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

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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The Alvarado scoring system in acute appendicitis: A 6-month cross-sectional study to evaluate its reliability in reducing the rate of negative appendicectomy at Queen’s Hospital, Burton

European Journal of Molecular & Clinical Medicine ◽

10.1016/j.nhccr.2017.10.031 ◽

2017 ◽

Vol 2 (0) ◽

pp. 32

Author(s):

Joshua Agilinko ◽

Naseem Waraich

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Negative Appendicectomy

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Prevalence of perforated appendicitis and its determinants in pediatric appendicitis patients admitted in tertiary care centre, South India: a cross sectional study

International Surgery Journal ◽

10.18203/2349-2902.isj20185020 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3926

Author(s):

Chandrashekar S. ◽

Lokesh M. G. ◽

Avinash S. R.

Keyword(s):

Acute Appendicitis ◽

Tertiary Care ◽

Perforated Appendicitis ◽

Cross Sectional Study ◽

Sectional Study ◽

Tertiary Care Centre ◽

Alvarado Score ◽

Cross Sectional ◽

Pediatric Age Group ◽

Perforated Appendix

Background: Appendicitis remains a common indication for urgent surgical intervention in pediatric age group. Acute appendicitis has the highest incidence during the second decade of life. When the diagnosis is performed, perforation could be already present in 30%-75% of children, with young children being at higher risk. The challenge for the practitioner is to perform a timely diagnosis of acute appendicitis in first years of life before complications occur.Methods: A facility based cross sectional study was conducted with sample size of 108. The patients diagnosed and operated for acute appendicitis using Alvarado score were correlated with intra operative findings.Results: Total 108 patients with median age of 11 (IQR 9–13) years, were included in the study in which 66% were male. Overall 18% (95% CI 11%-25%) had perforated appendix and 5% (95% CI 2%-11%) had appendicitis with abscess. Male gender, patients presenting with fever, guarding, rigidity and patients presenting 48 hours after developing symptoms, had higher chance of perforation. Mean count of WBC (17000 v/s 11000) and neutrophils (75% v/s 68%) were found to be higher in patients with perforated appendicitis.Conclusions: One-fifth of the pediatric appendicitis patients presenting in tertiary care patients had perforated appendicitis.

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Diagnostic efficacy of Fenyo-Lindberg scoring system in patients of acute appendicitis a one-year cross sectional study

International Surgery Journal ◽

10.18203/2349-2902.isj20205347 ◽

2020 ◽

Vol 7 (12) ◽

pp. 3998

Author(s):

Kartik Sahu ◽

Anil P. Bellad

Keyword(s):

Acute Appendicitis ◽

Sample Size ◽

Scoring System ◽

Cross Sectional Study ◽

Histopathological Diagnosis ◽

Sectional Study ◽

Diagnostic Efficacy ◽

Cross Sectional ◽

Group I ◽

One Year

Background: Diagnostic scores have been found to be very efficient. The present study was taken up to calculate diagnostic efficacy of Fenyo-Lindberg (FL) scoring system in patients of acute appendicitis.Methods: A one-year cross sectional study was done on 100 patients in patients with right lower quadrant pain. Group I had patients with score of -2 and above and group II with score below -2. The groups were compared with histopathological diagnosis. Then, the sensitivity, specificity, positive predictable value (PPV) and negative predictable value (NPV) were calculated.Results: In this study, the males were 52 and females were 48.15 patients, Total leucocyte count (TLC) had more than 14,000 whereas 16 patients had onset of pain in less than 24 hours. 47 patients had vomiting. Tenderness was present in all cases, while rebound tenderness was present in 54% of cases. 98% of patients had progression of pain, whereas migration was seen in 76%. 56% patients had increased pain on coughing. 54 patients had acute appendicitis on histopathology. The study shows that this scoring system has sensitivity of 72% and specificity of 71% in diagnosing acute appendicitis. The PPV was 75% and NPV was 68%.Conclusions: The FL score is an inexpensive clinical tool that may help the diagnosis of acute appendicitis. The results are comparable to previous studies but as the sample size is small, study has to be done in higher sample size to get the data necessary to generalize the findings and the fact that this study was first on this scoring system in India should also be considered.

