Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis

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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Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments

Revista Española de Quimioterapia ◽

10.37201/req/008.2021 ◽

2021 ◽

Author(s):

Kinda Altali Alhames ◽

Francisco Javier Martín-Sánchez ◽

Pedro Ruiz-Artacho ◽

Francisco Javier Ayuso ◽

Victoria Trenchs ◽

...

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Emergency Departments ◽

Low Risk ◽

C Reactive Protein ◽

Alvarado Score ◽

Old Patients ◽

Reactive Protein ◽

Surgical Data ◽

Suspected Acute Appendicitis

Objective. Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. Materials and methods. This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. Results. A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0). Conclusions. CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.

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Predictive value of C-reactive protein with Alvarado score in acute appendicitis

ANZ Journal of Surgery ◽

10.1111/ans.12408 ◽

2013 ◽

Vol 84 (5) ◽

pp. 335-336 ◽

Cited By ~ 5

Author(s):

Siva Thirumallai ◽

Suraj Ruwan Wijesuriya ◽

Andrew Mitchell ◽

Luc Delriviere

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

C Reactive Protein ◽

Alvarado Score ◽

Reactive Protein

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ALVARADO SCORE AND C-REACTIVE PROTEIN PREDICTOR OF SEVERITY IN ACUTE APPENDICITIS- AN INSTITUTION BASED STUDY

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2016/1165 ◽

2016 ◽

Vol 3 (102) ◽

pp. 5636-5640

Author(s):

Priya Radhakrishnan ◽

Vysakh Chandra ◽

Ramesan Chayampurath

Keyword(s):

Acute Appendicitis ◽

C Reactive Protein ◽

Alvarado Score ◽

Reactive Protein

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To determine the frequency of operations in acute appendicitis after antibiotic therapy.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.3167 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1233-1237

Author(s):

Sarwat Bibi ◽

Junaid Misbah ◽

Khurram Saqib

Keyword(s):

Acute Appendicitis ◽

Antibiotic Therapy ◽

Clinical Condition ◽

Cross Sectional Study ◽

Sectional Study ◽

Alvarado Score ◽

Cross Sectional ◽

Reactive Protein ◽

Trust Hospital ◽

Modified Alvarado Score

A descriptive, cross sectional study conducted to evaluate the results of conservative management of acute appendicitis with antibiotic therapy. Study Design: Descriptive, cross sectional study. Setting: Surgical Unit of Aziz Fatima Trust Hospital. Period: 1st Jan 2017 to 31st December 2018. Materials and Methods: The objective of this study is to determine the frequency of operations in acute appendicitis being treated by antibiotic therapy. A total of 140 patients were included in this study. Study patients having a modified Alvarado score of 7-9 received intravenous antibiotics (ciprofloxacin 400mg twice and metronidazole 500 mg thrice) for at least 24 hours. Patients’ whose status were improved as monitored by an improved modified Alvarado score and a decreased serial C reactive Protein measurement on the following morning, were discharged to continue with oral antibiotics. In patients whose clinical condition had not improved, intravenous treatment was prolonged for 48 hours and in case of deterioration in clinical condition, they were subjected to appendicectomy. Results: Mean age of the patients was 25.41±7.28 years. Out of 140 patients, 51 (36.4%) were male while remaining 89 patients (63.6%) were female. Regarding Alvarado score, 53 patients (37.9%) had 7 score, 60 patients (42.9%) had 8 score and 27 patients (19.6%) had 9 score. Mean Alvarado score was observed 7.81±0.73. Operation was needed in 13 patients (9.3%). Conclusion: In conclusion, acute appendicitis can be treated successfully with antibiotics. However, there is a risk of recurrence in cases of acute appendicitis, and this risk should be compared with the risk of complications after appendectomy.

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Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2015.10.004 ◽

2016 ◽

Vol 34 (2) ◽

pp. 189-192 ◽

Cited By ~ 12

Author(s):

Mohamed Zouari ◽

Mohamed Jallouli ◽

Hamdi Louati ◽

Rim Kchaou ◽

Rahma Chtourou ◽

...

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

C Reactive Protein ◽

Alvarado Score ◽

Reactive Protein

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

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/prolas-2019-0059 ◽

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.

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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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