  
Vol 2 (2) ◽  
pp. 224-228
Author(s):  
Niroj Banepali ◽  
Kamal Koirala ◽  
Rupesh Mukhiya ◽  
Rakesh Roshan Sthapit
Keyword(s):  
Acute Appendicitis ◽  
College Teaching ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Medical College ◽  
Lower Specificity ◽  
Negative Appendectomy Rate ◽  
Modified Alvarado Score ◽  
Ripasa Score

Introduction: Although acute appendicitis is a common surgical condition, its diagnosis can be elusive at times with misdiagnosis leading to serious complications. Various scoring systems have been developed to overcome this dilemma and the reported accuracies of these scores vary greatly.Materials and Methods: A retrospective review of charts was carried out to identify all patients admitted to KIST medical college teaching hospital from May 2015 to April 2016 with the diagnosis of acute appendicitis. A total of 120 cases that underwent surgery for suspected acute appendicitis were included. Modified Alvarado score and RIPASA scores were computed for each patient and the suggested cutoff values were used to find out the accuracy of these scores. Histopathological confirmation/report was considered as the standard for comparison.Results: A negative appendectomy rate of 11.67 % was observed (9.64 % for males and 16.22 % for females). Complicated appendicitis was found in 27.36% of patients. Modified Alvarado score had a sensitivity of 61.32 % and specificity of 71.43 % at a cut of value of 7. At cut off of > 7.5 for acute appendicitis, RIPASA score had a sensitivity of 97.17% and specificity of 57.14%. The accuracy of Modified Alvarado score was 62.5% while it was 92.5% for RIPASA score.Conclusions: RIPASA score demonstrated higher sensitivity and accuracy but lower specificity compared to the modified Alvarado score in our study group. More studies with larger sample size need to be carried out for further validation of this new score.

scholarly journals Usefulness of Modified Alvarado Score in Diagnosis of Acute Appendicitis in Adults

2015 ◽  
Vol 14 (4) ◽  
pp. 336-338
Author(s):  
Hari Pada Mondal ◽  
Md. Hadiuzzaman ◽  
Chandranath Mukhopadhyay ◽  
Shibram Chattopadhyay ◽  
Sajal Kumar Biswas ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Scoring System ◽  
Medical Science ◽  
Clinical Signs ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Negative Appendectomy Rate ◽  
Modified Alvarado Score

Background: Definitive diagnosis of acute appendicitis preoperatively is sometimes difficult. Failure to make a diagnosis is the main reason for persistent rate of morbidity and mortality. Various scoring systems are devised to aid diagnosis of acute appendicitis. In some studies the modified Alvarado score was helpful, reliable and practical in minimizing unnecessary appendectomy. Objective: The purpose of this study was to evaluate the usefulness of modified Alvarado score for the diagnosis of acute appendicitis. Materials and Method: A prospective study of 89 adult patients, admitted with abdominal pain suggestive of acute appendicitis, from July 2011 to June 2012, was conducted. Data including clinical signs and symptoms and laboratory findings were recorded in modified Alvarado score record form. All 89 patients underwent appendectomy. Final diagnosis was confirmed by histopathological examination. Reliability of scoring system was assessed by negative appendectomy rate and positive predictive value. Results: Out of 89 patients who underwent appendectomy, 85 had acute appendicitis on histopathology. Positive predictive value was 95.5% and negative appendectomy rate was 4.5%. 52.8% had score 7 or above and 47.2% had score less than 7. From score it is difficult to predict which patient warranted appendectomy and who may be safely observed or discharged. Conclusions: Diagnosis of acute appendicitis remains mainly clinical evaluation and it is more helpful than modified Alvarado scoring system in adults.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.336-338

scholarly journals Diagnosis and management of acute appendicitis by Alvarado scoring with ultrasonography as supportive tool

2017 ◽  
Vol 4 (8) ◽  
pp. 2806 ◽  
Author(s):  
Chenna Krishna Reddy Chada ◽  
Srikrishna Malepati ◽  
Jithendra Kandati ◽  
Sreeram Satish
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Open Appendectomy ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Predictive Values ◽  
Female Ratio ◽  
Male Predominance ◽  
Sensitivity Specificity

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Delay in management results in complications and misdiagnosis results in negative appendectomy. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. Alvarado score for diagnosis of acute appendicitis is an easy, affordable and diagnostic which has been evaluated early with variable reports. In cases with equivocal score, additional tools like sonography may provide a reliable result in accurate diagnosis of acute appendicitis. Objective of the study was to determine the diagnostic accuracy of Alvarado score and ultrasonography in diagnosis of acute appendicitis. To determine the sensitivity, specificity and predictive values of ultrasonography in cases operated with histopathological correlation.Methods: A prospective observational study was conducted at our hospital by department of general surgery for a period of six months. All suspected cases of appendicitis were scored by Alvarado score and cases with>5 were performed additional USG for further evaluation. All the cases of appendicitis that underwent surgery were further confirmed by histopathological correlation with USG and clinical Alvarado score.Results: A total of 200 cases were enrolled with male predominance (57.5%) and mean age of study group was 34.26±8.64 years and male to female ratio of 1.3:1.69% of cases presented with Alvarado score of 7 and above, while 21% of cases with 5-6. Migratory pain in RIF was the commonest symptom and tenderness RIF was the most common sign.160 cases (80%) were operated totally with 75% cases lap appendectomy and 25% cases by open appendectomy. USG was performed on 160 cases and 146 were positive and 14 were negative whereas histopathologically 142 cases were confirmed as Acute appendicitis. The sensitivity, specificity, PPV and NPV of USG is 97.18%, 55.56%, 94.52% and 71.43%. The accuracy of USG is 92.5.Conclusions: Acute appendicitis is first and foremost a clinical diagnosis with scoring systems and imaging being necessary adjuncts in equivocal cases. USG is an easily available tool in diagnosis of acute appendicitis. Application of USG as adjunct tool to Alvarado scoring improves the diagnostic accuracy.

Sign in / Sign up

Export Citation Format

Share Document