Accuracies of Diagnostic Methods for Acute Appendicitis

2013 ◽  
Vol 79 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Jong Seob Park ◽  
Jin Ho Jeong ◽  
Jong In Lee ◽  
Jong Hoon Lee ◽  
Jea Kun Park ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Physical Examination ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Negative Appendectomy ◽  
Pathologic Findings ◽  
Negative Appendectomy Rate ◽  
Sensitivity Specificity

The objectives were to evaluate the effectiveness of ultrasonography, computed tomography, and physical examination for diagnosing acute appendicitis with analyzing their accuracies and negative appendectomy rates in a clinical rather than research setting. A total of 2763 subjects were enrolled. Sensitivity, specificity, positive predictive value, and negative predictive value and negative appendectomy rate for ultrasonography, computed tomography, and physical examination were calculated. Confirmed positive acute appendicitis was defined based on pathologic findings, and confirmed negative acute appendicitis was defined by pathologic findings as well as on clinical follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 99.1, 91.7, 96.5, and 97.7 per cent, respectively; for computed tomography, 96.4, 95.4, 95.6, and 96.3 per cent, respectively; and for physical examination, 99.0, 76.1, 88.1, and 97.6 per cent, respectively. The negative appendectomy rate was 5.8 per cent (5.2% in the ultrasonography group, 4.3% in the computed tomography group, and 12.2% in the physical examination group). Ultrasonography/computed tomography should be performed routinely for diagnosis of acute appendicitis. However, in view of its advantages, ultrasonography should be performed first. Also, if the result of a physical examination is negative, imaging studies after physical examination can be unnecessary.

scholarly journals Comparison of Tzanakis Score vs Alvarado Score in the Effective Diagnosis of Acute Appendicitis

2015 ◽  
Vol 12 (1) ◽  
pp. 48-50 ◽  
Author(s):  
BR Malla ◽  
H Batajoo
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Scoring System ◽  
Final Diagnosis ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Effective Diagnosis ◽  
Sensitivity Specificity

Background Acute appendicitis is the most frequent surgical emergency encountered worldwide. This study was conducted to compare the efficacy of Tzanakis score and Alvarado score in diagnosing acute appendicitis.Objectives The aim of this study is to compare the efficacy of Tzanakis scoring system with Alvarado scoring system in diagnosing AA.Methods This was a retrospective and nonrandomized observational study conducted in Dhulikhel hospital. It included 200 clinically diagnosed cases of acute appendicitis who underwent emergency open or laparoscopic appendectomy during the year 2012. Final diagnosis of acute appendicitis was based on histological findings given by pathologist.Results The sensitivity, specificity, positive predictive value and negative predictive value of Tzanakis score was 86.9%, 75.0, 97.5% and 33.3% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of Alvarado score was 76.0%, 75.0%, 97.2% and 21.4% respectively. Negative appendectomy was 8.0%. Conclusion Tzanakis scoring system is an effective scoring system in diagnosing acute appendicitis.Kathmandu University Medical Journal Vol.12(1) 2014: 48-50

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 Accuracy of Ultrasound Scanning in Diagnosing Acute Appendicitis in Patients Admitted at Vicente Sotto Memorial Medical Center

2020 ◽  
Vol 3 (2) ◽  
pp. 134-139
Author(s):  
Uma Gurung ◽  
Dhiraj Gurung
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medical Center ◽  
Diagnostic Tools ◽  
Advantages And Disadvantages ◽  
Sensitivity Specificity ◽  
Suspected Acute Appendicitis

Introduction: Acute appendicitis is the most common abdominal surgical emergency. Both abdominal ultrasonography and computed tomography are common diagnostic tools in its diagnosis with each having its own advantages and disadvantages. Methods: Patients of suspected acute appendicitis were evaluated with an ultrasound to see the sensitivity, specificity, positive and negative predictive value of ultrasound for intraoperative appendicitis diagnosis. The study included 113 patients of suspected acute appendicitis presenting in the emergency during a one year duration. Sensitivity, specificity, positive predictive value and negative predictive value was calculated from their respective formulae. Results: The majority of the patients were male patients between the age group of 18 to 30. The sensitivity of ultrasound for diagnosis of acute appendicitis was 96% and specificity was 33%. The positive predictive value was 98% and the negative predictive value was 20% Conclusion: Ultrasound has good sensitivity and the low cost along with no radiation exposure makes this an acceptable screening investigative modality though due to low specificity, it would be recommended to go for a computed tomography scan if ultrasound shows negative result for appendicitis.  

scholarly journals A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

2019 ◽  
Vol 6 (11) ◽  
pp. 3937
Author(s):  
Waleed Yusif El Sherpiny
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Scoring System ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: Various diagnostic criteria have been described for diagnosing acute appendicitis. Of these, Alvarado score has been the most commonly used. The RIPASA score is a new diagnostic scoring system developed for the diagnosis of acute appendicitis and showed higher sensitivity, specificity and diagnostic accuracy as compared to Alvarado score. we want to compare prospectively Alvarado and RIPASA score by applying them to patients attending emergency department complaining of right iliac fossa pain that could probably be acute appendicitis.Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination of the removed appendix was taken as the gold standard for diagnosis of acute appendicitis.Results: Among (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  were 88.2%, 14.5%, 73.1%, 32%,and 68% 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 51.2%, 80 %, 91 %, 29%, and 57%, respectively. 87.5% of patients were correctly stratified by RIPASA under higher probability group while only 45% were classified by Alvarado as high probability.Conclusions: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, it can be applied   for the diagnosis of acute appendicitis.

