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

2019 ◽  
Vol 6 (6) ◽  
pp. 1954
Author(s):  
Sailendra Nath Paul ◽  
Dilip Kumar Das
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Lower Abdominal Pain ◽  
Complication Rates ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Operative Findings

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<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.

scholarly journals Max appendicitis score: a new diagnostic score for diagnosing acute appendicitis

2017 ◽  
Vol 4 (9) ◽  
pp. 3067
Author(s):  
Vidur Jyoti ◽  
Akhilesh Kumar ◽  
Preeti Yadav ◽  
Vaibhav Kapoor
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Scoring Systems ◽  
Cost Effective ◽  
Alvarado Score ◽  
Diagnostic Score ◽  
Negative Appendicectomy ◽  
Appendicitis Score

Background: Scoring systems are valuable and valid for discriminating between acute appendicitis and nonspecific abdominal pain. Alvarado scoring is classical and different modifications of Alvarado score have been introduced but none is ideal and negative appendicectomy rate is still high. The aim of the study is to design a more reliable scoring system which is cost effective, simple, easy to learn, high accuracy, which can be applied by any doctor at any health care facility.Methods: Retrospective study of 160 patients hospitalized with abdominal pain suggestive of acute appendicitis and subsequently operated over a period of 5 year from January 2012 to January 2017 at Max Super Speciality Hospital, Gurgaon.Results: In the present study based on six clinically most significant variables, a diagnostic accuracy of 96.25% was achieved while the same was 85% for classical Alvardo Score. This significantly increased the diagnostic accuracy and lowered the negative appendicectomy rate.Conclusions: Max Appendicitis Score is perfect scoring system for diagnosing appendicitis, it can be specially very handy in peripheral health centers where radiological facilities are sparse.

scholarly journals Comparison of Alvarado score and pediatric appendicitis score for clinical diagnosis of acute appendicitis in children—a prospective study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Muhammad Adil Iftikhar ◽  
Sajid Hameed Dar ◽  
Usman Ali Rahman ◽  
Maliha Javaid Butt ◽  
Mohammad Sajjad ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Correct Diagnosis ◽  
Scoring Systems ◽  
Alvarado Score ◽  
Symptoms And Signs ◽  
Appendicitis Score

Abstract Background Acute appendicitis is the most common surgical condition of children. Differential diagnosis of an acutely inflamed appendix in children includes a vast variety of diseases which can present with the same symptoms and signs as acute appendicitis. It is an important factor for delay in diagnosis. Many scoring systems are being used to reach a diagnosis within time and to reduce the rate of negative appendectomies. The purpose of this study was to compare both scoring systems (Alvarado and pediatric appendicitis scoring system) and to know which one is better to establish an early correct diagnosis of acute appendicitis in pediatrics, thus decreasing the morbidity and burden on hospital resources. Although many studies had been completed at the international level for comparing both of these scoring systems, the pediatric population in our region was still awaiting such an effort. So a prospective cohort study was designed. A total of 180 patients were recruited with 95% confidence level and 5% margin of error. Every enrolled patient was awarded clinical scores according to both the Alvarado scoring system and the pediatric appendicitis scoring system. Patients having a score of 7 or more by both scoring systems were considered “seven or more than seven group” and their appendectomies were performed and histopathology reports were reviewed. Patients having a score of 7 in one system and less than 7 in the other/both were considered “less than seven group” and were admitted in the ward for further clinical evaluation and observation. Results At cutoff 7, the Alvarado score showed a sensitivity of 85.5%, specificity of 70%, PPV of 96.5%, NPV of 33.3%, and diagnostic accuracy of 84.11% while the pediatric appendicitis score showed a sensitivity of 93.8%, specificity of 70%, PPV of 96.8%, NPV of 53.8, and diagnostic accuracy of 91.59%. Conclusion The pediatric appendicitis score (PAS) is superior in diagnosing acute appendicitis in the pediatric population than the Alvarado score as indicated by the values of diagnostic accuracy. So it can be a good diagnostic tool for pediatric patients presenting with clinical symptoms and signs of appendicitis.

