scholarly journals The Utility of the Alvarado Score in the Diagnosis of Acute Appendicitis in the Elderly

2017 ◽  
Vol 83 (7) ◽  
pp. 793-798 ◽  
Author(s):  
Anastasiya Shchatsko ◽  
Rebecca Brown ◽  
Trista Reid ◽  
Sasha Adams ◽  
Amy Alger ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Inclusion Criteria ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Left Shift ◽  
Right Lower Quadrant

Clinical scores determining the likelihood of acute appendicitis (AA), including the Alvarado score, were devised using a younger population, and their efficacy in predicting AA in elderly patients is not well documented. This study's purpose is to evaluate the utility of Alvarado scores in this population. A retrospective chart review of patients >65 years old presenting with pathologically diagnosed AA from 2000 to 2010 was performed. Ninety-six patients met inclusion criteria. The average age was 73.7 ± 1.5 years and our cohort was 41.7 per cent male. The average Alvarado score was 6.9 ± 0.33. The distribution of scores was 1 to 4 in 3.7 per cent, 5 to 6 in 37.8 per cent, and 7 to 10 in 58.5 per cent of cases. There was a statistically significant increase in patients scoring 5 or 6 in our cohort versus the original Alvarado cohort (P < 0.01). Right lower quadrant tenderness (97.6%), left shift of neutrophils (91.5%), and leukocytosis (84.1%) were the most common symptoms on presentation. In conclusion, our data suggest that altering our interpretation of the Alvarado score to classify elderly patients presenting with a score of ≥5 as high risk may lead to earlier diagnosis of AA. Physicians should have a higher clinical suspicion of AA in elderly patients presenting with right lower quadrant tenderness, left shift, or leukocytosis.

scholarly journals Vyresnio amžiaus žmonių ūminis apendicitas: simptomai, diagnostika ir gydymo rezultatai

2003 ◽  
Vol 1 (3) ◽  
pp. 0-0
Author(s):  
Donatas Venskutonis ◽  
Virmantas Daubaras ◽  
Juozas Kutkevičius
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Elderly Patients ◽  
Hospital Stay ◽  
The Elderly ◽  
Research Data ◽  
Laboratory Research ◽  
Lower Quadrant ◽  
The Right ◽  
Right Lower Quadrant

