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

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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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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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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Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

International Surgery Journal ◽

10.18203/2349-2902.isj20192078 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1954

Author(s):

Sailendra Nath Paul ◽

Dilip Kumar Das

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Scoring System ◽

Clinical Symptoms ◽

Lower Abdominal Pain ◽

Complication Rates ◽

Alvarado Score ◽

Negative Appendicectomy ◽

Operative Findings

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p<0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

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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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EVALUATION OF MODIFIED ALVARADO SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS AT TERTIARY CARE HOSPITAL IN WESTERN RAJASTHAN

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i2.964 ◽

2020 ◽

Vol 4 (2) ◽

Author(s):

Anil Kumar Dadhich ◽

Atul Kumar Sharma

Keyword(s):

Acute Appendicitis ◽

Acute Abdominal Pain ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Alvarado Score ◽

Common Complaint ◽

Emergency Department Patients ◽

Modified Alvarado Score ◽

High Degree

Background: Acute abdominal pain is a common complaint among emergency department patients. Methods: A 100 consecutive patients suspected of acute appendicitis who were admitted in department of surgery. They were prospectively evaluated using the modified Alvarado scoring (MAS) to determine whether or not they had acute appendicitis. Result: In present study, out of total 100 patients 78(78%) were have MAS score 7-9, 20% were have 5-6 and 2% have MAS score 1-4. Conclusion: The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy. Keywords: Modified Alvarado Score (MAS), acute appendicitis, Patients.

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Modified alvarado score in diagnosis of acute appendicitis: a clinicopathological study

International Surgery Journal ◽

10.18203/2349-2902.isj20180415 ◽

2018 ◽

Vol 5 (3) ◽

pp. 878

Author(s):

Sanjay Jain ◽

Ajay Gehlot ◽

M. C. Songra

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Alvarado Score ◽

Diagnostic Modality ◽

Delay In Diagnosis ◽

Modified Alvarado Score

Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies.Methods: A total 100 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of modified Alvarado scoring system and were subsequently operated, were included in the present study in our institute for period of 20 Months.Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients. Fever seen in 87% of patients and vomiting in78%. Modified Alvarado score of 9 had positive predictive value of 100% while negative predictive value 8.9%, while score between 7-8 had positive predictive value of 98.9% and negative predictive value 27.8%. The sensitivity was 86.1% and specificity was 83.3%. The ultrasonography showed a sensitivity of 94.68%. In present study rate of total white appendectomy was 6%. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.

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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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Diagnostic laparoscopy in acute abdominal pain

International Surgery Journal ◽

10.18203/2349-2902.isj20191029 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1104

Author(s):

Ravichandran Subramaniam

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Diagnostic Laparoscopy ◽

Acute Abdominal Pain ◽

Tertiary Care ◽

Medical Science ◽

Ovarian Torsion ◽

Care Hospital ◽

Number Of Patients ◽

Study Results

Background: Acute Abdominal pain is an important surgical problem in all age groups. Early diagnosis is needed to rule out life threatening conditions. Diagnostic laparoscopy is a modern useful tool in giving proper treatment for all needed individuals. The aim of the present endeavor is to study the use of laparoscope in patients with acute pain over the abdomen, to diagnose and confirm conditions like acute appendicitis, appendicular abscess, doudenal perforation, ileal perforation. Ovarian torsion. mass formation, etc. where clinical and imaging studies are inconclusive.Methods: This study was conducted in the tertiary care hospital and the Department of General Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Science and Research, Melmaruvathur. The period of study was from June 2017 to May 2018. All patients coming to the hospital with acute abdominal pain in the age group of ten years to seventy years were included in this study. Results: Majority of the patients had the findings relevant to the correct clinical diagnosis. However significant number of patients had unexpected findings and so the diagnosis was changed, and treatment also changed. Total 100 patients were included in this prospective study. 79 patients were found to have acute appendicitis. Duodenal perforation seen in 7 patients. Jejunal perforation seen in 2 patients. Mesenteric ischemia seen in 1 patient. Acute cholecystitis seen in 3 patients. Gall bladder perforation seen in 1 patient. Ectopic pregnancy was seen in 2 patients. Ovarian torsion seen in 3 patients. Ileocecal tuberculosis seen in 1 patient. No abnormality seen in 1 patient.Conclusions: The best approach in abdominal pain is to do diagnostic laparoscopy and proceed, rather than going for open laparotomy. Diagnostic laparoscopy gives all benefits of minimal invasive surgery. Not much of pain, shorter period of hospitalization, small scars, low infection rates and most importantly, accurate diagnosis and the correct treatment of most of the intra-abdominal conditions are the gifted things.

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Alvarado Score: still relevant in diagnosis of acute appendicitis: a prospective study with histopathological correlation

International Surgery Journal ◽

10.18203/2349-2902.isj20172600 ◽

2017 ◽

Vol 4 (7) ◽

pp. 2123

Author(s):

Rushil Jain ◽

Vimal Jain ◽

Shalit Jolly

Keyword(s):

Acute Appendicitis ◽

Histopathological Examination ◽

Imaging Techniques ◽

Clinical History ◽

Negative Appendectomy ◽

Emergency Setting ◽

Likelihood Ratios ◽

Alvarado Score ◽

Predictive Values ◽

Negative Appendectomy Rate

Background: Acute appendicitis is the most common abdominal emergency. Although abdominal surgeons have been encountering the acute appendicitis for more than 100 years, prompt diagnosis is still elusive in order to reduce morbidity and to avoid serious complications. Present study was conducted to evaluate the usefulness of Alvarado score in diagnosing acute appendicitis and its role in minimizing the negative appendectomy rate and correlating the same with histopathological findings of appendectomy specimens.Methods: This prospective correlational study was conducted in the Department of General Surgery, Mata Chanan Devi Hospital, New Delhi for a period of one year from January 2014 to December2014.Complete clinical history of the patients was collected in a predesigned proforma. A complete physical and systemic examination was done for all patients. Based on the Alvarado scoring system the patients were divided into three categories. Category 1 (score ranging from 1-4), Category 2 (score ranging from 5-6), Category 3 (score ranging from 7-10). Specimen of removed appendix was sent for histopathological examination and clinically correlated those findings with Alvarado score. Sensitivity, specificity, positive negative likelihood ratios, positive and negative predictive values and negative appendectomy rate were calculated.Results: Out of 100 cases (56 males and 44 females) 15 belonged to category-I, 30 belonged to category-II and 55 belonged to category-III. Surgical procedures were done in 67 patients along with conservative management. Final diagnosis by histopathology was found in 58 cases. The sensitivity and specificity of Alvarado score was found to be 89.66% and 92.86% respectively. PPV and NPV of Alvarado score is 94.55% and 86.67% respectively. The negative appendectomy rate was 13.4%.Conclusions: Alvarado score is a simple non-invasive diagnostic procedure, which is reliable, safe, repeatable and economical, easy and can be used in emergency setting, without expensive and complicated supportive diagnostic tool in diagnosing acute appendicitis and thus still very much relevant in today’s modern era with availability of gamut of expensive imaging techniques.

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