Comparison of Alvarado score and pediatric appendicitis score for clinical diagnosis of acute appendicitis in children—a prospective study

Abstract Background Acute appendicitis is the most common surgical condition of children. Differential diagnosis of an acutely inflamed appendix in children includes a vast variety of diseases which can present with the same symptoms and signs as acute appendicitis. It is an important factor for delay in diagnosis. Many scoring systems are being used to reach a diagnosis within time and to reduce the rate of negative appendectomies. The purpose of this study was to compare both scoring systems (Alvarado and pediatric appendicitis scoring system) and to know which one is better to establish an early correct diagnosis of acute appendicitis in pediatrics, thus decreasing the morbidity and burden on hospital resources. Although many studies had been completed at the international level for comparing both of these scoring systems, the pediatric population in our region was still awaiting such an effort. So a prospective cohort study was designed. A total of 180 patients were recruited with 95% confidence level and 5% margin of error. Every enrolled patient was awarded clinical scores according to both the Alvarado scoring system and the pediatric appendicitis scoring system. Patients having a score of 7 or more by both scoring systems were considered “seven or more than seven group” and their appendectomies were performed and histopathology reports were reviewed. Patients having a score of 7 in one system and less than 7 in the other/both were considered “less than seven group” and were admitted in the ward for further clinical evaluation and observation. Results At cutoff 7, the Alvarado score showed a sensitivity of 85.5%, specificity of 70%, PPV of 96.5%, NPV of 33.3%, and diagnostic accuracy of 84.11% while the pediatric appendicitis score showed a sensitivity of 93.8%, specificity of 70%, PPV of 96.8%, NPV of 53.8, and diagnostic accuracy of 91.59%. Conclusion The pediatric appendicitis score (PAS) is superior in diagnosing acute appendicitis in the pediatric population than the Alvarado score as indicated by the values of diagnostic accuracy. So it can be a good diagnostic tool for pediatric patients presenting with clinical symptoms and signs of appendicitis.

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Max appendicitis score: a new diagnostic score for diagnosing acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20173889 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3067

Author(s):

Vidur Jyoti ◽

Akhilesh Kumar ◽

Preeti Yadav ◽

Vaibhav Kapoor

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Scoring System ◽

Scoring Systems ◽

Cost Effective ◽

Alvarado Score ◽

Diagnostic Score ◽

Negative Appendicectomy ◽

Appendicitis Score

Background: Scoring systems are valuable and valid for discriminating between acute appendicitis and nonspecific abdominal pain. Alvarado scoring is classical and different modifications of Alvarado score have been introduced but none is ideal and negative appendicectomy rate is still high. The aim of the study is to design a more reliable scoring system which is cost effective, simple, easy to learn, high accuracy, which can be applied by any doctor at any health care facility.Methods: Retrospective study of 160 patients hospitalized with abdominal pain suggestive of acute appendicitis and subsequently operated over a period of 5 year from January 2012 to January 2017 at Max Super Speciality Hospital, Gurgaon.Results: In the present study based on six clinically most significant variables, a diagnostic accuracy of 96.25% was achieved while the same was 85% for classical Alvardo Score. This significantly increased the diagnostic accuracy and lowered the negative appendicectomy rate.Conclusions: Max Appendicitis Score is perfect scoring system for diagnosing appendicitis, it can be specially very handy in peripheral health centers where radiological facilities are sparse.

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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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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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A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective

Journal of Lumbini Medical College ◽

10.22502/jlmc.v6i2.264 ◽

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.

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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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RIPASA Score; Its Sensitivity, Specificity in Diagnosing Suspected Acute Appendicitis

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2021.11.3.650 ◽

1969 ◽

Vol 11 (3) ◽

pp. 151-155

Author(s):

Imtiaz Ahmad Khattak ◽

Waleed Mabood ◽

Muhammad Naeem ◽

Sohaib Ali ◽

Muhammad Adnan Khan Khattak

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Asian Population ◽

Scoring Systems ◽

Final Decision ◽

Senior Registrar ◽

Alvarado Score ◽

Negative Report ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Among acute emergencies, the most commonly occurring one is Acute appendicitis. Scoring systems have beendeveloped such as Alvarado and Modified Alvarado Scores. RIPASA Score has a higher sensitivity in the Asian population set.Thus, came about the plan of our examination to try things out with this new score and to check whether it undoubtedly performswellto the undertaking.Objectives To determine the sensitivity, specificity of the 16-point RIPASA scoring system in diagnosing suspected acuteappendicitis and its validationin correlation with histopathology.Material and Methods: The study was carried out in Khyber Teaching Hospital Peshawar Pakistan from January 2018 to June2018, Department of General Surgery. A total of 322 patients were included in the study. In ED, resident surgeons filled in theRIPASA Score proforma by taking a detailed history and doing a physical examination, and running labs along withultrasonography. The decisionto perform appendectomy was solelytaken bythe senior registrar which was the final decision andthe sample was sent forH/P later on.Results: Of the 322, patients who went through the surgery for acute appendicitis, 188 (58.4%) were male and 134 (41.6%) werefemale, 284(88.2%) had positive histopathology reports and 38 (11.8%) had a negative report. The sensitivity of the RIPASA Scoreat a cut-off value of 8.0 was 97.98%,with the specificity of 77%, and Positive Predictive value of 97.52%,and a Negative PredictiveValue of 86.3%.Conclusion: The clinical implication of RIPASA score is found to be more beneficial than the traditional Alvarado scoring system,thus could bringthe complications rates of appendectomy to significantly lowerfigures.Keywords: Acute Appendicitis,Alvarado Score,RIPASA Score,AsianPopulation, Sensitivity, Specificity