scholarly journals Comparison of RIPASA and Alvarado score in diagnosing acute appendicitis

2019 ◽  
Vol 6 (3) ◽  
pp. 740
Author(s):  
Suraj S. Kagwad ◽  
P. Karuppasamy
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Cost Effective ◽  
Clinical History ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: Acute appendicitis is a common cause of abdominal pain and can be difficult to diagnose, especially during its early stages.  The diagnosis of acute appendicitis is based on clinical history, examination combined with investigations. The purpose of this study is to compare between the RIPASA score and Alvarado score in the diagnosis of acute appendicitis. The aim of the present study was to compare the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Alvarado and RIPASA score.Methods: The cases for the study will be sourced from cases admitted in SVMCH and RC, Puducherry during the period of November 2016 to June 2018.Results: Out of the 144 patients in our study 133 patients were diagnosed with acute appendicitis as per HPE report.As per our study, sensitivity, specificity, PPV, NPV of RIPASA and Alvarado scoring system is 96.2%, 57.1%, 97.7% and 44.4%; 81.9%,85.7%, 95.1% and 20%  respectively. The diagnostic accuracy of RIPASA score is 94.3 as compared to 82.1 of Alvarado score.Conclusions: The RIPASA scoring system is a promising and has good sensitivity, specificity and diagnostic accuracy when compared to Alvarado scoring for Asian Population.RIPASA scoring system is an easy and reliable, cost effective diagnostic tool which reduce negative appendicectomy rates and the expensive radiological investigations for the diagnosis of acute appendicitis.

“A COMPARATIVE STUDY OF RIPASA SCORE AND ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS”

2021 ◽  
pp. 25-28
Author(s):  
M. Vijaya Kumar ◽  
Manasa Manasa
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Local Population ◽  
Scoring Systems ◽  
Signs And Symptoms ◽  
Alvarado Score ◽  
Predictive Values ◽  
Ripasa Score

Acute appendicitis is the most common condition encountered in the Emergency department .Alvarado and Modied Alvarado scores are the most commonly used scoring system used for diagnosing acute appendicitis.,but its performance has been found to be poor in certain population . Hence our aim was to compare the diagnostic accuracy of RIPASA and ALVARADO Scoring system and study and compare sensitivity, specicity and predictive values of these scoring systems. The study was conducted in Government district hospital Nandyal . We enrolled 176 patients who presented with RIF pain . Both RIPASA and ALVARADO were applied to them. Final diagnosis was conrmed either by CT scan, intra operative nding or post operative HPE report. Sensitivity,specicity, positive predictive value, negative predictive value, diagnostic accuracy was calculated both for RIPASA and ALVARADO. It was found that sensitivity and specicity of the RIPASA score in our study are 98.7% and 83.3%, respectively. PPV and NPV were 98.1% and 88.2% and sensitivity and specicity of the Alvardo score in our study are 94.3% and 83.3%, respectively. PPV and NPV were 98% and 62.5%.Diagnostic accuracy of RIPASA score and Alvarado score are 97% and 93% respectively. RIPASA is a more specic and accurate scoring system in our local population when compared to ALVARADO . It reduces the number of missed appendicitis cases and also convincingly lters out the group of patients that would need a CT scan for diagnosis (score 5-7.5 ) BACKGROUND: Acute appendicitis is one of the most commonly dealt surgical emergencies, with a lifetime prevalence rate of approximately 1 one in seven. The incidence is 1.5–1.9 per 1,000 in the male and female population, and is approximately 1.4 times greater in men than in women. Despite being a common problem, it remains a difcult diagnosis to establish, particularly among the young, the elderly and females of reproductive age, where a host of other genitourinary and gynaecological inammatory conditions can present with signs and symptoms that are 2 similar to those of acute appendicitis. A delay in performing an appendectomy in order to improve its diagnostic accuracy increases the risk of appendicular perforation and peritonitis, which in turn increases morbidity and mortality. A variable combination of clinical signs and symptoms has been used together with laboratory ndings in several scoring systems proposed for suggesting the probability of Acute Appendicitis and the possible subsequent management pathway. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and ALVARADO score are new diagnostic scoring systems developed for the diagnosis of Acute Appendicitis and has been shown to have signicantly higher sensitivity, specicity and diagnostic accuracy. AIMS AND OBJECTIVES PRIMARY OBJECT 1. To compare RIPASA Scoring system and ALVARADO Scoring system in terms of diagnostic accuracy in Acute Appendicitis. 2. To study and compare sensitivity, specicity and predictive values of above scoring systems. SECONDARY OBJECT 1. To study the rate of negative appendicectomy based on above scoring systems. CONCLUSION: The RIPASA score is a simple scoring system with high sensitivity and specicity for the diagnosis of acute appendicitis. The 14 clinical parameters are all present in a good clinical history and examination and can be easily and quickly applied. Therefore, a decision on the management can be made early. Although the RIPASA score was developed for the local population of Brunei, we believe that it should be applicable to other regions. The RIPASA score presents greater Diagnostic accuracy and Sensitivity and equal specicity as a diagnostic test compared to the Alvarado score and is helpful in making appropriate therapeutic decisions. In hospitals like ours, the diagnosis of AA relies greatly on the clinical evaluation performed by surgeons. An adequate clinical scoring system would avoid diagnostic errors, maintaining a satisfactory low rate of negative appendectomies by adequate patient stratication, while limiting patient exposure to ionizing radiation, since 21 there is an increased risk of developing cancer with computed tomography, particularly for the paediatric age group.

