Application of Modified Alvarado scoring system in the diagnosis of acute appendicitis: a study in a tertiary care hospital

Background: Acute Appendicitis is one of the common surgical diseases which require early intervention; however, it may lead to higher negative appendicectomy rates, in uncertain Diagnosis. Negative appendicectomy rate is 20-40%. There are various scoring systems to assist in diagnosis. The aim of this study is to assess the effectiveness of Modified Alvarado Scoring System (MASS) in patients with acute appendicitis in AGMC and GBP Hospital.Methods: This was a cross sectional study to evaluate the effectiveness of MASS in patients presenting with acute appendicitis. The Principal Investigator scored all the patients according to the variables of MASS and divided them into three groups. Group I included patients with MASS of four and below, Group II were patients with MASS of 5-6 and Group III included patients with MASS of seven and above. The diagnosis of acute appendicitis was confirmed by histopathological examination. Data was collected using a coded, pre-tested questionnaire and analyzed using SPSS statistical software version 11.5.Results: In this study, 36 cases out of 42 cases had acute appendicitis. The sensitivity of Modified Alvarado Score of >7 was 85.7% (proportion of true positive). The sensitivity was highest among males i.e., 92% while in females, it was 76.4%. Negative appendicectomy rates were highest among females (23.6%), whereas in case of males it was 8%.Conclusions: The present study has shown that MASS provides high degree of sensitivity, specificity, PPV, NPV and accuracy in the diagnosis of acute appendicitis and has found to be more helpful in and high positive predictive value for male patients as compared to females.

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A comparative study on RIPASA and modified Alvarado score in the diagnosis of acute appendicitis in tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20210931 ◽

2021 ◽

Vol 8 (3) ◽

pp. 944

Author(s):

Kodenge Raghavendra Rao ◽

D. Navya Sesha Harika ◽

Suragani V. Narayana ◽

Vinodh Kumar K. S. ◽

Chavala Pavan Kumar Yadav ◽

...

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Iliac Fossa ◽

Tertiary Care ◽

Scoring Systems ◽

Care Hospital ◽

Alvarado Score ◽

Modified Alvarado Score ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Acute Appendicitis is common surgical emergencies with a lifetime prevalence of approximately 1 in 7. Despite advances in diagnosis and treatment; acute Appendicitis is still associated with morbidity (10%) and mortality (1-5 %). Presentations of acute Appendicitis can mimic various acute medical and surgical conditions, and the diagnosis is predominantly a clinical one-different scoring systems used for aiding in early diagnosis of Acute Appendicitis and its prompt management. Alvarado score and RIPASA score are the most popular ones. So we retrospectively applied and compared Alvarado and RIPASA score in the diagnosis of acute Appendicitis in Indian population.Methods: In this study, we compared RIPASA score and Alvarado scoring system retrospectively by applying to 74 patients. This study period from November 2018 to March 2020. Both scores were calculated for patients presented with right iliac fossa pain. Sensitivity, specificity, positive predictive value (PPV), negative predictive (NPV), diagnostic accuracy for RIPASA and Alvarado system was calculated.Results: The sensitivity and specificity of the Alvarado score were 85.07% and 57.14% respectively. The sensitivity & specificity of RIPASA score were 91.04% and 71.42% respectively. Accuracy of the Alvarado scoring system is 82.44% and for RIPASA scoring system is 89.18%. The results show that the RIPASA scoring system is a better diagnostic tool for the diagnosis of Acute Appendicitis.Conclusions: RIPASA scoring system is simple, accurate, convenient, and more specific scoring system than the modified Alvarado scoring system for the Indian population.

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Evaluation of validity of scoring systems in diagnosing acute appendicitis: a single centre prospective observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20214807 ◽

2021 ◽

Author(s):

Rakesh Natesan S. ◽

Naren Kumar A.

