scholarly journals Sherren`s triangle hyperaesthesia a tool to rule out complicated appendicitis

2018 ◽  
Vol 5 (7) ◽  
pp. 2563
Author(s):  
Yashwant R. Lamture ◽  
Harshal Ramteke ◽  
Varsha Gajbhiye
Keyword(s):  
Data Analysis ◽  
Acute Appendicitis ◽  
Clinical Sign ◽  
Sensitivity And Specificity ◽  
Study Data ◽  
Complicated Appendicitis ◽  
Predictive Values ◽  
Surgical Emergency ◽  
Important Sign ◽  
Rule Out

Background: Acute appendicitis is the most common surgical emergency. In spite of sophisticated new investigations mainstay of diagnosis depends on clinical sign and symptoms, Sherren`s triangle hyperaesthesia is very important sign with controversial efficacy about it in available literature. Hence this study was undertaken to prove its efficacy of it.Methods: This study was conducted in 418 patients with 186 females and 251 males. Patients were of acute appendicitis operated for appendicectomy included in the study. Data analysis was done by data statistic software.Results: Sensitivity and specificity of hyperaesthesia in Sherren’s triangle were 47.7% and 42.9% respectively with positive and negative predictive values were 92.1% and 5.56%.Conclusions: Hence it indicates that hyperaesthesia in Sherren’s triangle is important sign to suspect to support diagnosis of acute appendicitis. It has minimal significance to rule out it.  This sign plays very important role in a diagnosis of complicated appendicitis like obstructive appendicitis.

scholarly journals A Study to Evaluate the Significance of Sherren’s Triangle Hyperaesthesia in a Treatment of Acute Appendicitis

2020 ◽  
Vol 3 (1) ◽  
pp. 12-15
Author(s):  
Amarnath Gupta ◽  
A P Singh
Keyword(s):  
Acute Appendicitis ◽  
Clinical Sign ◽  
Sensitivity And Specificity ◽  
Complicated Appendicitis ◽  
Predictive Values ◽  
Surgical Emergency ◽  
Study Results ◽  
Important Sign ◽  
Rule Out

Background: Acute appendicitis is the most common surgical emergency. In spite of sophisticated new investigations mainstay of diagnosis depends on clinical sign and symptoms, Sherren‘s triangle hyperaesthesia is very important sign with controversial efficacy about it in available literature. The aim of this study was to explore the significance of hyperaesthesia in Sherren’s triangle in a treatment of acute appendicitis. Subjects and Methods: This study was conducted in 418 patients with 186 females and 251 males. Patients were of acute appendicitis operated for appendicectomy included in the study. Results: Sensitivity and specificity of hyperaesthesia in Sherren’s triangle were 47.7% and 42.9% respectively with positive and negative predictive values were 92.1% and 5.56%. Conclusion: Hence it indicates that hyperaesthesia in Sherren’s triangle is important sign to suspect to support diagnosis of acute appendicitis. It has minimal significance to rule out it. This sign plays very important role in a diagnosis of complicated appendicitis like obstructive appendicitis.

scholarly journals The role of rebound tenderness in acute appendicitis and appendicular perforation

2017 ◽  
Vol 4 (2) ◽  
pp. 725
Author(s):  
Yashwant R. Lamture ◽  
Varsha P. Gajbhiye
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Study Data ◽  
Rebound Tenderness ◽  
Important Sign ◽  
Male Patients ◽  
Rule Out

Background: Acute appendicitis is the most common surgical emergency. Inspite of sophisticated new investigations mainstay of diagnosis depends on clinical sign and symptoms, rebound tenderness is very important sign with controversial views regarding it in available literature. Hence this study was undertaken to prove its efficacy of it related to rule out appendicular perforations.Methods: This study was conducted in 418 patients with 186 female and 251 male. Patients were of acute appendicitis operated for appendicectomy were included in the study. Data analysis was done by data statistic software.Results: The sensitivity and specificity of rebound tenderness to diagnose acute appendicitis is 65% and 73.6% respectively whereas the sensitivity and specificity of rebound tenderness to diagnose appendicular perforation was 94% and23.3% respectively with positive predictive value is 5 and negative predictive value is 99.Conclusions: Hence it indicates that rebound tenderness is very important to rule out complications like perforation or peritonitis and to support diagnosis of acute appendicitis. It has minimal significance to diagnose perforation of appendix as positive predictive value is less.

