scholarly journals Sensitivity and specificity of the Alvarado Score for the timely differential diagnosis of acute appendicitis for a case series in Samoa

2022 ◽  
pp. 103219
Author(s):  
Sione Pifeleti ◽  
Dyxon Hansell ◽  
Annette Kaspar
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Case Series ◽  
Alvarado Score

scholarly journals The use of ultrasonographic and Alvarado scores in evaluating abdominal pain suggestive of acute appendicitis

2017 ◽  
Vol 4 (2) ◽  
pp. 757 ◽  
Author(s):  
Jorge Fernández Álvarez ◽  
José Manuel Gómez López ◽  
Alberto M González Chávez ◽  
Benjamín Valente Acosta ◽  
Diego Abelardo Álvarez Hénandez ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Efficient Alternative ◽  
Two Parameters ◽  
The Right ◽  
Right Lower Quadrant

Background: Ultrasonographic scores for appendicitis to determine if, combined with Alvarado scores, they can increase the sensitivity and specificity of the diagnosis of appendicitis.Methods: All cases of abdominal pain suggestive of appendicitis presented between 2013 and 2015 were analysed. An Alvarado score was obtained. All patients underwent ultrasound, and an ultrasonographic score was determined, including the appendicitis classical findings.Results: Two hundred and fifty-one patients with abdominal pain in the right lower quadrant were analysed. Appendicitis was confirmed in 211 (84%) patients. For these patients, the average Alvarado score was 7.95/10 (±1.25) vs. 5.7/10 (± 1.11) for patients who did not have appendicitis (p < 0.001). In patients with confirmed appendicitis, the average ultrasonographic score was 2.48/6 (± 1.06) vs. 0.6/6 (± 0.92) for patients who did not have acute appendicitis (p < 0.001). The ultrasonographic score has a sensitivity of 90% and a specificity of 87% with only two parameters. The combination of the Alvarado and ultrasonographic scores decreased the percentage of negative appendectomies to 2.36% and increased the area under the curve by 0.970.Conclusions: The sum of the Alvarado and ultrasonographic scores provides an efficient alternative for diagnosing abdominal pain suggestive of appendicitis and predicts which patients should undergo surgery with good certainty.

VALIDAÇÃO DO ESCORE DE ALVARADO NO DIAGNÓSTICO DE APENDICITE AGUDA NOS PACIENTES DO HOSPITAL GERAL DE PALMAS: ANÁLISE RETROSPECTIVA DE 100 CASOS

2018 ◽  
Vol 5 (2) ◽  
pp. 25-28
Author(s):  
Luisa Coelho Milhomem ◽  
Luiz Antônio Gomes Amorim ◽  
Pedro Manuel González Cuellar
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Emergency Room ◽  
Sensitivity And Specificity ◽  
Diagnostic Method ◽  
Clinical Laboratory ◽  
Noninvasive Method ◽  
Alvarado Score ◽  
Cutoff Value ◽  
Suspected Diagnosis

RESUMO Objetivos: determinar a sensibilidade e especificidade do escore de Alvarado para o diagnóstico de apendicite aguda nos pacientes admitidos na emergência do Hospital Geral de Palmas. Métodos: o estudo foi realizado com a validação de método diagnóstico através do escore clínico-laboratorial para diagnóstico de apendicite aguda. A amostra estudada consistiu de 100 pacientes admitidos na emergência do HGP com dor abdominal e suspeita de apendicite aguda, no período de março a outubro de 2017. Os pacientes foram atendidos na emergência e avaliados quanto ao escore de Alvarado pelo cirurgião responsável, o residente de cirurgia e os internos. Resultados: tomando como ponto de corte o valor >7 pontos, encontramos uma sensibilidade de 71,05 % e especificidade de 84,93 %. Conclusões: o escore de Alvarado é um método pouco invasivo para diagnóstico, simples, rápido, que utilizando o ponto de corte >7 pontos, apresentou-se como um instrumento de alto valor na triagem dos nossos pacientes com suspeita diagnóstica de apendicite aguda. Palavras-chave: apendicite, diagnóstico, emergência. ABSTRACT Objectives: to determine the sensitivity and specificity of the Alvarado score for the diagnosis of acute appendicitis in patients admitted to the Emergency Hospital of Palmas. Methods: The study was performed with the validation of the diagnostic method through the clinical-laboratory score for the diagnosis of acute appendicitis. The sample consisted of 100 patients admitted to the emergency room of the HGP with abdominal pain and suspected of acute appendicitis, from March to October 2017. The patients were treated in the emergency room and evaluated for the Alvarado score by the surgeon in charge, the resident of surgery and the inmates. Results: taking as a cutoff value> 7 points, we found a sensitivity of 71.05% and specificity of 84.93%. Conclusions: The Alvarado score is a simple, fast, noninvasive method for diagnosis, which, using the cutoff point> 7 points was presented as a high-value instrument for the screening of our patients with suspected diagnosis of acute appendicitis. Keywords: appendicitis, diagnosis, emergency.