Keyword(s):

Observational Study ◽

Acute Appendicitis ◽

Prospective Observational Study ◽

Histopathological Examination ◽

Tertiary Care ◽

Life Time ◽

Scoring Systems ◽

Care Hospital ◽

Alvarado Score ◽

Predictive Values

Background: Acute appendicitis is a very common cause of acute abdominal pain, requiring surgical intervention with a 7% life time risk. Various clinical scoring systems like Alvarado, appendicitis inflammatory response (AIR), Tzanaki scores enables risk stratification. In this study, we have validated the diagnostic accuracy of various scoring systems like Alvarado, Tzanaki and AIR scores. Methods: We conducted a prospective observational study for patients admitted in a tertiary care hospital. A total of 81 patients were selected based on the inclusion and exclusion criteria. A detailed clinical history, physical examination, relevant blood investigations and necessary imaging were done for all the patients. Using the above data, the probability of acute appendicitis is calculated using the Alvarado, Tzanaki and AIR scores. The various scores obtained were compared with the histopathological examination (HPE) reports (reference standard) and values like sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated.Results: With regard to scores, Alvarado scores has a sensitivity 95.24%, specificity 77.78%, PPV of 93.75%, NPV of 82.35%. Tzanaki score has a sensitivity of 100%, specificity 23.5%, PPV of 83.12% and NPV of 100%. AIR score has a sensitivity of 95%, specificity of 66.67%, PPV of 89.06% and NPV of 82.35%. Conclusions: Alvarado score (cut off 7) has the best PPV (93.75%) and hence is the best scoring system to “rule in” a positive diagnosis. However, Tzanaki score (cut off 8) has the best NPV (100%) and hence is the best score to “rule out” a diagnosis of acute appendicitis.

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A study of correlation between clinical, radiological and pathological diagnosis of appendicitis: a retrospective analytic study

International Surgery Journal ◽

10.18203/2349-2902.isj20183446 ◽

2018 ◽

Vol 5 (9) ◽

pp. 3011

Author(s):

Prabhu R. ◽

Vijayakumar C. ◽

Balagurunathan K. ◽

Senthil Velan M. ◽

Kalaiarasi R. ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Scoring System ◽

Acute Abdominal Pain ◽

Histopathological Examination ◽

Tertiary Care ◽

Radiological Finding ◽

Clinical Signs ◽

Emergency Setting ◽

Alvarado Score

Background: Acute appendicitis is the most common cause of acute abdominal pain in young adults requiring emergency surgery. Appendicectomy is the most frequently performed surgery. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. A combination of clinical signs and symptoms with laboratory findings in many scoring systems are suggesting the probability of appendicitis and the possible subsequent management pathway. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological finding and histopathological examination for the diagnosis of acute appendicitis.Methods: A retrospective study was conducted in the department of general surgery in a tertiary care centre in South India. Total of 237 patients with acute abdominal pain were included and evaluated with the clinical Alvarado scoring system, radiological finding with (USG/CT abdomen) and histopathological examination for the diagnosis of acute appendicitis. The data was collected and analyzed retrospectively.Results: Of the 237 patients, 164 patients were male (69.1%) and rest is female. The correlation of the Alvaroda score with histopathological findings in groups with score > 7 and ≤7 the correlation of Alvarado score and the ultrasound findings were comparable between the study groups. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score >7 was 72.99%. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score ≤7 was decreased to 27%.Conclusions: The diagnostic accuracy of clinical features is far better than radiological investigations in the diagnosis of acute appendicitis. Therefore, it is concluded that it is better to use radiological investigations only to confirm the diagnosis of acute appendicitis rather to diagnose it.

