scholarly journals Evaluation of negative appendicectomy rate in cases of suspected acute appendicitis and to study the usefulness of ultrasonography in improving the diagnostic accuracy

2007 ◽  
Vol 69 (5) ◽  
pp. 194-197 ◽  
Author(s):  
Rajeev Sharma ◽  
Dev K. Kasliwal ◽  
Raj G. Sharma
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Negative Appendicectomy ◽  
Suspected Acute Appendicitis

EP.FRI.615 Assessing the reliability of the Adult Appendicitis Score in managing patients with suspected acute appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Carry Zheng ◽  
Shiela Lee ◽  
Steven Brown ◽  
Venkat Kanakala
Keyword(s):  
Acute Appendicitis ◽  
Risk Group ◽  
Pathological Finding ◽  
High Risk Group ◽  
Histological Diagnosis ◽  
Suspected Appendicitis ◽  
Tertiary Centre ◽  
Negative Appendicectomy ◽  
Age Range ◽  
Suspected Acute Appendicitis

Abstract Aims To evaluate the effectiveness of using a clinical prediction tool in the management of suspected acute appendicitis Methods Retrospective data was collected on patients undergoing appendicectomy at a single tertiary centre from November 2019 to June 2020. Inclusion criteria were all patients aged 18 and above undergoing diagnostic laparoscopy for suspected appendicitis. Exclusion criteria were all patients that had a pathological finding other than appendicitis at laparoscopy. The pre operative AAS score at first presentation was calculated and patients grouped into low(0-10), intermediate(11-15), and high(16 and above) risk. These groups were then compared to the histological findings. Results A total of 74 patients were included, 44 male and 30 female. The age range was from 18 to 83, with a median age of 36. Of 10 patients in the low risk group, 4 (40%) had appendicitis on histology. 36 out of 40 (90%) patients in the intermediate risk group had appendicitis and 100% of the 24 patients in the high risk group. Pearson’s coefficient showed a significant correlation between the AAS risk (low, intermediate, and high) and the histological diagnosis of appendicitis (r = 0.48, p = 0.000016). Conclusions Our study did show a positive correlation between the AAS risk stratification and histological diagnosis. Based on our findings we would recommend the adoption of this score in assessing patients with suspected acute appendicitis and minimising the negative appendicectomy rate.

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 Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments

2021 ◽  
Author(s):  
Kinda Altali Alhames ◽  
Francisco Javier Martín-Sánchez ◽  
Pedro Ruiz-Artacho ◽  
Francisco Javier Ayuso ◽  
Victoria Trenchs ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Emergency Departments ◽  
Low Risk ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Old Patients ◽  
Reactive Protein ◽  
Surgical Data ◽  
Suspected Acute Appendicitis

Objective. Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. Materials and methods. This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. Results. A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0). Conclusions. CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.

scholarly journals A three year prospective study-suspected acute appendicitis: diagnostic accuracy of modified Alvarado score versus ultrasonography in adults

2017 ◽  
Vol 4 (12) ◽  
pp. 3924
Author(s):  
Murhari D. Gaikwad ◽  
Anand Auti ◽  
Avinash Magare
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Prospective Study ◽  
Predictive Value ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Modified Alvarado Score ◽  
Suspected Acute Appendicitis

Background: To evaluate and compare diagnostic accuracy of modified Alvarado score and ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis.Methods: A prospective study of the patients who underwent appendectomy for suspected acute appendicitis at IIMS and R Medical College and Noor Hospital Warudi, Badnapur, Dist. Jalna (Maharashtra). The clinical (radiological) and ultrasonography data of 760 patients with suspected appendicitis was collected between March 2014 to Feb. 2017. These patients were evaluated by modified Alvarado score and ultrasonographically, which was corrected with histopathological finding.Results: Out of 760 patients 69.34% had acute appendicitis 63.81% had modified Alvarado score≥7 and 58.28% patients were ultrasonographically positive. In present study modified Alvarado score has sensitivity of 89.37% specificity 93.99% positive predictive value 97.11%, negative predictive value 79.64%, diagnostic accuracy of 81.32%.Conclusions: Modified Alvarado score can be used effectively in clinical decision making. When compare with ultrasonography neither one is advantageous. However, additional information provided by ultrasonography improves diagnostic accuracy.