Donatas Venskutonis, Virmantas Daubaras, Juozas KutkevičiusKauno medicinos universiteto Bendrosios chirurgijos klinika,Kauno 2-oji klinikinė ligoninė,Josvainių g. 2, LT-3021El paštas: [email protected] Įvadas / tikslas Apie 5–10% žmonių ūminiu apendicitu suserga būdami vyresnio amžiaus. Tyrimo tikslas – įvertinti vyresnio amžiaus žmonių, gydytų nuo apendicito, skundus, medicininės apžiūros, laboratorinių, instrumentinių tyrimų duomenis, laiką iki atvykimo į ligoninę ir diagnostinio laikotarpio trukmę, bendrą gulėjimo stacionare trukmę, apendicito patologines formas, komplikacijas ir baigtis, statistiškai įvertinti skirtumus, susijusius su lytimi. Ligoniai ir metodai Retrospektyviai išanalizuotos 158 vyresnio amžiaus žmonių, sirgusių ūminiu apendicitu 1991–2000 metais, ligos istorijos, įvertinti ligonių skundai, medicininės apžiūros, laboratorinių, instrumentinių tyrimų duomenys, laikas iki atvykimo į stacionarą ir diagnostinio laikotarpio trukmė, bendra gulėjimo stacionare trukmė, nustatytos patologinės apendicito formos, įvertintos komplikacijos ir baigtys. Rezultatai Vyrų ir moterų sergamumas ūminiu apendicitu yra panašus, mūsų duomenimis, jis šiek tiek dažniau pasireiškia moterims (55,7%) negu vyrams (44,3%). Ligoniai dažniausiai skundžiasi pilvo skausmu (100%), pykinimu (65,8%), vėmimu (43,7%), kiek rečiau dujų susilaikymu (37,3%), burnos džiūvimu (37,3%). Medicininės apžiūros duomenimis, visiems ligoniams buvo pilvo skausmas (100%), rečiau liežuvio apnašos (72,2%), teigiami Kocherio (44,9%) ir Rovzingo (39,9%) simptomai. Vidutinis nustatytas leukocitų skaičius buvo 11,4×109/l. Laikas, praėjęs nuo simptomų pradžios iki hospitalizavimo, yra gana ilgas (2 paros), o laikas nuo hospitalizavimo iki operacijos – 4,11 val. Išvados Vyresnio amžiaus žmonėms būdingas ilgas ikioperacinis laikotarpis. Dažniausi šių ligonių skundai yra pilvo skausmas, pykinimas, vėmimas. Pilvo skausmingumas nustatomas visiems ligoniams, paprastai dešinėje klubinėje srityje (87,3%). Raumenų tempimas dešinėje klubinėje srityje būdingas 67,7% ligonių, pilvaplėvės dirginimo reiškiniai dešinėje klubinėje srityje – 66,5%. Klinikinių požymių raiškos dažnumo skirtumas vyrų ir moterų statistiškai nereikšmingas. Prasminiai žodžiai: ūminis apendicitas, vyresnio amžiaus ligoniai. Acute appendicitis in the elderly: symptoms, diagnostics and treatment results Donatas Venskutonis, Virmantas Daubaras, Juozas Kutkevičius Background / objective 5–10% of the population fell ill with appendicitis in advanced age. The aim of the current study was to evaluate complaints of the elderly that had been ill with appendicitis: physical, laboratory, instrumental research data, the time before coming to hospital and the duration of the diagnostic period, in-hospital stay, the pathological forms, complications and outcome of appendicitis, to evaluate the statistical difference between males and females. Patients and methods In the course of the study, the charts of 58 senior patients that had been ill in 1991–2000 were analysed for complaints, laboratory, instrumental research data, time before coming to hospital, duration of the diagnostic period, in-hospital stay, as well as pathologic forms, complications and outcome of appendicitis. Results The frequency of acute appendicitis among male and female was found to be similar. Our data show that female morbidity (55.7%) is a little higher than male (44.3%). Most patients complained of abdominal pain (100%), nausea (65.8%), vomiting (43.7%), delay of wind (37.3%), desiccation of mouth (37.3%). The physical research data showed that all patients had abdominal pain (100%), rarely tousled tongue (72.2%), positive Kocher (44.9%) and Rovsing (39.9%) symptoms. Laboratory research data revealed the average leukocytes number to be 11.4. The interval between the patient’s coming to the hospital and the onset of symptoms and hospitalization was rather long (2 days). The average time from hospitalization till operation was 4 hours 11 minutes. Conclusions The interval between the patient’s coming to the hospital and the onset of symptoms and hospitalization is rather long among elderly patients. Most often complaints among elderly people are: abdominal pain, nausea, vomiting. All patients have abdominal pain, the most often pain localization is in the right lower quadrant (87,3%), right lower quadrant tenderness (67,7 %), irritation of the peritoneum in the right lower quadrant (66,5 %). The clinical differences between men and women are not statistically reliable. Keywords: acute appendicitis, elderly patients.

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.

scholarly journals RIPASA versus Alvarado score in the assessment of suspected appendicitis in children: a prospective study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Tülin Öztaş ◽  
Muhammet Asena
Keyword(s):  
Acute Appendicitis ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Quadrant Pain ◽  
Lower Quadrant Pain ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
Right Lower Quadrant ◽  
Ripasa Score

Abstract Background Diagnosis of acute appendicitis remains a problem in children with right lower quadrant pain. Challenging diagnosis and fears of missing an inflamed appendix may lead to a negative appendectomy. Many scoring systems have been developed to reduce ambiguities in the diagnosis of appendicitis. Alvarado is one of the most commonly used scoring methods in pediatric patients. The RIPASA score is considered to be a better diagnostic scoring method in adults compared to Alvarado. The present study aims to compare RIPASA and Alvarado scoring systems in determining the possibility of acute appendicitis in children with right lower quadrant pain. This study included 179 consecutive pediatric patients who were referred to pediatric surgery with suspicion of acute appendicitis. The cut-off value was >7.5 for the RIPASA score vs. ≥7 for the Alvarado score. The possibility of appendicitis was divided into three groups for the Alvarado score and four groups for the RIPASA score. Results In this study, 158 of 179 patients were operated on. In 140 of the operated patients, the diagnosis of appendicitis was confirmed by histopathology. The negative appendectomy rate was 11.4%. Specificity and negative predictive value of RIPASA score were higher than those of Alvarado (p<0.001). No difference was found between the two scores concerning sensitivity, positive predictive value, and the area under the receiver operator characteristics curve (p>0.05). Conclusion The RIPASA scoring system can be used as an alternative to the Alvarado scoring system in the management of patients with right lower quadrant pain in emergency services and pediatric outpatient clinics. With the use of the RIPASA score, more patients with a low likelihood of appendicitis can be detected and further contributed to the reduction of the negative appendectomy rate.