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External validation of Tzanakis scoring system in acute appendicitis in a rural hospital

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191631 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1536

Author(s):

Mohd Riyaz Lattoo ◽

Shabir Ahmad Mir ◽

Nayeemul Hassan Ganie ◽

Shabir Hussain Rather

Keyword(s):

Retrospective Study ◽

Acute Appendicitis ◽

Predictive Value ◽

Scoring System ◽

Histopathological Examination ◽

External Validation ◽

Scoring Systems ◽

Common Cause ◽

Negative Laparotomy ◽

Negative Appendicectomy

Background: Acute appendicitis is one of the most common cause of acute abdomen surgery. Several scoring systems have been adopted by physicians to aid in the diagnosis and decrease the negative appendicectomy rate. Tzanakis scoring system is one such score. Objective of present study was the validation of this scoring system in our population and compare its accuracy with histopathological examination (HPE).Methods: A retrospective study was carried out at the Department of Surgery at Mohammad Afzal Beigh Memorial Hospital Anantnag India. Tzanakis score was calculated in 288 patients who underwent appendicectomy from September 2016-2018 and HPE results were analysed.Results: 276 patients were eligible for the study. The sensitivity and specificity of Tzanakis score in diagnosing appendicitis was 90.66% and 73.68% respectively. The overall diagnostic accuracy was 86.23% with positive predictive value of 97.89% and negative predictive value of 36.84%.Conclusions: Tzanakis scoring system is an accurate modality in establishing the diagnosis of acute appendicitis and preventing a negative laparotomy.

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A comparison of Tzanakis and Alvarado scoring system in the diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20192370 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2080

Author(s):

R. Anupriya ◽

C. P. Ganesh Babu ◽

K. V. Rajan

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

Scoring System ◽

Histopathological Examination ◽

Cross Sectional Study ◽

Alvarado Score ◽

Cross Sectional ◽

Abdominal Emergency ◽

Gandhi Medical College ◽

Research Institute Hospital

Background: Appendicitis is the most common abdominal emergency worldwide. Lifetime risk of acute appendicitis is 8.6% and 6.7% for man and women respectively. Clinical examination is helpful in diagnosis of acute appendicitis in only 70-87% of the cases. To compare Tzanaki and Alvarado scoring system in diagnosing acute appendicitis.Methods: This was a prospective, comparative, cross-sectional study, which was conducted at the Mahatma Gandhi Medical College and Research Institute Hospital. Patients with acute appendicitis were included in the study. Relevant history, examination and laboratory investigations done. Patients were scored according to both Alvarado scoring system and Tzanakis scoring, and both were documented in the proforma. Sensitivity, specificity, positive predictive value, negative predictive value were assessed and compared for both scoring systems.Results: 70 patients were included in this study. 54.3% of patients have Tzanakis score more than 8. 35.7% of patients have Alvarado score more than 7. 82.9% of patients had evidence of appendicitis in histopathological examination. Tzanakis score: sensitivity– 65.52%, specificity- 100%, PPV– 100%, NPV– 37.50%, accuracy– 71.43%. Alvarado score: sensitivity– 36.21%, specificity– 66.67%, PPV- 84%, NPV– 17.78%, accuracy– 41.43%.Conclusions: Tzanakis scoring system is an effective scoring system in diagnosing acute appendicitis.

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Modified Alvarado scoring system as a diagnostic tool for acute appendicitis at a tertiary care teaching hospital, Central India: a cross sectional study

International Surgery Journal ◽

10.18203/2349-2902.isj20173142 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2439

Author(s):

Dilip Kothari ◽

Archana Kothari ◽

Abhishek Kalantri ◽

Pawan Bhambani

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Tertiary Care ◽

False Negative ◽

Cross Sectional Study ◽

General Information ◽

Human Beings ◽

Sectional Study ◽

Cross Sectional ◽

Negative Appendicectomy

Background: Acute Appendicitis forms an important emergency in the day-to-day surgical practice. It affects human beings irrespective of age, nationality and religion. Early diagnosis and prompt operative intervention is the key for successful management of acute appendicitis. However, the picture of acute appendicitis may not be classical, and in such situations, a policy of early intervention to avoid perforation may lead to high negative appendicectomy rates.Methods: A total of 80 patients were enrolled in the present cross sectional study. Their ages ranged from eleven to 72 years (mean 32.89 ± 15.87). A proforma containing general information about the patient plus eight variables based on the modified Alvarado scoring system was filled.Results: Histological examination confirmed appendicitis in 54 patients (67.5%). The remaining 26 patients were found to have normal appendix giving a negative appendicectomy rate of 32.5% being 36.8% and 28.3% for males and females respectively.Conclusions: This scoring system is easy, simple and cheap complementary aid for supporting the diagnosis of acute appendicitis. MASS can be used effectively in Indian setup to reduce the incidence of negative appendectomies. The patients are not unduly exposed to risks of delay in intervention or significant increase in number of false negative cases.