Acute Appendicitis - Study of Role of Ultrasound and CT Scan in Decision Making for Surgery in a Tertiary Care Government Hospital in Eastern India

2021 ◽  
Vol 8 (33) ◽  
pp. 3048-3053
Author(s):  
Jainendra Kumar ◽  
Akriti Komal
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Accurate Diagnosis ◽  
Final Decision ◽  
Sensitivity Specificity

BACKGROUND Acute appendicitis (AA) is one of the commonest causes of acute abdominal emergencies. Accurate diagnosis and earlier surgery is imperative in such cases. Ultrasonography (US), and computed tomography (CT), are main stays accurate diagnosis of this disease. This study was conducted to compare the accuracy of US and CT in the diagnosis of AA and reduce number of negative appendectomies. METHODS This prospective study was done after approval from institutional ethical committee and obtaining written consent. 164 patients with clinical features suggestive of AA, were selected from emergency department of Patna Medical College, Patna India during the period from January 2019 to December 2020. 98 were males and 66 females, mean age being 18.08 years. 142 patents (86.58 %) underwent surgery, and 22 patients (13.41 %) were kept on clinical observation in hospital after imaging. After detailed clinical workup and laboratory investigations, all patients were subjected to both US and CT examination. Each patient was reevaluated clinically, and a clinical correlation was done between both sets of results. Based on these, final decision was made. Accuracy was decided based on intra-operative findings in appendectomy group and were correlated with imaging findings later with histopathologic findings. RESULTS Males outnumbered females, abdominal pain was present in 100%. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of US in diagnosis of AA in our study were 92.6 %, 76.4 %, 95.3%, 71.0% and 88.9 % respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CT in diagnosis of AA were 99.1 %, 90.5 %, 98.6%, 87.8% and 97.8 % respectively. CONCLUSIONS US should be the first-line imaging modality as it is free from radiation. CT is recommended as additional imaging tool to raise accuracy in diagnosis except in pregnancy and selected pediatric patients. KEYWORDS Acute Appendicitis, Computed Tomography, Ultrasound

DIAGNOSTIC ACCURACY OF GRAY SCALE ULTRASONOGRAPHY VERSUS COLOR DOPPLER IN SUSPECTED CASES OF ACUTE APPENDICITIS

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Tahir Iqbal ◽  
Muhammad Usman Shahid ◽  
Ishfaq Ahmad Shad ◽  
Shahzad Karim Bhatti ◽  
Syed Amir Gilani ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Color Doppler ◽  
Diagnostic Tools ◽  
Gray Scale ◽  
Versus Color ◽  
Sensitivity Specificity

ABSTRACT: BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease. OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis. MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis. RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%. CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard.

Comparison of hydrosonography and transvaginal ultrasonography in the detection of intracavitary pathologies in women with abnormal uterine bleeding

2004 ◽  
Vol 14 (1) ◽  
pp. 57-63 ◽  
Author(s):  
M. A. Guven ◽  
T. Bese ◽  
F. Demirkiran
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Transvaginal Sonography ◽  
Normal Endometrium ◽  
Pathologic Findings ◽  
History Of ◽  
Sensitivity Specificity

BackgroundThe aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding.Study designProspective, randomized, and unblinded study.Material and methodsA total of 197 women (n = 130 premenopausal and n = 67 postmenopausal) aged between 23 and 71 years (mean age 45.7 ± 8.9) presenting with a history of abnormal uterine bleeding were included into the study. Hydrosonography was carried out by experienced gynecologists, on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure.ResultsThe surgical-pathologic examination confirmed normal physiologic endometrium in 50 (48%) of 104 women who were said to have normal endometrium on transvaginal sonography. Seventy (75%) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56, 68, 75, and 48%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 23 (30%) of 76 women who were said to have normal endometrium on hydrosonography. Among 121 women diagnosed of intracavitary pathologies on hydrosonography, 101 (81%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81, 73, 83, and 70%, respectively. Sensitivity and negative predictive value were significantly higher with hydrosonography. There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results.ConclusionHydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.