scholarly journals The role of ultrasonography in acute appendicitis

2017 ◽  
Vol 4 (5) ◽  
pp. 1769
Author(s):  
Yashwant R. Lamture ◽  
Varsha P. Gajbhiye ◽  
Vinay V. Shahapurkar
Keyword(s):  
Data Analysis ◽  
Acute Appendicitis ◽  
Crucial Role ◽  
Study Data ◽  
Normal Appendix ◽  
Chronic Appendicitis ◽  
Expert Radiologist ◽  
Negative Appendicectomy ◽  
Rule Out

Background:Acute appendicitis is the most common surgical emergency. Inspite of new investigations, mainstay of diagnosis depends on clinical sign and symptoms, laboratory and USG (ultrasonography) of abdomen. Out all these investigations USG is having a crucial role in a diagnosis of it. Hence this study was undertaken to prove its efficacy.Methods: This study was conducted in 418 patients with 186 females and 251 males. Patients were of acute appendicitis operated for appendicectomy were included in the study. Data analysis was done by Stata statistic software. Before surgery patients were subjected for necessary investigations including USG.Results:The mean age was 18.8 (range 8-83) years. Normal appendix found in 22 cases, hence negative appendicectomy rate was 6.6%.  Chronic appendicitis was found in 28 patients. Different pathology was found in 1 in the form of carcinoid of appendix (0.24%) but treated by appendicectomy. USG abdomen in present study showed sensitivity of 88.6% and specificity 92% with PPV and NPV was 98% and 52.3%, frequency reports were s/o acute appendicitis in 337 patients and normal in 82 subjects.Conclusions:It conclude that USG is very important tool to diagnose and rule out appendicitis and its complications like perforation or peritonitis. Its liberal use by expert radiologist can help to reduce negative appendicectomy rate.

scholarly journals Performance of Xpert® MTB/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsy

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chengjun Li ◽  
Chang Liu ◽  
Bingqi Sun ◽  
Wei Zhang ◽  
Yang Wang ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Reference Standard ◽  
Pleural Biopsy ◽  
Predictive Values ◽  
Biopsy Specimens ◽  
Biopsy Tissue ◽  
Liquid Culture System ◽  
Tissue Specimens ◽  
Composite Reference Standard ◽  
Rule Out

Abstract Background Etiological diagnosis of tuberculous pleuritis is challenging, owing to a paucity of Mycobacterium tuberculosis (MTB) in the affected region. Moreover, currently available methods, such as the detection of acid-fast bacilli and microbiological culture, are not always conducive to timely diagnosis and treatment. In this study, we evaluated the performance of Xpert® MTB/RIF assay (hereinafter referred to as “Xpert”) in detecting MTB in difficult-to-diagnose patients using suspensions of pleural biopsy tissue specimens obtained under direct thoracoscopic guidance. Methods One hundred and sixty patients with an unexplained pleural effusion were included from the Shenyang Tenth People’s Hospital and Shenyang Chest Hospital, China, between 2017 and 2018. The included patients underwent thoracoscopy under local anesthesia, with an intercostal incision of approximately 1.0 cm for biopsy. The biopsy specimens were used for pathological and etiological examinations. The Xpert test was evaluated for its sensitivity and specificity, as well as positive and negative predictive values (PPV and NPV, respectively), against data obtained using standards: the BACTEC™ MGIT™ 960 liquid culture system and a composite reference standard (CRS). Results The sensitivity and specificity of Xpert were 68.8 and 64.6%, respectively, against the MGIT 960 culture data. The PPV and NPV of Xpert were 56.4 and 75.6%, respectively. The sensitivity of Xpert was 69.0% against the CRS data, which was significantly higher than that of MGIT 960 culture (56.6%). The PPV and NPV of Xpert against the CRS data were 100.0 and 57.3%, respectively. Conclusions Xpert is a good rule-in test but has limited value as a rule-out test for the diagnosis of tuberculosis pleuritis.

scholarly journals Comparison of the appendicitis inflammatory response and Alvarado scoring systems in the diagnosis of acute appendicitis in children

2021 ◽  
Vol 14 (1) ◽  
pp. 75-80
Author(s):  
Mohammad Vaziri ◽  
◽  
◽  
Nahid Nafissi ◽  
Fariba Jahangiri ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Scoring System ◽  
Scoring Systems ◽  
Final Diagnosis ◽  
Multicentric Study ◽  
Generalized Peritonitis ◽  
History Of ◽  
Rule Out

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.

scholarly journals Could C-Reactive Protein be a Potential Biomarker of Complicated Acute Appendicitis?