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A study on the clinical and sonological correlation in the diagnosis and management of acute appendicitis in a tertiary care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20192365 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2053

Author(s):

Keerthi Mudavath ◽

Thinagaran K.

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Histopathological Examination ◽

Iliac Fossa ◽

Tertiary Care ◽

Negative Appendectomy ◽

Common Symptom ◽

Emergency Setting ◽

Alvarado Score ◽

Histopathological Findings

Background: Acute appendicitis is the most common acute surgical condition of the abdomen requiring early intervention. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. Alvarado score for diagnosis of acute appendicitis is easy and additional tools like sonography results in accurate diagnosis. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological findings and histopathological examination for the diagnosis of acute appendicitis.Methods: 100 cases of acute abdomen admitted in PES institute of medical sciences and research, Kuppam from December 2016 to June 2018 were included. Clinical examination was done and all patients were subjected to ultrasound abdomen examination and other relevant blood and imaging investigations.Results: Out of 100 patients 62 were males and 38 were Females. Most common symptom was pain in the right iliac fossa and patients with Alvarado Score 7 or > 7 subjected to USG followed by emergency appendectomy showed positive operative findings and histopathological findings. The overall specificity of abdominal USG in the diagnosis of acute appendicitis was 88.09% and sensitivity was 95.37%.Conclusions:The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and less expensive useful, reliable and non invasive way of confirming acute appendicitis thus helps in reducing negative appendectomy rate. The overall accuracy of diagnosis of acute appendicitis goes up to 90% with positive histopathological findings.

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Comparison of acute inflammatory score and Alvarado score in diagnosis of acute appendicitis at a tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20175405 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4034

Author(s):

Padmaja Rani Gopalam ◽

M. V. Saila Suman Konidala

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Financial Burden ◽

Tertiary Care ◽

Area Under The Curve ◽

High Specificity ◽

Lower Sensitivity ◽

Negative Appendectomy ◽

Care Hospital ◽

Alvarado Score

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. The most common and widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. A recently introduced appendicitis inflammatory response score (AIR) was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. The objective the present study was to evaluate the AIR score on cases of suspicious appendicitis and to compare it with Alvarado scorings system.Methods: A prospective study for a period of two years from March 2015 to February 2017 was conducted on consecutive patients who presented to emergency department and scoring was performed based on the necessary variables.Results: The present study was conducted on 300 cases suspicious of appendicitis. The results analysed showed the area under the ROC curve of the AIR score was 0.94 and better than the area under the curve of Alvarado score of 0.82. The AIR score also did well in difficult cases of women, children when compared to Alvarado score in diagnosis of appendicitis. In our study, in cases with >8 points, a lower sensitivity was observed in AIR scoring than Alvarado scoring (0.26 vs. 0.12), but was associated with higher specificity (1.00 vs. 0.95). In these cases, PPV turned out to be 1.00 for AIR scoring and 0.77 for Alvarado scoring.Conclusions: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Follow up of these cases will help in deciding surgical intervention in unnecessary cases. This scoring system also prevents unnecessary and costly radiological investigations thereby reducing the financial burden to the patients.

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Outcome of Alvarado scoring system in the diagnosis of acute appendicitis at a tertiary care teaching hospital

10.53350/pjmhs2115102649 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2649-2651

Author(s):

Afza Saleem ◽

Zahra Ali ◽

Wasif Majeed Chaudhry ◽

Aruj Alam ◽

Muhammad Shoaib ◽

...

