Evaluation of Clinical Alvarado Scoring System and CT Criteria in the Diagnosis of Acute Appendicitis

Aim. The aim was to evaluate the clinical Alvarado scoring system and computed tomography (CT) criteria for the diagnosis of acute appendicitis.Material and Methods. 117 patients with acute abdominal pain who underwent abdominal CT were enrolled in this retrospective study. Patient demographics, clinical Alvarado scoring, CT images, and pathologic results of the patients were evaluated.Results. 39 of the 53 patients who were operated on had pathologically proven acute appendicitis. CT criteria of appendiceal diameter, presence of periappendiceal inflammation, fluid, appendicolith, and white blood cell (WBC) count were significantly correlated with the inflammation of the appendix. The best cut-off value for appendiceal diameter was 6.5 mm. The correlation between appendiceal diameter and WBC count was 80% (P=0.01<0.05). The correlation between appendiceal diameter and Alvarado score was 78.7% (P=0.01<0.05).Conclusion. Presence of CT criteria of appendiceal diameter above 6.5 mm, periappendiceal inflammation, fluid, and appendicolith should prompt the diagnosis of acute appendicitis. Since patients with acute appendicitis may not always show the typical signs and symptoms, CT is a helpful imaging modality for patients with relatively low Alvarado score and leukocytosis and when physical examination is confusing.

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

10.36106/ijar/3200856 ◽

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.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20183446 ◽

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.

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CLINICOPATHOLOGICAL STUDY OF ACUTE APPEDDICITIS WITH SPECIAL REFERENCE TO THE ROLE OF WBC COUNT, C-REACTIVE PROTEIN (CRP), USG AND ALVARADO SCORE IN DIAGNOSIS

10.36106/ijsr/6025101 ◽

2020 ◽

pp. 59-61

Author(s):

Md. Mushir Reyaz ◽

Kumari Pallavi ◽

C. M. Narayan ◽

Debarshi Jana

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Scoring System ◽

Iliac Fossa ◽

The Other ◽

C Reactive Protein ◽

Alvarado Score ◽

Reactive Protein ◽

Right Iliac Fossa Pain ◽

Wbc Count

Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies. Methods: A total 140 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of WBC count, C-Reactive protein (CRP), USG and Alvarado scoring system and were subsequently operated, were included in the present study in our institute. Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients.Most of the patients of acute appendicitis presented with more than one of above symptoms. The most common presenting symptom was right iliac fossa pain affecting 96.19% of cases (migratory 62.86% and non-migratory 33.33%), followed by anorexia (78.10%) and nausea (66.67%). The other symptoms were fever (65.71%), vomiting (46.67%), constipation (28.57%), right sided flank pain (22.86%), dysurea (19.05%), suprapubic pain (15.24%), diarrhoea (14.29%) and generalized abdominal pain (13.33%) in decreasing order of frequency. Right iliac fossa pain was the most common presentation in non-appendicitis group, followed by anorexia. There was no significant difference in symptoms among these two groups.In this study 54.29% of patients with acute appendicitis had Alvarado score between 7 – 8 and 34.29% of patients with acute appendicitis had Alvarado score between 9 – 10. On the other hand majority of the patients of non-appendicitis group had a score below 7. Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.

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Effectiveness of Modified Alvarado Scoring System for Diagnosis of Acute Appendicitis

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/660 ◽

2021 ◽

Vol 10 (37) ◽

pp. 3252-3256

Author(s):

Suhas Devanathan ◽

Darshana Tote ◽

Sandip Shinde

Keyword(s):

Acute Appendicitis ◽

Acute Abdomen ◽

Predictive Value ◽

Scoring System ◽

Age Groups ◽

Clinical Signs ◽

Signs And Symptoms ◽

Alvarado Score ◽

Modified Alvarado Score ◽

Ripasa Score

BACKGROUND Acute appendicitis is very commonly diagnosed when a patient presents with acute abdomen. This is more commonly seen in the young and middle-aged individuals. The clinical signs and symptoms determine the diagnosis and management. Scoring systems are in plenty to diagnose acute appendicitis and mainly include the presenting signs and symptoms, but are not acceptable for all populations with different age groups. Modified Alvarado scoring system is a timed tested scoring system used in different populations and age groups with good efficacy and to provide a bedside clinical diagnosis of acute appendicitis. The purpose of this study was to assess effectiveness of modified Alvarado score in the early diagnosis of acute appendicitis. METHODS A prospective observational study was done which incorporated 50 patients presenting with the signs and symptoms pointing out to acute appendicitis, clinically. The patients were evaluated by Modified Alvarado score during admission and based on the treating surgeon’s decision, were operated. Finally, the score was compared with the diagnosis achieved with a histopathological examination of the operated specimen. RESULTS The sensitivity of raja isteri penigran anak saleha appendicitis (RIPASA) score was 70.58 %, specificity was 68.75 %, positive predictive value (PPV) was 82.75 %, negative predictive value (NPV) of RIPASA score was 52.38 % and the diagnostic accuracy of RIPASA score was 70 %. CONCLUSIONS Modified Alvarado scoring system is simple scoring system which can be used in a bedside manner but uses specific and limited features for the diagnosis of acute appendicitis which limits the effectiveness of this scoring system. KEY WORDS Acute Abdomen, Clinical Scoring System, Modified Alvarado Scoring System