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Management of Acute Appendicitis during COVID-19 Pandemic in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.6307 ◽

2021 ◽

Vol 59 (235) ◽

Author(s):

Anupama Thapa Basnet ◽

Suraj Singh ◽

Bijay Thapa ◽

Anuj Kayastha

Keyword(s):

Acute Appendicitis ◽

Conservative Management ◽

Binary Data ◽

Tertiary Care ◽

Medical Science ◽

Cross Sectional Study ◽

Care Centre ◽

Sectional Study ◽

Tertiary Care Centre ◽

Cross Sectional

Introduction: Acute appendicitis is the most common reason for abdominal surgery in children. Though appendectomy considered the gold standard there are a lot of complications related to it. Conservative management of acute appendicitis is not new to medical science. In pandemic like COVID-19 when all the health systems were about to shut-down because of lack of manpower and resources, we started a trial of non-operative management. The main aim of this study is to find out the management of acute appendicitis during COVID-19. Methods: This was a descriptive cross-sectional study conducted in a tertiary care centre. Data collection was done from the record section which included the patients diagnosed with acute appendicitis from February 2020 to July 2020 after obtaining ethical clearance from Institutional Review Committee. Cases of appendicular lump, appendicular abscess, appendicular perforations have been excluded. Data was collected and entry was done in Statistical Package for the Social Science software version 20, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The conservative management of acute appendicitis was done in 44 cases (55.7%) while 35 cases (44.3%) had to undergo appendectomy. Conclusions: COVID-19 can complicate the perioperative course as a result of direct lung injury and multiple organ dysfunctions and can also bring serious threats to the safety of medical staffs involved in managing the acute appendicitis case operatively, so conservative management can be considered as an alternative way of management of acute appendicitis in the pandemic outbreak.

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Use and relevance of modified alvarado scoring system in diagnosis of acute appendicitis: a cross sectional study from West Bengal, India

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20191139 ◽

2019 ◽

Vol 6 (2) ◽

pp. 346

Author(s):

Malay K. Barman ◽

Mahua Chanak ◽

Kaustav Das ◽

Koel Mukherjee

Keyword(s):

Health Care ◽

Primary Health Care ◽

Acute Appendicitis ◽

Scoring System ◽

West Bengal ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Remote Areas ◽

Primary Health

Background: For successful management of acute appendicitis, early diagnosis and intervention is needed. Incorrect diagnosis may allow significantly increased morbidity and mortality. Several studies across the globe shows that Modified Alvarado Scoring System (MASS) does not need high end instrument and can be done in emergency situation for accessing acute appendicitis and reducing the chances of unnecessary surgery. To access the efficacy of MASS for diagnosis of acute appendicitis in remote areas with primary health care facilities, present study was done at Siliguri of Darjeeling district of West Bengal which was 580 km distant from state capital (Kolkata).Methods: A cross sectional study over a period of 16 months was conducted among the patients admitted at North Bengal Medical College and Hospital suspected to have acute appendicitis. The diagnosis was confirmed by histopathological examination. Written consent was obtained from the patients before commencement of the study. MASS was applied to the patients and the results were compared with histopathological findings. Appropriate statistical analysis has been done by SPSS (version 16.0).Results: A total of 75 patients (44 males and 31 females) were considered. The sensitivity and specificity of MASS in this study were 75.86% (71.43% for males and 80% for females) and 82.61% (80% for males and 87.5% for females) respectively. Study revealed statistically significant (p<0.000) association between Histopathological report and MASS.Conclusions: To reduce the chances of negative appendectomy and for better diagnosis of appendicitis, MASS may be more useful at primary health care centres those are located in remote areas as it was very simple, easy and cost effective.

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Is Ultrasound a Viable Imaging Modality for the Diagnosis of Hepatocellular Carcinoma? A Cross-Sectional Study

Annals of Punjab Medical College ◽

10.29054/apmc/2021.1089 ◽

2021 ◽

Vol 15 (1) ◽

pp. 9-11

Author(s):

Reeta Rani ◽

Keyword(s):

Hepatocellular Carcinoma ◽

Predictive Value ◽

Tertiary Care ◽

False Negative ◽

Cross Sectional Study ◽

Arterial Phase ◽

Care Hospital ◽

Sectional Study ◽

Mri Scan ◽

Cross Sectional

Background: Radiologists are always questioning the use of an imagine modality as compared to the other, this study helps answer that question for the diagnosis of Hepatocellular carcinoma. Objective: To compare the use of MRI imaging technique with ultrasonography for the diagnosis of hepatocellular carcinoma. Study Design: The type of study is a Prospective Cross-Sectional study. Settings: A large tertiary care hospital in Karachi, Pakistan. Duration: One year from July 2018 to July 2019. Methodology: The inclusion criteria was all the patients who were referred to us with symptoms for concern for hepatic tumors. For the MRI we used a 1.5 tesla machine, and for the ultrasound we used a conventional grey scale ultrasonography with a probe of 5 MHz. We performed multiphasic contrast enhanced MRI’s, with images taken both before the injection of the contrast and afterwards in the various phases such as the arterial phase, portal venous phase and finally the delayed phase respectively. Results: The study population consisted of n=110 patients having a mean age of 46.5 +/- 5.50 years. There were n= 78 (70.90%) males and n= 32 (20.09%) females. N= 101 (91.81%) patients had a diagnosis of hepatocellular carcinoma as per MRI scan, for ultrasound n= 47 (42.72%) patients were diagnosed as true positive, n= 2 (1.81%) were false positive, n= 54 (49.09%) were false negative, while n= 7 (6.36%) cases were truly negative. The specificity was 77.77% the sensitivity was 46.53%, the positive predictive value was 95.91%, negative predictive value was 11.4%, and accuracy was 49.09% respectively. Conclusion: We found that the specificity of ultrasound as a diagnostic modality for hepatocellular carcinoma as compared to the MRI scan is good, however it is only able to correctly identify about half the patients, hence care should be taken when interpreting the results of ultrasound for hepatocellular carcinoma.

