scholarly journals Evaluation of combined use of modified Alvarado score and Ultrasound in predicting acute appendicitis: a prospective study

2018 ◽  
Vol 5 (11) ◽  
pp. 3594
Author(s):  
Nirajan Kansakar ◽  
P. N. Agarwal ◽  
Rajdeep Singh ◽  
Anurag Mishra ◽  
Jyoti Kumar ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Accurate Diagnosis ◽  
Negative Appendectomy ◽  
Chi Square ◽  
Diagnostic Laboratory ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Exact Test ◽  
Modified Alvarado Score

Background: Appendicitis is notorious in its ability to simulate other conditions and accurate diagnosis is imperative for preventing complications of appendicitis on one hand and avoiding negative appendectomy on other. Despite extraordinary advances in modern radiography imaging and diagnostic laboratory investigations, the accurate diagnosis of acute appendicitis remains an enigmatic challenge.Methods: We evaluated 32 patients with features suggestive of acute appendicitis between September 2013 to March 2015. It was a cross-sectional observational study that included modified Alvarado score (MAS) and ultrasound (USG) in predicting appendicitis and correlated both these individually as well as combined, with histopathological findings. Statistical analysis was done by Chi-square test with Yates correction, Fischer’s exact test and unpaired Students’ t test.Results: Ultrasound was found to be more sensitive (74.19%) and accurate (75.0%) as compared to MAS (41.94% and 43.75% respectively). The specificity and positive predictive value (PPV) were similar in both the parameters (100% each). Also, when both the MAS and Ultrasound were combined in predicting acute appendicitis, the sensitivity, negative predictive value and accuracy increased to 80.64%, 14.29% and 81.25% respectively with specificity and PPV being the same as when MAS and USG were considered individually.Conclusions: It is advised that both modified Alvarado score and ultrasound whenever available should be used to predict acute appendicitis to increase the number of positive cases and reduce negative appendectomy and hence reduce the morbidity and mortality.

A Comparison between the Diagnostic Accuracy of Alvarado and Tzanaki Scoring Systems in Acute Appendicitis

2021 ◽  
Vol 15 (12) ◽  
pp. 3175-3177
Author(s):  
Anum Iftikhar ◽  
Muhammad Arsalan ◽  
Sheeza Azaz ◽  
S H Waqar ◽  
Sajid Ali Shah ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Cross Sectional

Aim: To find out how accurate the Alvarado and Tzanaki scoring systems are in diagnosing acute appendicitis taking histopathology as gold standard. Methods: A cross-sectional prospective study was conducted from August 2019 to July 2020 at Department of General Surgery, Pakistan Institute of Medical Sciences Islamabad. Sixty patients were included, all of whom had appendectomies after a clinical diagnosis of acute appendicitis. Samples were submitted for histopathology, which was used as the gold standard for the definitive diagnosis of acute appendicitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and negative appendectomy rate of Alvarado and Tzanaki scoring systems was calculated using SPSS version 23. Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Alvarado score at optimal cut-off threshold of ≥7.0, were calculated as 74%, 55%, 90%, 27% and 71.66% respectively. The cut-off threshold point of Tzanaki score was set at more than 8, which yielded a 94.11% sensitivity and an 88.88% specificity. The positive predictive value was 99.95% and the negative predictive value was 72.72%. The Alvarado and Tzanaki scoring systems had negative appendectomy rates of 9.5% and 2.04%, respectively. Conclusion: The Tzanaki scoring system has a better diagnostic accuracy for acute appendicitis as compared to the Alvarado score. Keywords: Acute appendicitis, Alvarado score, Tzanaki score

scholarly journals Evaluación de la Escala de Alvarado versus Score de Respuesta Inflamatoria de la Apendicitis, Hospital José Carrasco Arteaga 2018

2020 ◽  
Vol 12 (2) ◽  
pp. 112
Author(s):  
Jorge Roberto Rodas Andrade ◽  
Marco Vinicio Urgilés Rivas ◽  
Julio Cesar Ordoñez Cumbe ◽  
Karla Marisela Cabrera Abad ◽  
Patricia Piedad Naulaguari Medina
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Roc Curve ◽  
Predictive Value ◽  
Test Validity ◽  
Public Health Issue ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Modified Alvarado Score ◽  
Response Score

