scholarly journals Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis

2020 ◽  
Vol 19 (3-4) ◽  
pp. 109-119
Author(s):  
Senol Tahir ◽  
Andrej Nikolovski ◽  
Martina Ambardjieva ◽  
Petar Markov ◽  
Dragoslav Mladenovik ◽  
...  

Introduction. The diagnosis of acute appendicitis (AA), as the most common cause of acute abdominal pain, has changed in the past decade by introducing scoring systems in addition to the use of clinical, laboratory parameters, and radiological examinations. This study aimed to assess the significance of the four scoring systems (Alvarado, Appendicitis Inflammatory Response (AIR), Raya Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis) in the prediction of delayed appendectomy. Materials and methods. The study included 100 respondents, who were diagnosed with AA in the period from January 2018 to February 2019 and were also operated on. In addition to the clinical, laboratory, and ultrasonographic examinations, four scoring systems (Alvarado, AIR, RIPASA, and Tzanakis) were used to diagnose AA. According to the obtained histopathological (HP) findings, the patients were divided into 3 groups: timely appendectomy, delayed appendectomy and unnecessary appendectomy. Using the sensitivity and specificity of all 4 scoring systems, ROC analysis was performed to predict delayed appendectomy. Results. In the study that included 100 patients (58% men, 42% women), after the appendectomy was performed, the resulting HP showed that 74% had a timely appendectomy, while 16% had delayed and 10% had an unnecessary appendectomy. For the prediction of delayed appendectomy, the area under the ROC curve showed a value of 0.577 for the Alvarado score, 0.504 for the AIR, 0.651 for the RIPASA, and 0.696 for the Tzanakis. Sensitivity and specificity for the Alvarado score was 54% and 62%, for RIPASA 62.5% and 63.5%, for Tzanakis 69% and 60.8%, respectively. Combining the three scoring systems (Alvarado, RIPASA, and Tzanakis), the surface area under the ROC curve was 0.762 (95% CI 0.521–0.783), with a sensitivity of 85% and a specificity of 62%. Conclusion. In our study, the diagnostic accuracy of RIPASA and Tzanakis showed better results than Alvarado, while AIR cannot be used to predict delayed appendectomy in our population. However, the simultaneous application of all three scoring systems, RIPASA, Tzanakis and Alvarado, has shown much better discriminatory ability, with higher sensitivity and specificity, as opposed to their use alone. Combining scoring systems should help in proper diagnosis to avoid negative appendectomy, but additional studies with a larger number of patients are needed to support these results.

2021 ◽  
Vol 15 (12) ◽  
pp. 3175-3177
Author(s):  
Anum Iftikhar ◽  
Muhammad Arsalan ◽  
Sheeza Azaz ◽  
S H Waqar ◽  
Sajid Ali Shah ◽  
...  

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


2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Suman Baral ◽  
Neeraj Thapa ◽  
Raj Kumar Chhetri ◽  
Rupesh Sharma

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.


2021 ◽  
Vol 14 (1) ◽  
pp. 75-80
Author(s):  
Mohammad Vaziri ◽  
◽  
◽  
Nahid Nafissi ◽  
Fariba Jahangiri ◽  
...  

Our objective was to compare the diagnostic accuracy of Alvarado and appendicitis inflammatory response (AIR) scoring systems among children suspected of acute appendicitis concerning their postoperative outcomes. During a two-year period, a prospective multicentric study was carried in the selected hospitals of Iran. All children who were admitted with the diagnosis of acute appendicitis were enrolled in the study. However, patients suffering from generalized peritonitis or those who had a history of abdominal surgery were excluded. Before decision-making, each patient’s score according to two appendicitis scoring systems was calculated. The clinical outcomes and diagnosis of patients were then compared to the results of each scoring system. For those patients who were a candidate for surgery, the final diagnosis of acute appendicitis was made by histopathology. Patients were divided into a high- and low-risk group according to scoring systems outcomes. Among the patients with a low score for appendicitis, the AIR scoring system had a sensitivity and specificity of 95% and 74%, respectively, which was more promising in comparison to that of the Alvarado system (90% and 70%, respectively). Regarding the patients at higher risk of acute appendicitis, none of the scoring systems provided reliable results since both systems showed sensitivity and specificity of less than 50%, which was not sufficient to distinguish patients who are a candidate for surgery. AIR and Alvarado scoring systems are not accurate models to predict the risk of acute appendicitis among children; however, the AIR system could be used as a reliable material to rule out the acute appendicitis diagnosis.


