scholarly journals Comparison of Alvarado and RIPASA scoring systems in diagnosis of acute appendicitis and correlation with intraoperative and histopathological findings

2017 ◽  
Vol 4 (5) ◽  
pp. 1755 ◽  
Author(s):  
Mahendra Kumar Regar ◽  
Ganpat Singh Choudhary ◽  
Chandrakanta Nogia ◽  
Dharmendra Kumar Pipal ◽  
Anand Agrawal ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Scoring Systems ◽  
Exclusion Criterion ◽  
P Value ◽  
Chi Square ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Histopathological Findings ◽  
Negative Appendicectomy

Background: Despite extraordinary advances in modern radiology and laboratory investigations an accurate diagnosis of acute appendicitis cannot be made in atypical cases. No single diagnostic aid can dramatically reduce the rate of negative appendicectomy.Methods: To reduce the rate of negative appendicectomies, application of RIPASA and Alvarado scoring done in every clinically diagnosed cases of appendicitis in a prospective study from January 2015 to January 2016 was done. 100 patients with right lower quadrant abdominal pain fulfilling the inclusion and exclusion criterion underwent appendicectomy in Mahatma Gandhi Hospital, Dr. S.N. Medical college, Jodhpur, Rajasthan, India.Results: The results of both scoring system were reported and were correlated with intraoperative and histopathological findings. Chi-square test was applied to calculate the p-value for the association between the variables of studied. The mean age was 24.86 years (10-80 years) and there were 61 males and 39 females in the study. Histopathological examination confirmed appendicitis in 95 patients with 5 negative appendicectomies. Negative appendicectomy rate for RIPASA and Alvarado score was 2.17% and 1.54% respectively. Accuracy for RIPASA and Alvarado score was 93% and 68% respectively.Conclusions: RIPASA score is a more valuable tool for diagnosing acute appendicitis with 93% accuracy, sensitivity 94.74% and specificity 60%; inspite of sophisticated investigations like CT, thus reducing the cost of treatment and minimize negative appendicectomy rate.

scholarly journals To evaluate the diagnostic accuracy of alvarado score, C-reactive protein, ultrasonography and computed tomography in acute appendicitis and to correlate them with operative and histological findings

2016 ◽  
Vol 4 (1) ◽  
pp. 361
Author(s):  
Dharmendra Kumar Pipal ◽  
Saurabh Kothari ◽  
Harshit Shrivastava ◽  
Amit Soni ◽  
Vibha Pipal
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Exclusion Criterion ◽  
P Value ◽  
Chi Square ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Negative Appendicectomy ◽  
Gandhi Medical College ◽  
A Prospective Study

Background:Despite extraordinary advances in modern radiology and laboratory investigations an accurate diagnosis of acute appendicitis cannot be made in atypical cases. No single diagnostic aid can dramatically reduce the rate of negative appendicectomy.Methods: To reduce the rate of negative appendicectomies by the combined use of diagnostic modalities in a prospective study from July 2011 to December 2012 was done. 100 patients with right lower quadrant abdominal pain fulfilling the inclusion and exclusion criterion underwent appendicectomy in Mahatma Gandhi Medical College and Hospital, Jaipur, India.Results:The results of the diagnostic aids were reported in combination using the ‟or” rule and were correlated with intraoperative and histopathological findings. Chi-square test was applied to calculate the p value for the association between the variables of studied. The mean age was 26±11.25 years (10-59 years) and there were 70 males and 30 females in the study. Histopathological examination confirmed appendicitis in 90 patients with 10 negative appendicectomies. A negative appendicectomy rate of 5.71% in men and 20% in women was observed.Conclusions:Alvarado score in combination with ultrasonography is a valuable tool for diagnosing acute appendicitis inspite of sophisticated investigations like CT, thus reducing the cost of treatment and preventing negative appendicectomy rate.

scholarly journals Serum fibrinogen level as a diagnostic tool in diagnosis of acute appendicitis

2018 ◽  
Vol 5 (6) ◽  
pp. 2340
Author(s):  
Jay M. Makadia ◽  
Adessh P. Jain
Keyword(s):  
Acute Appendicitis ◽  
Fibrinogen Level ◽  
Histopathological Examination ◽  
Randomized Study ◽  
P Value ◽  
Histopathological Diagnosis ◽  
Chi Square ◽  
Alvarado Score ◽  
Diagnostic Modality ◽  
Duration Of Symptoms

Background: Objective of present study was to evaluate the importance of serum fibrinogen level in diagnosis of acute appendicitis and relation between clinical examination, ALVARADO score, USG Abdomen and Histopathological examination in operated case of acute appendicitis.Methods: This prospective randomized study was done in SSG Hospital and government medical college, Vadodara in August 2016 to December 2016, Symptoms, signs, duration of symptoms, and laboratory investigations along with ultrasound of abdomen were recorded; Alvarado score was calculated and recorded in all the cases, serum fibrinogen levels were measured before surgery. After undergoing definitive surgery histopathological report of specimen of appendix were obtained and the ultimate diagnosis was kept on the basis of histopathological results. Data were recorded using Microsoft Excel, on the basis of histopathological diagnosis two groups were formed one of acute appendicitis another of non-appendicitis. Sensitivity, specificity, accuracy along with negative and positive predictive value was calculated. chi square test was used for calculation of p value, p value of <0.05 was considered significant.Results: During the study period, 213 patients underwent surgery for suspected acute appendicitis. Appendicitis was confirmed in 198 (93%) patients. Out of which 135 (63.4%) patients were male and 78 (36.6%) female. The best diagnostic cut-off point for fibrinogen was found at 300 mg/dl, for Alvarado score at 7.Conclusions: The use of fibrinogen blood level may be a new diagnostic modality in the diagnosis of acute appendicitis. The formulation of a triple test is recommended as a criteria in deciding emergency surgery.