scholarly journals Raja Isteri Pengiran Anak Saleha Appendicitis score for the diagnosis of acute appendicitis in comparison with the Alvarado score

2020 ◽  
Vol 7 (2) ◽  
pp. 459
Author(s):  
Mannem G. K. Reddy ◽  
V. Mahidhar Reddy
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Scoring Systems ◽  
Signs And Symptoms ◽  
College Hospital ◽  
Alvarado Score ◽  
Threshold Point ◽  
Ripasa Score

Background: Different scoring systems have been created to increase diagnostic accuracy, and they are inexpensive, non-invasive, and easy to use and reproduce. The modified Alvarado score is widely used in emergency services. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was formulated in 2010 and has greater sensitivity and specificity. The aim of our article was to compare the usefulness of modified RIPASA score and Alvarado score in the diagnosis of patients with abdominal pain and suspected acute appendicitis.Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis, conducted at the Narayana medical college hospital, Nellore. The questionnaires used for the evaluation process were applied to the patients suspected of having appendicitis.Results: A total of 100 patients, 95% underwent laparoscopic procedure. The cut-off threshold point of the Alvarado score was set at 7.0, which yielded a sensitivity of 65% and a specificity of 52%. The positive predictive value was 65%. The cut-off threshold point of the modified RIPASA score was set at 7.5, which yielded 90% sensitivity and 72% specificity. The positive predictive value was 89% and the NPV was 30%.Conclusions: On comparing both the scores, sensitivity and specificity was higher for modified RIPASA score. The positive predictive value was higher for the Alvarado and negative predictive value was higher for RIPASA score. Bothe p values were statistically significant.

scholarly journals Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children

2019 ◽  
Vol 73 (4) ◽  
pp. 379-386
Author(s):  
Astra Zviedre ◽  
Arnis Eņģelis ◽  
Pēteris Tretjakovs ◽  
Irisa Zīle ◽  
Aigars Pētersons
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Laboratory Tests ◽  
School Age Children ◽  
School Age ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Serum Cytokines ◽  
Tnf Α

Abstract The aim of the study was to determine whether the Alvarado score (AS) together with laboratory tests could be used to distinguish patients with acute appendicitis (AA) from acute mesenteric lymphadenitis (AML). Fifty-seven patients (7–18 years) with suspected AA were included in the prospective study (October 2010 – October 2013). Thirty-one patients underwent surgery for AA and 26 were not treated surgically and were diagnosed AML on ultrasonography. AS, white blood cell count (WBC), C – reactive protein (CRP) and serum cytokines (EGF, IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, TNF-α) were obtained on admission and were compared between groups. Mean age of the 57 patients was 12.9 (SD 3.2). Accuracy (AR) for AS ≥ 7 alone was 73.7% for AA. Modified AS with certain serum cytokines seemed to be a reliable tool for initial differential diagnosis between AA and AML in school-age children. Based on these results, AS ≥ 7, WBC ≥ 10.7 × 103/µL and serum IL-6 ≥ 4.3 pg/mL assessed altogether will yield more sensitivity for AA. Also for further advanced diagnostics, we propose to take into account the serum IL-6, IL-8, MCP-1, CRP cut-off levels in the differential diagnosis between complicated and uncomplicated AA to decide whether the treatment should be conservative or surgical.

scholarly journals Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis

2020 ◽  
Vol 19 (3-4) ◽  
pp. 109-119
Author(s):  
Senol Tahir ◽  
Andrej Nikolovski ◽  
Martina Ambardjieva ◽  
Petar Markov ◽  
Dragoslav Mladenovik ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Clinical Laboratory ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Simultaneous Application ◽  
Number Of Patients