2018 ◽  
Vol 5 (2) ◽  
pp. 25-28
Author(s):  
Luisa Coelho Milhomem ◽  
Luiz Antônio Gomes Amorim ◽  
Pedro Manuel González Cuellar

RESUMO Objetivos: determinar a sensibilidade e especificidade do escore de Alvarado para o diagnóstico de apendicite aguda nos pacientes admitidos na emergência do Hospital Geral de Palmas. Métodos: o estudo foi realizado com a validação de método diagnóstico através do escore clínico-laboratorial para diagnóstico de apendicite aguda. A amostra estudada consistiu de 100 pacientes admitidos na emergência do HGP com dor abdominal e suspeita de apendicite aguda, no período de março a outubro de 2017. Os pacientes foram atendidos na emergência e avaliados quanto ao escore de Alvarado pelo cirurgião responsável, o residente de cirurgia e os internos. Resultados: tomando como ponto de corte o valor >7 pontos, encontramos uma sensibilidade de 71,05 % e especificidade de 84,93 %. Conclusões: o escore de Alvarado é um método pouco invasivo para diagnóstico, simples, rápido, que utilizando o ponto de corte >7 pontos, apresentou-se como um instrumento de alto valor na triagem dos nossos pacientes com suspeita diagnóstica de apendicite aguda. Palavras-chave: apendicite, diagnóstico, emergência. ABSTRACT Objectives: to determine the sensitivity and specificity of the Alvarado score for the diagnosis of acute appendicitis in patients admitted to the Emergency Hospital of Palmas. Methods: The study was performed with the validation of the diagnostic method through the clinical-laboratory score for the diagnosis of acute appendicitis. The sample consisted of 100 patients admitted to the emergency room of the HGP with abdominal pain and suspected of acute appendicitis, from March to October 2017. The patients were treated in the emergency room and evaluated for the Alvarado score by the surgeon in charge, the resident of surgery and the inmates. Results: taking as a cutoff value> 7 points, we found a sensitivity of 71.05% and specificity of 84.93%. Conclusions: The Alvarado score is a simple, fast, noninvasive method for diagnosis, which, using the cutoff point> 7 points was presented as a high-value instrument for the screening of our patients with suspected diagnosis of acute appendicitis. Keywords: appendicitis, diagnosis, emergency.


2020 ◽  
Vol 7 (2) ◽  
pp. 459
Author(s):  
Mannem G. K. Reddy ◽  
V. Mahidhar Reddy

Background: Different scoring systems have been created to increase diagnostic accuracy, and they are inexpensive, non-invasive, and easy to use and reproduce. The modified Alvarado score is widely used in emergency services. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score was formulated in 2010 and has greater sensitivity and specificity. The aim of our article was to compare the usefulness of modified RIPASA score and Alvarado score in the diagnosis of patients with abdominal pain and suspected acute appendicitis.Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis, conducted at the Narayana medical college hospital, Nellore. The questionnaires used for the evaluation process were applied to the patients suspected of having appendicitis.Results: A total of 100 patients, 95% underwent laparoscopic procedure. The cut-off threshold point of the Alvarado score was set at 7.0, which yielded a sensitivity of 65% and a specificity of 52%. The positive predictive value was 65%. The cut-off threshold point of the modified RIPASA score was set at 7.5, which yielded 90% sensitivity and 72% specificity. The positive predictive value was 89% and the NPV was 30%.Conclusions: On comparing both the scores, sensitivity and specificity was higher for modified RIPASA score. The positive predictive value was higher for the Alvarado and negative predictive value was higher for RIPASA score. Bothe p values were statistically significant.