scholarly journals Diagnostic Accuracy of the Alvarado Scoring System in Patients Undergoing Appendicectomy at the University Teaching Hospital in Lusaka

2020 ◽  
Vol 4 (2) ◽  
pp. 21-28
Author(s):  
Songiso Mutumba ◽  
◽  
J Mulundika ◽  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Teaching Hospital ◽  
Roc Curve ◽  
Scoring System ◽  
Area Under The Curve ◽  
University Teaching ◽  
Alvarado Score ◽  
Negative Case ◽  
The University

Background: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis has been associated with a reduction of negative appendicectomies. This study aimed to assess the diagnostic accuracy of the Alvarado scoring system at predicting acute appendicitis in patients undergoing appendicectomy at the University Teaching Hospital (UTH). Methods: A prospective study was done to evaluate the diagnostic value of the Alvarado score in patients undergoing appendicectomy at the UTH. Data was collected from the participants diagnosed with acute appendicitis and undergoing appendicectomy. The Alvarado scores for all the participants enrolled into the study were tabulated and correlated with the histopathology results. The sensitivity and the specificity of the Alvarado score was determined and used to construct the ROC curve using the SPSS version 20. The area under the curve was used to determine the diagnostic accuracy of the Alvarado score in this study. Setting: The University Teaching Hospital in Lusaka, Zambia. Results: To determine the diagnostic accuracy of the Alvarado score the ROC curve test was run in SPSS version 20. The results showed that the area under the curve was C=0.842 with SE=0.047 and 95% CI from 0.750 to 0.934. The area under the curve represents the probability that the Alvarado score result for a randomly chosen positive case will exceed the result for a randomly chosen negative case. It shows from the ROC that the Alvarado score is a good indicator to anticipate acute appendicitis. In other words, these results have confirmed that the Alvarado scoring system has very high predictive ability to discriminate acute appendicitis from normal appendix subjects. Conclusion: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis at UTH will reduce the rate of negative appendicectomies. This will lead to a reduction in unnecessary operations, which are a burden on the health care system.