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Diagnostic Accuracy Of RIPASA Scoring System In Presumptive Accurate Diagnosis Of Acute Appendicitis : A case control study

10.22541/au.162740073.30858831/v1 ◽

2021 ◽

Author(s):

Mehwish Mooghal ◽

Wajiha Khan ◽

Shahid Mehmood ◽

Lal Bux ◽

Asrar Ahmad ◽

...

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Scoring System ◽

Tertiary Care ◽

Cross Sectional Study ◽

Accurate Diagnosis ◽

Negative Appendectomy ◽

Care Hospital ◽

Cross Sectional ◽

Ripasa Score

Introduction: The RIPASA scoring system was established specifically for Asians. Chong CF in his study consisting of 312 patients who had an emergency appendectomy concluded that optimal cut-off threshold score for negative appendectomy was 7.5. Objective: To determine the diagnostic accuracy of RIPASA scoring system in presumptive accurate diagnosis of acute appendicitis by taking histopathology as the gold standard. Materials and methods: This Cross Sectional Study was carried out at Surgery department at a tertiary care hospital, Karachi over a period of 6 months, from 15th December 2019 to 15th June 2020. A total of 141 patients of both gender of suspected cases of acute appendicitis presenting with sign and symptoms were included in the study. Patients underwent detailed history, general and physical examination and scoring of patients according to RIPASA scoring scale and then decision of appendectomy was taken on the basis of RIPASA score. Removed appendix samples were sent for histopathology. Results: Age range in this study was from 15 to 50 years with mean age of 30.191±6.09 years and mean RIPASA score was 5.375±1.77. Majority of patients were males (58.9%). RIPASA score diagnosed 28(19.9%) and histopathology diagnosed 27(19.1%) patients with acute appendicitis. RIPASA score showed sensitivity of 85.2%, specificity 95.6%, diagnostic accuracy 94%, PPV 82.1% and NPV was 96.4%. Conclusion: We conclude that RIPASA scoring system is the scoring system of choice in diagnosis of the acute appendicitis with good sensitivity albeit a hit high and specificity albeit a bit low profile.

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20183876 ◽

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.

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Knowledge, Attitude, And Practice Regarding Nursing Interruptions Among Nurses in Tertiary Care Hospital: A Cross-Sectional Study

International Journal of Health, Medicine and Nursing Practice ◽

10.47941/ijhmnp.582 ◽

2021 ◽

Vol 3 (2) ◽

pp. 17-35

Author(s):

Simon Javed ◽

Muhammad Hussain ◽

Kausar Parveen ◽

Muhammad Afzal

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Unique Contribution ◽

Care Hospital ◽

Human Beings ◽

Sectional Study ◽

Cross Sectional ◽

Attitude And Practice ◽

Knowledge Attitude And Practice

Purpose: Nursing is a profession who belong to care of community, a universal perception. Nurses job criteria belongs to many distractions and obstacles in performing their job. Interruption is considered to be part of workplace. The nursing profession responsibility and reliability are of high concerns because it deals with the life of human beings. Interruption at workplace compromises the patient safety. The study sought to explore the knowledge, attitude, and practices regarding nursing interruption among nurses. Methodology: Descriptive cross-sectional study design used. Questionnaire a tool used to collect data from tertiary care hospital (n=115). The tool contains a dimension of knowledge attitude and practice scoring of questionnaires as knowledge 50 score, attitude 45 and practice 28, respectively number questions each domains knowledge 10, attitude 9 and practice 7. Results: The KAP regarding interruption among Pakistani nurses score range (26-123). The means of knowledge attitude and practices respectively 31.2957 ± 7.21229, 33.1478 ± 5.68507, 19.5826 ± 3.86841. the collective mean and standard deviation of knowledge attitude and practice 84.0261 ± 16.76577. correlation statistically significant in KAP (p<0.05). Coefficient of correlation knowledge enhance practices. The combined KAP of respondents was 69%. Unique contribution to theory, practice and policy: Knowledge attitude and practice prime parameters of confirming the quality of understanding and performance. Study concluded that nurses have moderate level of knowledge attitude and practice 69%. The knowledge and attitude positive coefficient correlation, enhance each other. Gender, increased academic qualification, attention of leader and experience correlation with KAP. Experience and age group 10-15 years possess a high degree of knowledge attitude and practice. There is a need for interruption management training moreover requiring leader attention. Basic understating about interruption on a clinical place not considerably efficient. The dependent variable causes a 20% variance in the criterion variable.

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