2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Tülin Öztaş ◽  
Muhammet Asena

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.


2017 ◽  
Vol 4 (3) ◽  
pp. 1065
Author(s):  
Suresh Patil ◽  
Rahul Harwal ◽  
Sharanabasappa Harwal ◽  
Sangamesh Kamthane

Background: Acute appendicitis is one of the most common surgical emergencies encountered by doctors on call with emergency appendicectomy being a very common outcome of emergency laparotomies. There's been a marked decline in mortality over the past 50 years, but the rates of perforation and negative laparotomy have not changed much as they're influenced by factors untouched by technological advances.Methods: A prospective comparative study to compare appendicitis inflammatory response score (AIR) and Alvarado scoring systems in evaluating suspected cases of acute appendicitis. 100 patients presenting with pain in the right lower quadrant of abdomen at the surgical clinics at Basaveshwar Teaching and General Hospital, Kalaburagi, Karnataka, India, who after clinical examination and relevant investigations were provisionally diagnosed to have acute appendicitis and warranted surgery for the same were evaluated using the scoring systems - Alvarado Score and Appendicitis Inflammatory Response Score. The scores were tallied and compared with final histopathology report. The study was conducted for a period of one and a half year.Results: The results revealed that AIR (at score >4) demonstrated a higher sensitivity and specificity compared to Alvarado score (89.9 versus 78.6%) and (63.6 versus 54.5) respectively. Alvarado showed a slightly better sensitivity at score>8 (21.3 versus 12.3%).Conclusions: The Appendicitis Inflammatory Response Score outperformed the Alvarado score. It holds promise to be incorporated into the clinician's daily inventory in efficiently diagnosing Appendicitis.


2019 ◽  
Vol 2 (2) ◽  
pp. 224-228
Author(s):  
Niroj Banepali ◽  
Kamal Koirala ◽  
Rupesh Mukhiya ◽  
Rakesh Roshan Sthapit

Introduction: Although acute appendicitis is a common surgical condition, its diagnosis can be elusive at times with misdiagnosis leading to serious complications. Various scoring systems have been developed to overcome this dilemma and the reported accuracies of these scores vary greatly.Materials and Methods: A retrospective review of charts was carried out to identify all patients admitted to KIST medical college teaching hospital from May 2015 to April 2016 with the diagnosis of acute appendicitis. A total of 120 cases that underwent surgery for suspected acute appendicitis were included. Modified Alvarado score and RIPASA scores were computed for each patient and the suggested cutoff values were used to find out the accuracy of these scores. Histopathological confirmation/report was considered as the standard for comparison.Results: A negative appendectomy rate of 11.67 % was observed (9.64 % for males and 16.22 % for females). Complicated appendicitis was found in 27.36% of patients. Modified Alvarado score had a sensitivity of 61.32 % and specificity of 71.43 % at a cut of value of 7. At cut off of > 7.5 for acute appendicitis, RIPASA score had a sensitivity of 97.17% and specificity of 57.14%. The accuracy of Modified Alvarado score was 62.5% while it was 92.5% for RIPASA score.Conclusions: RIPASA score demonstrated higher sensitivity and accuracy but lower specificity compared to the modified Alvarado score in our study group. More studies with larger sample size need to be carried out for further validation of this new score.


