Monitoring Complications of Medically Managed Acute Appendicitis

2018 ◽  
Vol 84 (10) ◽  
pp. 1684-1690
Author(s):  
Anaar Siletz ◽  
Jonathan Grotts ◽  
Catherine Lewis ◽  
Areti Tillou ◽  
Ali Cheaito ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Treatment Outcomes ◽  
Chart Review ◽  
Nonoperative Management ◽  
Additional Treatment ◽  
Alvarado Score ◽  
Initial Management ◽  
Complicated Course ◽  
One Year ◽  
Nonoperative Group

Nonoperative management of acute appendicitis is becoming widespread, but recurrence and the potential for a complicated course are important concerns. An admission report-based institutional database was created to monitor appendicitis treatment outcomes. Complications and complexity of surgery were recorded based on manual chart review. A cohort of patients spanning one year was analyzed. Initial management was operative in 181 (82%) and nonoperative in 39 (18%) cases. There were no differences in demographics, BMI, or Alvarado score. One operative patient and 17 non-operative patients required additional treatment for recurrence/nonresolution (0.6% vs 44%, P < 0.00001). Twenty-eight (15%) operative patients and 17 (44%) nonoperative patients had complications ( P = 0.0003). Thirty-six (19.9%) operations in the operative group and 8 (53.3%) in the non-operative group were classified as complex ( P = 0.007). Hospital stay was longer in the nonoperative group (one vs two days, P = 0.005). Two incidental malignancies in the operative group and one in the nonoperative group were identified. These results are consistent with prior studies showing that recurrence/nonresolution is common after nonoperative management. For patients with recurrence/nonresolution, surgery may be more complex.

How Reliable Is Alvarado Score and Its Subgroups in Ruling Out Acute Appendicitis and Suggesting the Opportunity of Nonoperative Management or Surgery?

2017 ◽  
Vol 265 (6) ◽  
pp. E84-E85 ◽  
Author(s):  
Salomone Di Saverio ◽  
Arianna Birindelli ◽  
Alice Piccinini ◽  
Fausto Catena ◽  
Andrea Biscardi ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Nonoperative Management ◽  
Alvarado Score

scholarly journals Acute Appendicitis and Its Management: A Hospital Based Study

2021 ◽  
Vol 8 (10) ◽  
pp. 333-338
Author(s):  
Mubashar Akram ◽  
Iram Shokat ◽  
Mudasar Akram
Keyword(s):  
Acute Appendicitis ◽  
Conservative Management ◽  
Standard Procedure ◽  
High Morbidity ◽  
Alvarado Score ◽  
Medical College ◽  
History Of ◽  
Laboratory Investigations ◽  
One Year

Background: Acute appendicitis is the most common acute surgical condition of the abdomen, which if complicated by perforation or peritonitis has high morbidity and mortality. Aim: The aim of this study is to analyze the presentation, diagnosis and management of acute appendicitis along with the role of conservative management in uncomplicated cases. Materials and Methods: This study was conducted in Govt. Medical College Jammu over a period of one year w.e.f September 2017 to August 2018 and included 120 patients. Diagnosis in the suspected patients was based on history, clinical examination coupled with laboratory investigations and imaging modalities like ultrasound/ CT Scan wherever required. Results: 120 patients of acute appendicitis were treated over the period of one year at our center. Abdominal pain was the most common and constant presentation seen in 112 patients followed by vomiting (82), history of fever (60), history of constipation and distension (20) and another 12 had history of diarrhoea. Six patients (5%) responded favorably to conservative management. Conclusion: Acute appendicitis is a common surgical emergency requiring detailed history and meticulous examination coupled with X-ray and ultrasonography for diagnosis. Appendectomy is the standard procedure of choice and wherever feasible laparoscopic appendectomy offers the advantage of less pain, short hospital stay, earlier return to work and overall cost. Keywords: Acute Appendicitis, Appendectomy, Alvarado Score, Phlegmon, Abscess.

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.

Plate fixation compared with nonoperative treatment of displaced midshaft clavicular fractures: a randomized clinical trial

2018 ◽  
Vol 100-B (10) ◽  
pp. 1385-1391 ◽  
Author(s):  
A. H. Qvist ◽  
M. T. Væsel ◽  
C. M. Jensen ◽  
S. L. Jensen
Keyword(s):  
Nonoperative Management ◽  
Constant Score ◽  
Controlled Trial ◽  
Plate Fixation ◽  
Nonoperative Treatment ◽  
Dash Score ◽  
Locking Screws ◽  
One Year ◽  
Nonoperative Group