scholarly journals MODIFIED ALVARADO SCORE

2010 ◽  
Vol 17 (04) ◽  
pp. 546-550
Author(s):  
SYED WARIS ALI SHAH ◽  
CHAUDHRY AHMED KHAN ◽  
SIKANDER ALI MALIK ◽  
AHMED WAQAS ◽  
AJMEL MUNIR TARRAR ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Military Hospital ◽  
P Value ◽  
Alvarado Score ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score

objective: To compare the frequency of inflamed appendix in suspected patients of acute appendicitis having Modified Alvarado Score (MAS) of 7 or more with patients having MAS of 6 or below. Design: Comparative cross sectional study. Place and duration of study: The study was carried out at Surgical Departments of Combined Military Hospital (CMH) and Military Hospital (MH) Rawalpindi from April 2006 to April 2007. Material and Methods: This study involved 100 patients who were operated with provisional diagnosis of acute appendicitis. Preoperatively MAS of each patient was calculated and the patients were divided in two groups. Group-I had MAS of 7 or more while Group-II had MAS of 6 or below. Postoperatively appendices of all the patients were sent for histopathological examination and its result regarding presence or absence of acute appendicitis was then compared with MAS of respective group. Results: (a) Group-I:- A total of 72 patients with 64(88.9%) positive inflamed appendices on histology. Negative appendicectomy rate 8(11.1%), (b) Group-II:- A total of 28 patients with 8(28.6) positive inflamed appendices. Negative appendicectomy rate 20(71.4%). There is statistical significant difference of positive appendicectomy rate between two groups with (p-value<0.001). Conclusion: Frequency of inflamed appendix is more in patients having MAS of seven orabove. The number of negative appendicectomies can be reduced by using MAS in clinical practice.

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

2018 ◽  
Vol 6 (10) ◽  
pp. 3192
Author(s):  
Anup Kumar Saha ◽  
Ankit Sandhu ◽  
Kumar Vikram
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Scoring Systems ◽  
Care Hospital ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Group I ◽  
Negative Appendicectomy

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.

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

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.

scholarly journals RIPASA score or Alvarado score: diagnosing acute appendicitis

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. 

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

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. 

scholarly journals Is Alvarado Score Helpful for Pediatrician in Diagnosis of Acute Appendicitis? Our Center Experience

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Sedigheh Rafiei Tabatabaei ◽  
Abdollah Karimi ◽  
Mohammad Nassiri ◽  
Leily Mohajerzadeh ◽  
Shahnaz Armin ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Pediatric Population ◽  
Scoring Systems ◽  
Cross Sectional Study ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Lower Quadrant ◽  
Suspected Appendicitis ◽  
Rebound Tenderness

Background: Many problems in the diagnosis of patients with suspected appendicitis have led to the design of clinical scoring systems. In children, diagnostics tools for appendicitis are more critical. Younger patients, diagnostic challenges become more. Practical scoring systems are useful without any particular material and necessitate novel ability. Objectives: However, in spite of the reported outstanding consequences, these scoring systems are not employed regularly. Methods: In this cross-sectional study performed from October 2016 to October 2017, ten provinces out of the 31 provinces in Iran were randomly selected. A total of 631 patients referring to the hospitals with the suspicion of acute appendicitis were assessed. Related variables such as age, sex, right lower quadrant (RLQ) pain, migration of pain to RLQ, nausea, and presence of vomiting, anorexia, tenderness in RLQ and guarding, presence of rebound tenderness, and degree of fever were taken from recorded files by pediatricians. Alvarado scoring system was used for included cases to assess the accuracy of this test for diagnosis of appendicitis in our centers. Results: The mean age of eligible patients was 9.3 ± 3.21 years ranged from 3 years to 18 years, and 380 (60.5%) were male. Using the Alvarado score system in this study, considering the cut-off point value of 7 to decide for operation, the positive predictive value (PPV) showed 32.6%, and negative predictive value (NPV) was 76.73%, with a sensitivity of 44.05% and, specificity of 66.95%. There were statistically no significant correlations among the scoring of the Alvarado and diagnosis of AA (P < 0.05). Regarding receiver operator characteristic curves (ROC), the area under curve (AUC) was 0.58 (0.54 to 0.63) for Alvarado. The AUC was very low, so there was no value for the diagnosis of appendicitis. According to the findings of the present study, the cut-off point of 4.5 is suggested for the diagnosis of acute appendicitis in children with a sensitivity of 73% and specificity of 58%. Conclusions: Although the Alvarado scores supply obviously practical diagnostic information in the management of pediatric population with supposed appendicitis, this method delivers no adequate PPV for clinical practice as a safe way for determining necessary operation.

scholarly journals RIPASA versus Alvarado score in the assessment of suspected appendicitis in children: a prospective study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Tülin Öztaş ◽  
Muhammet Asena
Keyword(s):  
Acute Appendicitis ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Quadrant Pain ◽  
Lower Quadrant Pain ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
Right Lower Quadrant ◽  
Ripasa Score

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.

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

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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