2018 ◽  
Vol 26 (6) ◽  
pp. 323-327
Author(s):  
Zehra Unal Ozdemir ◽  
Hakan Ozdemir ◽  
Oguzhan Sunamak ◽  
Cebrail Akyuz ◽  
Mehmet Torun

Background:Acute appendicitis is a very common surgical emergency. Early and correct diagnosis and early intervention are necessary to prevent complications. It is often diagnosed on clinical signs and a certain ratio of negative appendectomy is acceptable. For early and accurate diagnosis, various scoring systems such as Alvarado, Ohmann, Eskelinen and more recently Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) have been developed.Objective:In this study, we aimed to compare the effectiveness and accuracy of scoring systems.Materials and methods:The patients who attended emergency department and operated with acute appendicitis pre-diagnosis were evaluated retrospectively. Alvarado, Ohmann, Eskelinen, and RIPASA scores were calculated and compared with histopathologic results by reviewing the patient files.Results:A total of 76 patients (44 males and 32 females) were included in the study. The mean age was 33.8 ± 13.2 years. Of which, 59 patients (77.6%) were diagnosed to have acute appendicitis on histopathological examination. The mean leukocyte count was 13.9 ± 3.7 × 103μL. Sensitivity and specificity of Alvarado, Ohmann, Eskelinen, and RIPASA were 36%–82%; 58%–71%; 36%–8%, and 68%–71%, respectively. Cut-off values were 8, 14, 55.63, and 10, respectively. RIPASA had the highest accuracy. The cut-off value of leukocyte counts was 13,900 × 103/μL. Sensitivity and specificity were 64% and 88%, respectively; positive predictive value was 95%. In the receiver operating curve analysis, the area under the curve was found to be 74%.Conclusion:The RIPASA scoring system is a more reliable scoring system than Ohmann, Eskelinen, and Alvarado scoring systems. In cases of suspected acute appendicitis, it may be useful to evaluate patients with RIPASA score in emergency departments by general practitioners, where there is no general surgeon. Thus, patients can be guided in a timely manner to reduce the complications that may arise from delays. The cut-off value of 13,900 × 103/μL is an important marker for the presence of acute appendicitis.


2017 ◽  
Vol 4 (8) ◽  
pp. 2806 ◽  
Author(s):  
Chenna Krishna Reddy Chada ◽  
Srikrishna Malepati ◽  
Jithendra Kandati ◽  
Sreeram Satish

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Delay in management results in complications and misdiagnosis results in negative appendectomy. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. Alvarado score for diagnosis of acute appendicitis is an easy, affordable and diagnostic which has been evaluated early with variable reports. In cases with equivocal score, additional tools like sonography may provide a reliable result in accurate diagnosis of acute appendicitis. Objective of the study was to determine the diagnostic accuracy of Alvarado score and ultrasonography in diagnosis of acute appendicitis. To determine the sensitivity, specificity and predictive values of ultrasonography in cases operated with histopathological correlation.Methods: A prospective observational study was conducted at our hospital by department of general surgery for a period of six months. All suspected cases of appendicitis were scored by Alvarado score and cases with>5 were performed additional USG for further evaluation. All the cases of appendicitis that underwent surgery were further confirmed by histopathological correlation with USG and clinical Alvarado score.Results: A total of 200 cases were enrolled with male predominance (57.5%) and mean age of study group was 34.26±8.64 years and male to female ratio of 1.3:1.69% of cases presented with Alvarado score of 7 and above, while 21% of cases with 5-6. Migratory pain in RIF was the commonest symptom and tenderness RIF was the most common sign.160 cases (80%) were operated totally with 75% cases lap appendectomy and 25% cases by open appendectomy. USG was performed on 160 cases and 146 were positive and 14 were negative whereas histopathologically 142 cases were confirmed as Acute appendicitis. The sensitivity, specificity, PPV and NPV of USG is 97.18%, 55.56%, 94.52% and 71.43%. The accuracy of USG is 92.5.Conclusions: Acute appendicitis is first and foremost a clinical diagnosis with scoring systems and imaging being necessary adjuncts in equivocal cases. USG is an easily available tool in diagnosis of acute appendicitis. Application of USG as adjunct tool to Alvarado scoring improves the diagnostic accuracy.


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