scholarly journals APPLICATION OF APPENDICITIS INFLAMMATORY RESPONSE (AIR) SCORING SYSTEM FOR DIAGNOSIS OF ACUTE APPENDICITIS AND ITS COMPARISON WITH ALVARADO SCORE

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Ghaus Mohd Chouhan ◽  
Mahesh Kumar Sharma
Keyword(s):  
Inflammatory Response ◽  
Acute Appendicitis ◽  
High Specificity ◽  
High Risk Group ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Positive Predict Value ◽  
High Negative Predictive Value ◽  
The Right ◽  
Right Lower Quadrant

Background: The appendicitis inflammatory response (AIR) score is recently developed diagnostic tool that uses seven scored variables to stratify patients into low-, intermediate and high risk group. Methods: The present study was conducted in the department of surgery. 100 patients presenting with pain in the right lower quadrant of abdomen, who after clinical examination were provisionally diagnosed to have acute appendicitis and warranted surgery for the same. Results: AIR (98.00%) were more sensitive than Modified alverdo score (90.00%). Specificity (100%) and positive predict value (100%) were same in MAS & AIR. Conclusion: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Keywords: AIR, MAS, Acute appendicitis

scholarly journals APPLICATION OF APPENDICITIS INFLAMMATORY RESPONSE (AIR) SCORING SYSTEM FOR DIAGNOSIS OF ACUTE APPENDICITIS AND ITS COMPARISON WITH ALVARADO SCORE

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Pramod Kumar ◽  
Sandeep Sarawagi ◽  
Devi Singh Kachhawa
Keyword(s):  
Inflammatory Response ◽  
Acute Appendicitis ◽  
High Specificity ◽  
High Risk Group ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Positive Predict Value ◽  
High Negative Predictive Value ◽  
The Right ◽  
Right Lower Quadrant

Background: The appendicitis inflammatory response (AIR) score is recently developed diagnostic tool that uses seven scored variables to stratify patients into low-, intermediate and high risk group. Methods: The present study was conducted in the department of surgery. The popultion consists of 100 patients presenting with pain in the right lower quadrant of abdomen, who after clinical examination were provisionally diagnosed to have acute appendicitis and warranted surgery for the same. Results: AIR (98.91%) were more sensitive than Modified alverdo score (89.3%). Specificity (100%) and positive predict value (100%) were same in MAS & AIR Conclusion- To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Keywords: AIR, MAS, Acute appendicitis

Appendicitis: a rare adverse event in colonoscopy

2021 ◽  
Vol 14 (7) ◽  
pp. e242523
Author(s):  
Samer Al-Dury ◽  
Mohammad Khalil ◽  
Riadh Sadik ◽  
Per Hedenström
Keyword(s):  
Emergency Department ◽  
Adverse Event ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Physical Examination ◽  
De Novo ◽  
Perforated Appendicitis ◽  
Lower Quadrant ◽  
The Right ◽  
Right Lower Quadrant

We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3 months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6 hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.

Kasai Procedure in Patients Older Than 90 Days: Worth a Cut

2021 ◽  
Author(s):  
Marie Uecker ◽  
Joachim F. Kuebler ◽  
Nagoud Schukfeh ◽  
Eva-Doreen Pfister ◽  
Ulrich Baumann ◽  
...  
Keyword(s):  
Treatment Option ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Primary Treatment ◽  
Inclusion Criteria ◽  
Bridge To Transplant ◽  
Kasai Procedure ◽  
Native Liver ◽  
Native Liver Survival

Abstract Introduction Age at Kasai portoenterostomy (KPE) has been identified as a predictive factor for native-liver survival in patients with biliary atresia (BA). Outcomes of pediatric liver transplantation (LT) have improved over recent years. It has been proposed to consider primary LT as a treatment option for late-presenting BA infants instead of attempting KPE. We present our experience with patients older than 90 days undergoing KPE. Materials and Methods A retrospective chart review of patients with BA undergoing KPE at our institution between January 2010 and December 2020 was performed. Patients 90 days and older at the time of surgery were included. Patients' characteristics, perioperative data, and follow-up results were collected. Eleven patients matched the inclusion criteria. Mean age at KPE was 108 days (range: 90–133 days). Results Postoperative jaundice clearance (bilirubin < 2 mg/dL) at 2-year follow-up was achieved in three patients (27%). Eight patients (73%) received a liver transplant at a mean of 626 days (range: 57–2,109 days) after KPE. Four patients (36%) were transplanted within 12 months post-KPE. Two patients died 237 and 139 days after KPE due to disease-related complications. One patient is still alive with his native liver, currently 10 years old. Conclusion Even when performed at an advanced age, KPE can help prolong native-liver survival in BA patients and offers an important bridge to transplant. In our opinion, it continues to represent a viable primary treatment option for late-presenting infants with BA.