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A comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20180430 ◽

2018 ◽

Vol 5 (3) ◽

pp. 796

Author(s):

Vamsavardhan Pasumarthi ◽

C. P. Madhu

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Roc Curve ◽

Predictive Value ◽

Scoring System ◽

Alvarado Score ◽

Predictive Values ◽

Sensitivity Specificity ◽

Ripasa Score

Background: The RIPASA Score is a new diagnostic scoring system developed for the diagnosis of Acute Appendicitis which showed higher sensitivity, specificity and diagnostic accuracy compared to ALVARADO Score, particularly when applied to Asian population. Not many studies have been conducted to compare RIPASA and ALVARADO scoring systems. Hence, author want to compare prospectively Alvarado and RIPASA score by applying them to the patients attending the hospital with right iliac fossa pain that could probably be acute appendicitis.Methods: A prospective analysis of 116 cases admitted with RIF pain during a 2 years period was performed. Patients between 15-60 years were scored as per Alvarado and RIPASA scoring system. Histopathological reports of the cases were collected and compared with the scores. ROC curve area analysis was performed to examine diagnostic accuracy of RIPASA and ALVARADO scores.Results: The sensitivity of ALVARADO score is estimated to be 52.08 for a cut off of 6. The specificity is 80%, positive predictive value is 92.59, negative predictive value is 25.81. The Diagnostic accuracy of ALVARADO scoring is found to be 56.9. The sensitivity, specificity, positive predictive value and negative predictive values of RIPASA scoring system are 75%, 65%, 91.14%, 35.14%. The diagnostic accuracy of RIPASA score is 73.28.Conclusions: The difference in the diagnostic accuracy between ALVARADO and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.

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

10.53350/pjmhs2115123175 ◽

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

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RIPASA score or Alvarado score: diagnosing acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20210920 ◽

2021 ◽

Vol 8 (3) ◽

pp. 879

Author(s):

Talabadi Parmeshwar ◽

Geeta Sandeep Ghag ◽

Vipul Versi Nandu

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Imaging Techniques ◽

Scoring Systems ◽

Diagnostic Value ◽

Early Years ◽

P Value ◽

Alvarado Score ◽

Patient Admissions ◽

Ripasa Score

Background: Appendicitis is a much studied about topic since the early years. Even with the advances in imaging techniques, appendicitis still relies upon clinical examination as a main resort of diagnosis. To aid this, several scoring systems have been developed taking into account various symptoms, signs and some basic laboratory investigations. Many studies have been done worldwide to check the sensitivity and specificity of each of these clinical scoring systems in the diagnosis of acute appendicitis. Though the most famous one is the Alvarado scoring system, there is none universally accepted scoring system used for diagnosis so far.Methods: 100 patients with RIF pain and who were suspected of acute appendicitis were evaluated for a period of 24 months. Evaluation was done with regards to RIPASA and Alvarado scoring in all these patients. All the results of both the scoring systems were reported and correlated with histopathological findings. Statistical test were applied to calculate the p value for the association between the variables of studied.Results: There was definitive agreement that both the scoring systems are positively correlating with each other with respect to the diagnosis of the disease (p value 0.0001). The difference in diagnostic accuracy of 25% between the RIPASA score and Alvarado score was statistically significant (p<0.0001). On analysis with chi-square test, both scores are significant at level 1 (p=0.0001). But RIPASA score has higher sensitivity and diagnostic value when compared to Alvarado score.Conclusions: The use of RIPASA scoring would help in decreasing the unwarranted patient admissions and also expensive radiological investigations.

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A comparative study of RIPASA and Alvarado score for the diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20204930 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4006

Author(s):

Praveena Suresh ◽

Rajan Janardhanan ◽

Deepak Paul

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Prospective Observational Study ◽

Iliac Fossa ◽

Scoring Systems ◽

Alvarado Score ◽

Medical College ◽

Right Iliac Fossa Pain ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. There are many scoring systems to predict the diagnosis of acute appendicitis. The most commonly used scoring system is Alvarado scoring system but, it is far from perfect. In this study we compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system to Alvarado scoring system in correctly diagnosing acute appendicitis.Methods: This prospective observational study was conducted in the department of general surgery, Sree Gokulam Medical College and Research Foundation. It comprised of 60 consecutive patients who were admitted with suspicion of appendicitis who had right iliac fossa pain. RIPASA and Alvarado scoring was done and compared to histopathology after surgery. Sensitivity, specificity and accuracy was calculated.Results: Majority of the patients were below 30 years of age majority were males 36 (60%). When Alvarado score predicted appendicitis in 31 (51.77%) and RIPASA in 54 (90%). When the RIPASA score was >7.5 the sensitivity was 100%, specificity 67% and accuracy was 95%.Conclusions: RIPASA scoring system is more accurate to diagnose acute appendicitis especially when RIPASA score is >7.5. literatures.

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