Introduction. The diagnosis of acute appendicitis (AA), as the most common cause of acute abdominal pain, has changed in the past decade by introducing scoring systems in addition to the use of clinical, laboratory parameters, and radiological examinations. This study aimed to assess the significance of the four scoring systems (Alvarado, Appendicitis Inflammatory Response (AIR), Raya Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis) in the prediction of delayed appendectomy. Materials and methods. The study included 100 respondents, who were diagnosed with AA in the period from January 2018 to February 2019 and were also operated on. In addition to the clinical, laboratory, and ultrasonographic examinations, four scoring systems (Alvarado, AIR, RIPASA, and Tzanakis) were used to diagnose AA. According to the obtained histopathological (HP) findings, the patients were divided into 3 groups: timely appendectomy, delayed appendectomy and unnecessary appendectomy. Using the sensitivity and specificity of all 4 scoring systems, ROC analysis was performed to predict delayed appendectomy. Results. In the study that included 100 patients (58% men, 42% women), after the appendectomy was performed, the resulting HP showed that 74% had a timely appendectomy, while 16% had delayed and 10% had an unnecessary appendectomy. For the prediction of delayed appendectomy, the area under the ROC curve showed a value of 0.577 for the Alvarado score, 0.504 for the AIR, 0.651 for the RIPASA, and 0.696 for the Tzanakis. Sensitivity and specificity for the Alvarado score was 54% and 62%, for RIPASA 62.5% and 63.5%, for Tzanakis 69% and 60.8%, respectively. Combining the three scoring systems (Alvarado, RIPASA, and Tzanakis), the surface area under the ROC curve was 0.762 (95% CI 0.521–0.783), with a sensitivity of 85% and a specificity of 62%. Conclusion. In our study, the diagnostic accuracy of RIPASA and Tzanakis showed better results than Alvarado, while AIR cannot be used to predict delayed appendectomy in our population. However, the simultaneous application of all three scoring systems, RIPASA, Tzanakis and Alvarado, has shown much better discriminatory ability, with higher sensitivity and specificity, as opposed to their use alone. Combining scoring systems should help in proper diagnosis to avoid negative appendectomy, but additional studies with a larger number of patients are needed to support these results.

scholarly journals A comparative study to assess efficacy of Tzanakis score and Alvarado score for effective diagnosis of patients with acute appendicitis at a tertiary care centre in North Karnataka: a one-year prospective analytical study

2020 ◽  
Vol 7 (6) ◽  
pp. 1742 ◽  
Author(s):  
Dron Sharma ◽  
R. S. Koujalagi
Keyword(s):  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Tertiary Care ◽  
Negative Appendectomy ◽  
Medical Procedure ◽  
Tertiary Care Centre ◽  
Alvarado Score ◽  
One Year ◽  
Effective Diagnosis

Background: Acute appendicitis standout amongst the most widely recognized reasons for intense stomach torment. There is no ideal symptomatic assessment apparatus to distinguish acute appendix if indications are ambiguous, bringing about longer analytic procedure and it might prompt deferring of medical procedure and related increment in morbidity and fatality. In the meantime, speedy management may prompt negative appendectomy with expanded morbidity and consumption of healthcare resources.Methods: A Hospital based one year prospective study was conducted at KLEs Dr Prabhakar Kore Hospital Belagavi, Karnataka from 1st January 2018 to 31st December 2018 and required data was collected from 100 patient who were clinically diagnosed to have acute appendicitis and all patients were assessed using Alvarado score and Tzanakis score and HPR for all patients were used as gold standard to evaluate the efficacy of both scoring systems.Results: The sensitivity and specificity of Tzanakis score was 80.6% (at score >8) and 100% (at score >8) respectively.  positive predictive value in present study being 100% and negative predictive value being 41.3%. The sensitivity and specificity of Alvarado score was 11.3% (at score >8) and 100% (at score >8) respectively.Conclusions: Tzanakis Score outperformed Alvarado score displaying higher sensitivity with similar specificity.

scholarly journals Comparison between AIR score and Alvarado score in cases of non-perforated and perforated acute appendicitis

2019 ◽  
Vol 6 (4) ◽  
pp. 1108
Author(s):  
Debabrata Gope ◽  
Anuradha Santosh Dnayanmote ◽  
Saurav Mahesh Thakkar ◽  
Akriti Rajkumar Tulsian ◽  
Shweta Achuthan Kutty ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Acute Abdominal Pain ◽  
Pathological Examination ◽  
Alvarado Score ◽  
Sensitivity Specificity ◽  
Higher Sensitivity

Background: Acute abdominal pain is a common complaint in the emergency department. Diagnostics of one of the most common pathologies behind acute abdominal pain, acute appendicitis, has radically changed over the last decades. There are several different diagnostic scores for suspected acute appendicitis. The Alvarado score being most widely known. Appendicitis Inflammatory Response (AIR) score was designed to overcome drawbacks of previous scores. This score incorporated the C-reactive protein value in its design and was developed and validated on a prospective cohort of patients with suspicion of acute appendicitis.Methods: Patients with pain in RIF were admitted. Scores were assessed, patients whose score was significant by either of the system were subjected for appendicectomy. The specimens of appendix were sent for histo-pathological examination (HPE). Post-operative histopathology report was correlated with the scores. Sensitivity, specificity, positive predictive value and negative predictive for AIR and Alvarado score were calculated.Results: For scores >4, AIR score has higher sensitivity and specificity. The negative predictive value (NPV) of AIR score was higher and the positive predictive value (PPV) of AIR score was also high. For scores >8, Alvarado score has higher sensitivity as compared to AIR score whereas AIR score has higher specificity as compared to Alvarado score. NPV of Alvarado score was higher while PPV of AIR score was higher.Conclusions: In this study AIR score had Alvarado score displaying higher sensitivity and specificity.

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

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