A Comparison between the Diagnostic Accuracy of Alvarado and Tzanaki Scoring Systems in Acute Appendicitis

2021 ◽  
Vol 15 (12) ◽  
pp. 3175-3177
Author(s):  
Anum Iftikhar ◽  
Muhammad Arsalan ◽  
Sheeza Azaz ◽  
S H Waqar ◽  
Sajid Ali Shah ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Cross Sectional

Aim: To find out how accurate the Alvarado and Tzanaki scoring systems are in diagnosing acute appendicitis taking histopathology as gold standard. Methods: A cross-sectional prospective study was conducted from August 2019 to July 2020 at Department of General Surgery, Pakistan Institute of Medical Sciences Islamabad. Sixty patients were included, all of whom had appendectomies after a clinical diagnosis of acute appendicitis. Samples were submitted for histopathology, which was used as the gold standard for the definitive diagnosis of acute appendicitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and negative appendectomy rate of Alvarado and Tzanaki scoring systems was calculated using SPSS version 23. Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Alvarado score at optimal cut-off threshold of ≥7.0, were calculated as 74%, 55%, 90%, 27% and 71.66% respectively. The cut-off threshold point of Tzanaki score was set at more than 8, which yielded a 94.11% sensitivity and an 88.88% specificity. The positive predictive value was 99.95% and the negative predictive value was 72.72%. The Alvarado and Tzanaki scoring systems had negative appendectomy rates of 9.5% and 2.04%, respectively. Conclusion: The Tzanaki scoring system has a better diagnostic accuracy for acute appendicitis as compared to the Alvarado score. Keywords: Acute appendicitis, Alvarado score, Tzanaki score

Detection of local failures after management of nasopharyngeal carcinoma: a prospective, controlled trial

2008 ◽  
Vol 122 (11) ◽  
pp. 1230-1234 ◽  
Author(s):  
S M Ragab ◽  
F A Erfan ◽  
M A Khalifa ◽  
E M Korayem ◽  
H A Tawfik
Keyword(s):  
Computed Tomography ◽  
Nasopharyngeal Carcinoma ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
External Beam Radiotherapy ◽  
Reliability Coefficient ◽  
Histological Findings ◽  
Significant Agreement ◽  
Sensitivity Specificity

AbstractObjectives:To conduct a prospective study (1) to evaluate and compare the efficacies of nasopharyngeal endoscopy and computed tomography in the diagnosis of local failure of external beam radiotherapy for nasopharyngeal carcinoma, and (2) to assess whether multiple endoscopic nasopharyngeal biopsies are superior to a single, targeted biopsy, for the same purpose.Methods:Forty-six patients who had been treated with external beam radiotherapy for primary nasopharyngeal carcinoma were enrolled in the study. For every patient recruited, computed tomography, rigid nasopharyngeal endoscopy and nasopharyngeal biopsies were performed 12 weeks after radiotherapy.Results:Twelve weeks after treatment, six patients (13 per cent) had evident disease on histological examination of biopsies. Nasopharyngeal endoscopy showed a sensitivity, specificity, positive predictive value and negative predictive value of 66.6, 95, 66.6 and 95 per cent, respectively. There was statistically significant agreement between the endoscopic findings and the histological findings (Kappa reliability coefficient = 0.617, p < 0.01). Computed tomography showed a sensitivity, specificity, positive predictive value and negative predictive value of 50, 45, 12 and 85.7 per cent, respectively. There was no statistically significant agreement between the computed tomography findings and the histological findings (Kappa reliability coefficient = 0.021, p > 0.05). A targeted, single biopsy performed under endoscopic control demonstrated excellent sensitivity, specificity, positive predictive value and negative predictive value, being 83.3, 100, 100 and 97.5 per cent, respectively. The Kappa test showed a very statistically significant agreement between the histological findings for the single and the multiple endoscopic biopsies (Kappa reliability coefficient = 0.897, p < 0.001).Conclusions:Rigid nasopharyngeal endoscopy should be considered the primary follow-up tool after radiotherapy treatment of nasopharyngeal carcinoma, with computed tomography being reserved for patients with histological or symptomatic indications. Routine postnasal biopsies are not necessary, given the excellent specificity and negative predictive value of rigid nasopharyngeal endoscopy. Single, targeted endoscopic biopsy provides an excellent alternative to the usual multiple biopsies. In addition, it reduces cost, time, morbidity and patient discomfort.

scholarly journals Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

2011 ◽  
Vol 93 (8) ◽  
pp. 639-641 ◽  
Author(s):  
VCY Tang ◽  
A Attwell-Heap
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Ureteral Stent ◽  
The Difference ◽  
Contrast Ct ◽  
Sensitivity Specificity

INTRODUCTION The aim of this study was to validate the use of non-contrast computed tomography (CT) with a ureteral stent in situ instead of ureteroscopy for identification of renal tract stones. METHODS All patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively. Statistical analysis was performed to compare any differences between CT and ureteroscopy in the identification of stones. RESULTS Overall, 57 patients were included in the study. The difference between CT and ureteroscopy findings was statistically significant. CT identification of stones with a stent in situ had a sensitivity of 86%, a specificity of 46%, a positive predictive value of 63%, a negative predictive value of 76% and an accuracy of 67%. CONCLUSIONS Our study suggests that non-contrast CT is inferior to the ‘gold standard’ of ureteroscopy. It lacks sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Therefore, we cannot recommend using non-contrast CT to replace ureteroscopy.

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