scholarly journals ACUTE APPENDICITIS;

2014 ◽  
Vol 21 (06) ◽  
pp. 1139-1143
Author(s):  
Zahid Saeed
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Acute Abdomen ◽  
Carcinoid Tumour ◽  
Diagnostic Tools ◽  
Associated Conditions ◽  
Proper Diagnosis ◽  
Negative Appendicectomy ◽  
Appendiceal Inflammation ◽  
Time Of Presentation

Background: Acute appendicitis is the commonest cause of acute abdomen presenting in emergency room, which is mainly diagnosed on clinical grounds. Objective: To determine the diagnostic accuracy in patient of acute appendicitis and to review the pathological diagnosis. Material and Method: A retrospective study was conducted at PNS SHIFA hospital at Karachi; from May 2012 to April 2013. A total of 120 patients were included in the study who presented with acute abdomen and clinically diagnosed as acute appendicitis. Emergency appendectomy was done in all consecutive subjects and intra operative finding along with histo-pathological reports were compared with clinical diagnosis. Results: A total of 120 patients were included in the study who underwent appendicectomy during this period. The majority of our patients were in the age group between 15-30 years (66.5%) and presented within 24 h of onset of symptoms. The most common symptoms were abdominal pain (100%), vomiting (57.4%) and anorexia (49.0%). Pyrexia was noted in 41.0%.Localized abdominal tenderness with positive release sign was mainly present. The most common incision was gridiron (57.2%) followed by Lanz (37.3%) and in remaining Rutherford Morrison incision was made. Acute appendiceal inflammation and gangrenous appendicitis was present in 67% and 13%, respectively. The perforation rate was 5.0% and there was a direct correlation with time of presentation. There were no patients with carcinoid tumour or adenocarcinoma. Parasites and other associated conditions were seen in 3 % of cases. On the basis of histo-pathological report, 84% were found to have acute appendicitis with negative appendicectomy rate of 16.0%. Conclusions: Clinical surgical skill is good enough to diagnose acute appendicitis but auxiliary diagnostic tools can help to elevate the diagnostic accuracy,but these are not 100% accurate and at times may not be available.So clinial good judgement is essential for proper diagnosis and that can be confirmed by histopathology report.

The Value of Scoring Systems for the Diagnosis of Acute Appendicitis

2015 ◽  
Vol 87 (2) ◽  
Author(s):  
Dominik A. Walczak ◽  
Dariusz Pawełczak ◽  
Agata Żółtaszek ◽  
Rajmund Jaguścik ◽  
Wojciech Fałek ◽  
...  
Keyword(s):  
Data Analysis ◽  
Acute Appendicitis ◽  
Hospital Admission ◽  
Diagnostic Accuracy ◽  
Scoring Systems ◽  
Diagnostic Value ◽  
Accurate Diagnosis ◽  
Normal Appendix ◽  
Detailed Medical History ◽  
Suspected Acute Appendicitis

AbstractAccurate diagnosis of acute appendicitis (AA) is still a problem and is not always easy, even for experienced surgeons. Studies have shown that 20 to 30% of the appendices removedwere normal. Therefore, various scoring systems have been developed to aid in the diagnosis of doubtful cases and reduce the number of unnecessary appendectomies.The aim of this study was to assess the diagnostic value of different scoring systems in acute appendicitis.Material and methods. The study involved 94 patients who underwent laparotomy due to suspected acute appendicitis. Medical examination at hospital admission was performed by a resident and a general surgery specialist. The probability of AA was evaluated using six different scoring systems: Alvarado, Fenyo, Eskelinen, Ohman, Tzankis, and RIPASA. The resident calculated the results in individual systems. The decision to perform the operation was taken by a specialist surgeon who did not know the results.Results. Normal appendix was removed in 26% of cases. Eskelinen, RIPASA and Alvarado systems showed highest sensitivity (99%, 88% and 85%, respectively). Tzankis and Fenyo systems showed highest specificity (62% and 50%, respectively).Conclusions. Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis

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