2014 ◽  
Vol 21 (6) ◽  
pp. 354-360
Author(s):  
Cy Lai ◽  
Yk Leung ◽  
Ca Graham
Keyword(s):  
Hong Kong ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Complicated Appendicitis ◽  
C Reactive Protein ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
Reactive Protein ◽  
Potential Biomarker ◽  
Clinical Records

Introduction The purpose of this study is to evaluate the diagnostic value of C-reactive protein (CRP) to identify complicated appendicitis (defined as perforation, abscess or gangrenous appendicitis) versus simple appendicitis. Methods A retrospective study was performed in the emergency department (ED) of Prince of Wales Hospital in the New Territories of Hong Kong. The clinical records of patients admitted to the surgical wards via the ED over 17 months were reviewed by a research assistant. We included all patients aged >13 years who had a provisional diagnosis of “acute appendicitis” or “right lower quadrant pain”. We excluded patients with pregnancy, previous appendicectomy, incomplete medical records or no CRP levels determined before operation and those who discharged themselves from hospital against medical advice after admission. The outcome of this study was the CRP level in relation to the presence of complicated appendicitis. ROC curve analysis was employed to identify the optimum cut-off level of CRP which had the best sensitivity and specificity to identify complicated appendicitis compared to simple appendicitis. Results Forty-two patients were diagnosed to have acute appendicitis, 31 of whom had complicated appendicitis. CRP level was higher in the group of complicated appendicitis (p<0.05). We identified an optimum cut-off value for CRP of 40.1 mg/L to discriminate between complicated and non-complicated appendicitis. The sensitivity and specificity of CRP to identify complicated appendicitis were 71.0% and 100% respectively at this cut-off level. Conclusion High CRP levels could possibly predict the diagnosis of complicated appendicitis and facilitate more appropriate surgical care. This finding needs to be confirmed in prospective and larger multicentre studies. (Hong Kong j.emerg.med. 2014;21:354-360)

Swan-neck sign of the big toe - association with hypocalcaemia

2007 ◽  
Vol 37 (4) ◽  
pp. 238-241
Author(s):  
Kishore S Agarwal ◽  
Noopur Baijal ◽  
Lokesh Tiwari ◽  
Neeraj Verma ◽  
Mohit Sahni ◽  
...  
Keyword(s):  
Clinical Sign ◽  
Sensitivity And Specificity ◽  
Serum Calcium ◽  
Metatarsophalangeal Joint ◽  
Febrile Seizures ◽  
Interphalangeal Joint ◽  
Predictive Values

The sensitivity and specificity of a new clinical sign of hypocalcaemia were evaluated. The Swan-neck sign, wherein infants with symptomatic hypocalcaemia keep their big toe hyperextended at the metatarsophalangeal joint and flexed at the interphalangeal joint, was looked for in 25 infants presenting with non-febrile seizures, alongside their serum calcium levels. The study showed that the sign had a sensitivity of 63.6% and specificity of 66.6%. (Predictive values of positive and negative tests were 93.3% and 20%, respectively.) This is compared with the standard Trousseau and Chvostek signs.

scholarly journals Ruling out COVID-19 by chest CT at emergency admission when prevalence is low: the prospective, observational SCOUT study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ulf Teichgräber ◽  
Amer Malouhi ◽  
Maja Ingwersen ◽  
Rotraud Neumann ◽  
Marina Reljic ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sensitivity And Specificity ◽  
Virus Disease ◽  
Negative Likelihood Ratio ◽  
Chest Ct ◽  
Rt Pcr ◽  
Predictive Values ◽  
Suspected Infection ◽  
General Wards ◽  
Rule Out

Abstract Background It is essential to avoid admission of patients with undetected corona virus disease 2019 (COVID-19) to hospitals’ general wards. Even repeated negative reverse transcription polymerase chain reaction (RT-PCR) results do not rule-out COVID-19 with certainty. The study aimed to evaluate a rule-out strategy for COVID-19 using chest computed tomography (CT) in adults being admitted to the emergency department and suspected of COVID-19. Methods In this prospective, single centre, diagnostic accuracy cohort study, consecutive adults (≥ 18 years) presenting with symptoms consistent with COVID-19 or previous contact to infected individuals, admitted to the emergency department and supposed to be referred to general ward were included in March and April 2020. All participants underwent low-dose chest CT. RT-PCR- and specific antibody tests were used as reference standard. Main outcome measures were sensitivity and specificity of chest CT. Predictive values were calculated based on the theorem of Bayes using Fagan’s nomogram. Results Of 165 participants (56.4% male, 71 ± 16 years) included in the study, the diagnosis of COVID-19 was confirmed with RT-PCR and AB tests in 13 participants (prevalence 7.9%). Sensitivity and specificity of chest CT were 84.6% (95% confidence interval [CI], 54.6–98.1) and 94.7% (95% CI, 89.9–97.7), respectively. Positive and negative likelihood ratio of chest CT were 16.1 (95% CI, 7.9–32.8) and 0.16 (95% CI, 0.05–0.58) and positive and negative predictive value were 57.9% (95% CI, 40.3–73.7) and 98.6% (95% CI, 95.3–99.6), respectively. Conclusion At a low prevalence of COVID-19, chest CT could be used as a complement to repeated RT-PCR testing for early COVID-19 exclusion in adults with suspected infection before referral to hospital’s general wards. Trial registration ClinicalTrials.gov: NCT04357938 April 22, 2020.