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Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00074-y ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Ademola Olusegun Talabi ◽

Tewogbade Adeoye Adedeji ◽

Oludayo Adedapo Sowande ◽

Olusanya Adejuyigbe

Keyword(s):

Acute Appendicitis ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

C Reactive Protein ◽

Blood Cell Count ◽

Alvarado Score ◽

Reactive Protein ◽

Wbc Count

Abstract Background The diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis. Results The ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001. Conclusion Alvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

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Predictive Value of Alvarado Score and Ultrasound in the Diagnosis of Acute Appendicitis (A prospective study

Journal of the Faculty of Medicine Baghdad ◽

10.32007/jfacmedbagdad.6241807 ◽

2021 ◽

Vol 62 (4) ◽

pp. 99-103

Author(s):

Waleed Saadi Ahmed ◽

Salah M. Tajer ◽

Hend M. Sayaly

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Signs And Symptoms ◽

Cost Effective ◽

General Surgeon ◽

Emergency Ward ◽

Alvarado Score ◽

Combined Application ◽

Abdominal Emergencies ◽

A Prospective Study

Background: Acute appendicitis is the commonest non traumatic cause of acute abdominal pain that needs surgical management .Alvarado score and ultrasonographies are the most cost effective, easy and available aids for diagnosis. The aim of the study was determining the reliability of Alvarado score and ultrasound in the diagnosis of acute appendicitis. Results: The study was applied with 100 cases with different types of abdominal pain at presentation with 51 males and 49 females .The sensitivity was97.3% ,specificity 90%, and accuracy 89 of combined usage of Alvarado score and U/S findings preoperatively. Patients and method: A prospective non-interventional study including patients admitted with suggestive history with signs and symptoms of acute appendicitis to the surgical emergency ward of Baghdad teaching hospital from July 1st 2017 to Feb 10th 2018, Alvarado score calculated and ultrasonography done for each patient enrolled in this study, then to be followed for intraoperative findings. Conclusions: Combined application of Alvarado score and U/S has sensitivity 94.1% ,specificity 90% and accuracy 89% . In our medical facility and emergency ward, acute appendicitis remains as one of the top acute abdominal emergencies needing surgery in patients presenting with atypical clinical ﬁnding. So diagnosis becomes difﬁcult. So Alvarado score along with ultrasound findings are useful for increasing the reliability in emergency department for accurate diagnosis of acute appendicitis therefore there should be training for the use of U/S by emergency physician and general surgeon in the diagnosis of acute appendicitis in order to decrease the rate of negative appendectomies .

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Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

Journal of Pediatric Diseases ◽

10.24294/jpedd.v1i0.100 ◽

2017 ◽

Vol 1 ◽

pp. 1

Author(s):

Tamer Fakhry ◽

Mohamed Shawky

Keyword(s):

Acute Appendicitis ◽

Imaging Modality ◽

Radiology Department ◽

University Hospitals ◽

Normal Appendix ◽

Differential Leukocyte Count ◽

Alvarado Score ◽

Ultrasound Findings ◽

Clinical Scoring ◽

Us Findings

Appendicitis is the most common cause of emergency abdominal surgeries in children. Ultrasound (US) has been proven to be a helpful imaging modality in patient evaluation, especially in children suspected of appendicitis. The Alvarado score is a 10-point scoring system for the diagnosis of appendicitis based on clinical data and differential leukocyte count. The aim of the present study was to evaluate a combination of clinical scoring (Alvarado score) and US findings for accurate diagnosis of appendicitis in children. The study was done in Menoufia University Hospitals from March 2011 to January 2013. 322 children with abdominal pain clinically suspected of having appendicitis were included in the study and clinically assessed to calculate the Alvarado score. Patients were referred to the radiology department for abdominal US. Among the 153 of the 322 patients who were operated on, 149 patients were diagnosed pre-operatively with acute appendicitis and 4 girls were diagnosed with complex ovarian cysts. Of the 149 patients diagnosed with appendicitis, the percentage of appendicitis was 93% (139/149) and 10 (7%) patients had normal appendix. The prevalence of appendicitis among the patients of the study was 43% (139/322). In conclusion, a combination of Alvarado scores and abdominal US is a good approach for the diagnosis of appendicitis in children to reduce the number of laparotomies for normal appendix. In the case of normal appendix or nonvisualization of the appendix via abdominal US without a high Alvarado score, appendicitis can be safely ruled out. If it is proven as an inflamed appendix on US or a high Alvarado score, patient should be subjected for appendectomy without delay.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20192078 ◽

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.

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

University of Zambia Journal of Agricultural and Biomedical Sciences ◽

10.53974/unza.jabs.4.2.441 ◽

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.

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