scholarly journals Ectopic decidua of the appendix: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Manabu Kaneko ◽  
Hiroaki Nozawa ◽  
Hirofumi Rokutan ◽  
Koji Murono ◽  
Tetsuo Ushiku ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Rare Entity ◽  
Lower Quadrant ◽  
Case Presentation ◽  
Decidual Tissue ◽  
Abdominal Symptoms ◽  
History Of ◽  
Myxoid Degeneration ◽  
Right Lower Quadrant

Abstract Background Ectopic decidua is the presence of decidual tissue outside the uterus. Ectopic decidua of the appendix is a rare entity that can present with abdominal symptoms mimicking appendicitis. We report a case of a 39-year-old female patient at 27 weeks gestational age with a 2-day history of right lower quadrant abdominal pain. Case presentation The patient was referred to our hospital with suspicion of either acute appendicitis or threatened rupture of the uterus, the latter of which was considered unlikely following close examination. Therefore, she underwent emergency appendectomy via laparotomy. Microscopic examination revealed decidual tissue with myxoid degeneration in the subserosal layer of the tip side of the appendix, without endometriosis, which was compatible with ectopic decidua (deciduosis). Conclusions Because it is extremely difficult to distinguish ectopic decidua of the appendix from acute appendicitis, even with various imaging modalities, we should be aware that ectopic decidua of the appendix is a differential diagnosis for acute appendicitis in pregnant women.

scholarly journals Clinical Prediction Score for Ruptured Appendicitis in ED

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Thidathit Prachanukool ◽  
Chaiyaporn Yuksen ◽  
Welawat Tienpratarn ◽  
Sorravit Savatmongkorngul ◽  
Panvilai Tangkulpanich ◽  
...  
Keyword(s):  
White Blood Cells ◽  
Prediction Score ◽  
Multivariable Logistic Regression Analysis ◽  
Pathology Report ◽  
High Morbidity ◽  
Inclusion Criteria ◽  
Lower Quadrant Pain ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain

Background. Ruptured appendicitis has a high morbidity and mortality and requires immediate surgery. The Alvarado Score is used as a tool to predict the risk of acute appendicitis, but there is no such score for predicting rupture. This study aimed to develop the prediction score to determine the likelihood of ruptured appendicitis in an Asian population. Methods. This study was a diagnostic, retrospective cross-sectional study in the Emergency Medicine Department of Ramathibodi Hospital between March 2016 and March 2018. The inclusion criteria were age >15 years and an available pathology report after appendectomy. Clinical factors included gender, age>60 years, right lower quadrant pain, migratory pain, nausea and/or vomiting, diarrhea, anorexia, fever>37.3°C, rebound tenderness, guarding, white blood cell count, polymorphonuclear white blood cells (PMN) > 75%, and pain duration before presentation. The predictive model and prediction score for ruptured appendicitis were developed by multivariable logistic regression analysis. Result. During the study period, 480 patients met the inclusion criteria; of these, 77 (16%) had ruptured appendicitis. Five independent factors were predictive of rupture, age>60 years, fever>37.3°C, guarding, PMN>75%, and duration of pain>24 hours to presentation. A score >6 increased the likelihood ratio of ruptured appendicitis by 3.88 times. Conclusion. Using the Ramathibodi Welawat Ruptured Appendicitis Score (RAMA WeRA Score) developed in this study, a score of >6 was associated with ruptured appendicitis.

Cochlear Implantation in the Elderly: Results and Quality-of-Life Assessment

2002 ◽  
Vol 111 (10) ◽  
pp. 890-895 ◽  
Author(s):  
Hamid R. Djalilian ◽  
Sharon L. Smith ◽  
Timothy A. King ◽  
Samuel C. Levine
Keyword(s):  
Quality Of Life ◽  
Complication Rate ◽  
Cochlear Implantation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Life Assessment ◽  
Test Results

To assess the efficacy, quality of life, and complication rate of cochlear implantation in patients over 60 years of age, we performed a retrospective chart review of 31 cochlear implant patients more than 60 years old at the time of surgery (mean, 70 years; range, 62 to 86 years). All patients had improvement in their audiological test results after operation. Twenty-eight patients (93%) are regular implant users at a median follow-up of 12 months. Major complications occurred in 2 patients (6%). We conclude that cochlear implantation in the elderly population has excellent results, with a complication rate similar to that in patients less than 60 years old, and yields an improved quality of life.

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