scholarly journals Study of the association of serum procalcitonin with leukocytosis in predicting complicated acute appendicitis

2020 ◽  
Vol 7 (7) ◽  
pp. 2300
Author(s):  
Thana Ram Patel ◽  
Amit Jain ◽  
Lakshman Agarwal ◽  
Vakta Ram Choudhary ◽  
Dinesh Bijarniya
Keyword(s):  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Complicated Appendicitis ◽  
Protein Levels ◽  
Reactive Protein ◽  
Level Measurement ◽  
Wbc Count ◽  
Operative Findings ◽  
Age Range ◽  
Complicated Acute Appendicitis

Background: Delay in the diagnosis of complicated appendicitis and its treatment results in an increased rate of postoperative morbidity, mortality and hospital stay. The diagnosis of appendicitis rests on a combination of signs of inflammation such as fever, pain and tenderness; leukocytosis, and elevated C-reactive protein levels, interleukin-6 (IL6) and procalcitonin. Raised level of serum procalcitonin in bacterial infection has been used to further improve the diagnosis of complicated AA.Methods: One-hundred ten patients of appendicitis confirmed by intra-operative findings and final pathologist report, who underwent appendectomy consisting 25 women (22.73%) and 85 men (77.27%) with a mean age of 25 years (age range 15-55 years) were included in this study. Serum procalcitonin value was measured by chemi E411 Cobas method (chemilumiscent immunoassay system) using the B.R.A.H.M.S PCT kit. Serum PCT level >0.5 ng/ml was consider as risk for progression to severe systemic disease.Results: At a 0.5 ng/dl cut-off value of PCT, the sensitivity and specificity of PCT level measurement for acute complicated appendicitis prediction was 90% and 97.14% respectively. Association between WBC count and PCT value shows the sensitivity and specificity in 40 case of acute complicated appendicitis prediction was 86% and 75% respectively.Conclusions: Both the higher PCT values and leukocytosis correlates well with  infectious post-operative complications for acute appendicitis and it can help to carry out timely surgical intervention which is highly recommended in complicated appendicitis(correlates PCT >0.5 ng/dl).

scholarly journals Diagnostic Indexes Findings in Early Stages of Appendicitis (DIFESA Study): a reanalysis from the POSAW study database

2021 ◽  
pp. 35
Keyword(s):  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Subgroup Analysis ◽  
Histopathological Examination ◽  
Laparoscopic Appendicectomy ◽  
Good Reliability ◽  
Predictive Values ◽  
Intraoperative Diagnosis ◽  
Optimal Approach ◽  
Study Database

Purpose: The resection of a normal-looking appendix during laparoscopic appendicectomy (LA) remains a dilemma. The optimal approach requires reliable macroscopic judgment by the surgeons. The aim of this study is to assess the surgeon’s ability to laparoscopically diagnose acute appendicitis (AA) in its initial uncomplicated grades. Method: Subgroup analysis from the POSAW study, 2016. Patients diagnosed with initial grades of AA (0 – 1) who underwent LA were included (n=718). The median age was 29.4 years, and 52% were female. The accuracy of the macroscopic intraoperative diagnosis was assessed with the histopathological examination of the resected specimens, and the agreement between the surgeon’s and the pathologist’s judgment was established. Results: Of the 79 appendices classified intraoperatively as normal-looking, 18 (22.8%) had some inflammation degree. Of the 639 appendices classified intraoperatively as inflamed, 101 (15.8%) were normal. The intraoperative surgeon’s judgment had an accuracy of 83.4% and a moderate to low agreement (Kappa 0.42). The sensitivity and specificity values were 96.8% and 37.7%, and the positive and negative predictive values were 84.2% and 77.2%, respectively. Conclusion: The surgeon’s intraoperative diagnosis of uncomplicated AA’s initial grades is not sufficiently accurate to establish good reliability for appendicectomy. The surgeon overestimates the presence of appendicular inflammation.

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