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 A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis

2018 ◽  
Vol 5 (3) ◽  
pp. 796
Author(s):  
Vamsavardhan Pasumarthi ◽  
C. P. Madhu
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Roc Curve ◽  
Predictive Value ◽  
Scoring System ◽  
Alvarado Score ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: The RIPASA Score is a new diagnostic scoring system developed for the diagnosis of Acute Appendicitis which showed higher sensitivity, specificity and diagnostic accuracy compared to ALVARADO Score, particularly when applied to Asian population. Not many studies have been conducted to compare RIPASA and ALVARADO scoring systems. Hence, author want to compare prospectively Alvarado and RIPASA score by applying them to the patients attending the hospital with right iliac fossa pain that could probably be acute appendicitis.Methods: A prospective analysis of 116 cases admitted with RIF pain during a 2 years period was performed. Patients between 15-60 years were scored as per Alvarado and RIPASA scoring system. Histopathological reports of the cases were collected and compared with the scores. ROC curve area analysis was performed to examine diagnostic accuracy of RIPASA and ALVARADO scores.Results: The sensitivity of ALVARADO score is estimated to be 52.08 for a cut off of 6. The specificity is 80%, positive predictive value is 92.59, negative predictive value is 25.81. The Diagnostic accuracy of ALVARADO scoring is found to be 56.9. The sensitivity, specificity, positive predictive value and negative predictive values of RIPASA scoring system are 75%, 65%, 91.14%, 35.14%. The diagnostic accuracy of RIPASA score is 73.28.Conclusions: The difference in the diagnostic accuracy between ALVARADO and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.

scholarly journals Comparative study between clinical diagnosis using modified Alvarado score and ultrasound imaging in decreasing negative appendectomy rate

2021 ◽  
Vol 8 (4) ◽  
pp. 1185
Author(s):  
Sayali S. Samudre ◽  
Anil S. Munde
Keyword(s):  
Acute Appendicitis ◽  
Comparative Study ◽  
Ultrasound Imaging ◽  
Health Resources ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score ◽  
Operative Findings ◽  
Fitting In

Background: Acute appendicitis is the acute inflammation of appendix which is the most common cause of acute surgical emergencies. Appendicitis can mimic other pathologies. Removing normal appendix is an economical burden both on patients and health resources. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis.Methods: This was prospective comparative study carried out in 200 patients over the period of 2 years. Patients with clinical features of acute appendicitis and fitting in inclusion and exclusion criteria were selected. Detailed history was noted and clinical examination was done. Necessary investigations were done, modified Alvarado score was calculated and all were subjected to ultrasonography of abdomen and pelvis. Intra operative findings were noted about nature of appendix and histopathology findings were noted.Results: The sensitivity of ultrasound is 78.19% and specificity is 50%. The sensitivity of modified Alvarado scoring system is 78.7% and specificity is 25%. Negative appendicectomy rate in the study was 6%.Conclusions: Modified Alvarado score has slightly higher sensitivity and ultrasound imaging has higher specificity of in the diagnosis of acute appendicitis and in decreasing negative appendicectomy rates. Ultrasound imaging provides good supportive diagnosis in cases of low or equivocal modified Alvarado scores.

scholarly journals A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective

2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Suman Baral ◽  
Neeraj Thapa ◽  
Raj Kumar Chhetri ◽  
Rupesh Sharma
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Scoring System ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Sensitivity Specificity

Introduction: Various diagnostic criteria have been described for acute appendicitis. For decades the most commonly used one has been Alvarado score. RIPASA scoring system has also been developed for Asian population which has shown highest sensitivity and diagnostic accuracy. This study aimed to compare these two diagnostic criteria in Nepalese population attending a tertiary center. Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination was taken as the gold standard for diagnosis. Statistical analysis was done using McNemar's test as applicable. Results: Ninety nine (90 %) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 94.5%, 27.27 %, 92.16 %, 37.5 %, 88.18% and 7.84% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 71.72%, 72.73 %, 95.95 %, 22.22%, 71.82 %, and 4.05 % respectively. 94.5% of patients were correctly stratified by RIPASA under higher probability group while only 71.8 % were classified by Alvarado (p value= 0.0001). Conclusion: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, this method can be applied in Nepalese setting for the diagnosis of acute appendicitis.

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

2017 ◽  
Vol 4 (12) ◽  
pp. 4029
Author(s):  
Rajkishore Singh ◽  
Rajiv Singh ◽  
Kulwant Singh
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Clinical Teaching ◽  
Research Centre ◽  
Medical Sciences ◽  
Alvarado Score ◽  
Major Procedure ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score

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.

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