Keyword(s):

Acute Appendicitis ◽

Teaching Hospital ◽

Clinical Judgment ◽

Scoring System ◽

Iliac Fossa ◽

Tertiary Care ◽

Accurate Diagnosis ◽

Care Hospital ◽

Alvarado Score ◽

Surgical Residents

Background: Diagnosis of acute appendicitis is usually made on the basis of clinical judgment and experience of the surgeon. It may sometimes become a challenge due to variability in presentation. It is not unusual for surgical residents & consultants to miss the diagnosis. Aim: To evaluate the effectiveness of Alvarado score in making an accurate diagnosis of acute appendicitis and assessing its sensitivity at a tertiary care hospital, in Lahore, Pakistan. Methods: A Prospective observational study was conducted at the department of Surgery, Ghurki Trust Teaching Hospital (GTTH). The data was collected from 117 patients on a self-designed proforma over a one-year period i.e., from 1st January 2018 to 31st December 2018 with the suspected diagnosis of acute appendicitis and who underwent surgery. The variables were evaluated with Alvarado scoring system to assess its effectiveness and sensitivity. The data was analyzed using SPSS vr 23. Results: Demographic results showed 73(62.4%) males and 44(37.6%) female. The mean age was 23 years and most of the patient were in age group 11-20years 55(47%). Abdominal pain was the commonest feature found in all the patients followed by Nausea in 72% and migration of pain to Right Iliac fossa 60%. Complicated appendicitis was found as gangrenous (7.5%) and perforated (6%). 53% of the cases were performed by on-call team consisted of SRs and surgical residents. Conclusion: Alvarado score is an effective scoring system in making an accurate diagnosis of acute appendicitis. It can be very useful in the prompt management of patients with equivocal features and in extreme of ages. Keywords: Acute appendicitis, Clinical scoring, Alvarado score

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A COMPARATIVE STUDY OF TZANAKIS SCORE VS ALVARADO SCORE IN THE DIAGNOSIS OF ACUTE APPEDICITIS

10.36106/paripex/3903441 ◽

2020 ◽

pp. 39-41

Author(s):

Shouryabrata Choudhury ◽

Bhaskar Sharma ◽

Neelanjana Paul

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

Scoring System ◽

Open Appendectomy ◽

Scoring Systems ◽

Alvarado Score ◽

Duration Of Symptoms ◽

Medical College ◽

Negative Appendicectomy ◽

Sensitivity Specificity

Background: Acute appendicitis is the most common cause of sudden abdominal pain requiring surgery. Prolong duration of symptoms before the surgical intervention increases the risk of morbidity and mortality due to perforation. There have been several scoring systems to help the decision making process to reach diagnosis of acute appendicitis. ALVARADO and modified ALVARADO are the two most commonly used system worldwide. This study is being done to assess the accuracy of the TZANAKIS SCORING SYSTEM and ALVARADO SCORING SYSTEM in the diagnosis of acute appendicitis and reduce the rate of negative appendicectomy. Methodology: This was a hospital based prospective observational study conducted on patients admitted in the Department of General Surgery, Silchar Medical college and Hospital. This study was based on the analysis of 100 patients diagnosed to have acute appendicitis and underwent emergency open appendectomy from March 1st ,2020 – August 31st 2020. Aims and objectives: The aim of the present study is to assess the compare the accuracy of TAZANAKIS Scoring system and ALVARDO scoring system in the diagnosis of acute appendicitis. Results: The sensitivity, specificity, positive predictive value and negative predictive value of Tzanakis score was 83.72, 78.57, 96.0 and 44.0 respectively and of Alvarado score was 65.11, 35.71, 86.1 and 14.28 respectively. Negative appendicectomy was 14%. Conclusion: Tzanakis scoring system is an effective scoring system to establish the accurate diagnosis of acute appendicitis and helps in reducing negative appendicectomy rate.

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