AimsRecent studies of nonoperatively treated displaced midshaft clavicular fractures have shown a high incidence of nonunion and unsatisfactory functional outcome. Some studies have shown superior functional results and higher rates of healing following operative treatment. The aim of this study was to compare the outcome in these patients after nonoperative management with those treated with fixation.Patients and MethodsIn a multicentre, parallel randomized controlled trial, 146 adult patients with an acute displaced fracture of the midthird of the clavicle were randomized to either nonoperative treatment with a sling (71, 55 men and 16 women with a mean age of 39 years, 18 to 60) or fixation with a pre-contoured plate and locking screws (75, 64 men and 11 women with a mean age of 40 years, 18 to 60). Outcome was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) Score, the Constant Score, and radiographical evidence of union. Patients were followed for one year.ResultsA total of 60 patients in the nonoperative group and 64 in the operative group completed one-year follow-up. At three months’ follow-up, both the median DASH (1.7 vs 8.3) and median Constant scores (97 vs 90) were significantly better in the operated group (both p = 0.02). After six months and one year, there was no difference in the median DASH or Constant scores. The rate of nonunion was lower in the operative group (2 vs 11 patients, p < 0.02). Nine patients in the nonoperative group underwent surgery for nonunion. The plate was subsequently removed in 16 patients (25%). One patient had a new fracture after removal of the plate and one underwent revision surgery for failure of fixation.ConclusionFixation of a displaced midshaft clavicular fracture using a pre-contoured plate and locking screws results in faster functional recovery and a higher rate of union compared with nonoperative management, but the function of the shoulder is equal after six months and at one year. Cite this article: Bone Joint J 2018;100-B:1385–91.

Predictive Value of Alvarado Score and Pediatric Appendicitis Score in the Success of Nonoperative Management for Simple Acute Appendicitis in Children

2020 ◽  
Author(s):  
Audelia Eshel Fuhrer ◽  
Igor Sukhotnik ◽  
Yoav Ben-Shahar ◽  
Mark Weinberg ◽  
Tal Koppelmann
Keyword(s):  
High Risk ◽  
Acute Appendicitis ◽  
Nonoperative Management ◽  
Alvarado Score ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Complications Rate ◽  
Appendicitis Score

Abstract Introduction During the past decade, nonoperative management (NOM) for simple acute appendicitis (SAA) in children has been proven safe with noninferior complications rate. The aim of this study was to examine Alvarado score and pediatric appendicitis score (PAS) together with other factors in predicting failure of NOM in children presenting with SAA. Materials and Methods Patients aged 5 to 18 years admitted to our department between 2017 and 2019 diagnosed with SAA were given a choice between surgical management and NOM. We divided the NOM patients into two groups: successful treatment and failed NOM, comparing their files for Alvarado score and PAS and other clinical and demographic factors, with a mean follow-up of 7 months. Failure was determined as need for appendectomy following conservative treatment due to any reason. Results A total of 85 patients answered criteria and chose NOM. Overall failure rate was 32.9%. We found no difference in the mean Alvarado score and PAS as well as in each component of both scores between success and failed NOM groups. However, when using the risk classification of the scores, we found a significant correlation between high-risk Alvarado score and failed NOM. After adjusting for age, gender, duration of symptoms, diagnosis of tip appendicitis, and presence of appendicolith, the odds of failure were four times higher among high-risk Alvarado group. Conclusion Alvarado score of 7 or higher, older age, and diagnosis of an appendicolith on imaging are possible predictors for failure of NOM for SAA in children.

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 A retrospective evaluation of Alvarado score in diagnosing acute appendicitis in a tertiary care hospital at Pondicherry

2021 ◽  
Vol 8 (4) ◽  
pp. 1089
Author(s):  
G. Ray ◽  
S. Selvakumaran
Keyword(s):  
Acute Appendicitis ◽  
Laboratory Finding ◽  
Tertiary Care ◽  
False Negative ◽  
Age Groups ◽  
False Negative Rate ◽  
Care Hospital ◽  
Alvarado Score ◽  
Diagnostic Skills ◽  
One Year

Background: Acute appendicitis is a common and sometimes confusing cause of acute abdomen in all age groups. Diagnosis of appendicitis can be difficult, occasionally taxing the diagnostic skills of even the most experienced surgeon. Despite the increased use of USG, CT, the rate of misdiagnosis of appendicitis has remained the same (15.3%). To evaluate the usefulness of the Alvarado score as a simple and reliable tool in preoperative diagnosis of acute appendicitis.Methods: This retrospective study conducted on 97 cases includes all patients who were admitted with a clinical diagnosis of acute appendicitis for a period of one year from February 2019 to January 2020 at IGMCRI Pondicherry with clinical suspicions of acute appendicitis were included in the study. The modified scoring system is based on 3 signs, 3 symptoms, and 1 laboratory finding. The patient was classified as males, females, and children (<12 years). These were further grouped based on the scores 7-9, 5-6, and <5.Results: A total of 80 patients with a score of 7-9 and 5-6 were operated on. Among males with a score of 7-9, 35 patients were operated and 34 were found to have an inflamed appendix. Females with scores 7-9, 16 were operated and 11 were found to have an inflamed appendix.Conclusions: Alvarado scores significantly reduce the number of negative laparotomies without increasing the overall rate of appendicular perforation. It is very effective in men and children but diagnostic laparoscopy or ultrasonography is advised to minimize the high false-negative rate in women.

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