BACKGROUND: Acute appendicitis is the main cause of non-traumatic acute abdomen worldwide, it is still a public health issue and the diagnosis can be challenging. When an atypical case is presented, is necessary to use diagnostic scores, like Alvarado Score, Modified Alvarado Score, RIPASA, among others. The aim of this study was to determine the test validity of Inflammatory Response Score versus Alvarado Score, for acute appendicitis diagnosis in 16 year old and older patients. METHODS: This is a descriptive, cross-sectional, validity test study, to compare AIR Score and Alvarado Score, with the Gold-Standard histopathology results. A sample of 292 patients that went under appendectomy at Hospital José Carrasco Arteaga during 2018 was studied. We considered sensitivity, specificity, positive predictive value (PPV), negative predictive value (VPN), ROC curve and Likelihood Ratio. RESULTS: 49.7% patients were young adults, 62.7% of the patients were male. Alvarado Score showed a 88.5% sensitivity, 29.6% specificity, PPV of 81.7%, 42.2% NPV, 1.23 LR+ and 0.38 –LR; compared to 94.7% sensitivity, 76.5% specificity, 93.5% PPV, 80.3% NPV, 4.02 +LR, 0.611 -LR for Appendicitis Immflamatory Response Score. ROC curve for AIRS was 0.897, higher than Alvarado Score (0.611); being AIRS a more precise diagnostic test than Alvarado Score. CONCLUSIÓN: AIRS showed higher sensitivity (94.7%) and specificity (76.5%) than Alvarado Score (88.5%, 29.6% respectively). Alvarado Score is sensitive enough for acute appendicitis diagnosis, but not specific enough to exclude the diagnosis. AIRS shows a higher Likelihood Ratio and ROC curve than Alvarado Score, but the posttest probability is low for identifying acute appendicitis cases.

scholarly journals Usefulness of Modified Alvarado Score in Diagnosis of Acute Appendicitis in Adults

2015 ◽  
Vol 14 (4) ◽  
pp. 336-338
Author(s):  
Hari Pada Mondal ◽  
Md. Hadiuzzaman ◽  
Chandranath Mukhopadhyay ◽  
Shibram Chattopadhyay ◽  
Sajal Kumar Biswas ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Scoring System ◽  
Medical Science ◽  
Clinical Signs ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Negative Appendectomy Rate ◽  
Modified Alvarado Score

Background: Definitive diagnosis of acute appendicitis preoperatively is sometimes difficult. Failure to make a diagnosis is the main reason for persistent rate of morbidity and mortality. Various scoring systems are devised to aid diagnosis of acute appendicitis. In some studies the modified Alvarado score was helpful, reliable and practical in minimizing unnecessary appendectomy. Objective: The purpose of this study was to evaluate the usefulness of modified Alvarado score for the diagnosis of acute appendicitis. Materials and Method: A prospective study of 89 adult patients, admitted with abdominal pain suggestive of acute appendicitis, from July 2011 to June 2012, was conducted. Data including clinical signs and symptoms and laboratory findings were recorded in modified Alvarado score record form. All 89 patients underwent appendectomy. Final diagnosis was confirmed by histopathological examination. Reliability of scoring system was assessed by negative appendectomy rate and positive predictive value. Results: Out of 89 patients who underwent appendectomy, 85 had acute appendicitis on histopathology. Positive predictive value was 95.5% and negative appendectomy rate was 4.5%. 52.8% had score 7 or above and 47.2% had score less than 7. From score it is difficult to predict which patient warranted appendectomy and who may be safely observed or discharged. Conclusions: Diagnosis of acute appendicitis remains mainly clinical evaluation and it is more helpful than modified Alvarado scoring system in adults.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.336-338

scholarly journals RIPASA vs Modified Alvarado Scoring System for diagnosis of Appendicitis

2018 ◽  
Vol 14 (4) ◽  
pp. 213-216
Author(s):  
Bhusan Raj Timilsina ◽  
Rajiv Shah ◽  
Sudeep Raj KC ◽  
Hari Prasad Upadhyay ◽  
Sunita Lamsal ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Scoring System ◽  
Asian Population ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Modified Alvarado Score ◽  
Threshold Point ◽  
Ripasa Score

INTRODUCTION: Acute appendicitis is the most common surgical condition presented to the emergency department. Clinical scoring systems such as the Alvarado and modified Alvarado scoring system were developed with the goal of reducing the negative appendectomy rate to 5%–10%. In the other hand the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian population. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in the Nepalese population. METHODS: This study included 125 patients who had undergone appendectomies from March of 2017 to January 2018. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. RESULTS: A total of 125 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 68.64% and a specificity of 28.57%. The PPV was 95% and the NPV was 5.12%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded 88.13% sensitivity and 28.57% specificity. The PPV was 95.41% and the NPV was 12.5%. CONCLUSION: Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity similar to the modified Alvarado scoring system. KEYWORDS: Acute appendicitis, Modified Alvarado Score, RIPASA score.

scholarly journals Advantage of ultrasonography in the diagnosis of acute appendicitis at Al-Karama Teaching Hospital

2019 ◽  
Vol 6 (3) ◽  
pp. 702
Author(s):  
Mohammed Hillu Surriah ◽  
Amine Mohammed Bakkour ◽  
Nidaa Ali Abdul Hussain
Keyword(s):  
Acute Appendicitis ◽  
Teaching Hospital ◽  
Predictive Value ◽  
Diagnostic Technique ◽  
Cost Effective ◽  
Cross Sectional Study ◽  
Negative Appendectomy ◽  
Cross Sectional ◽  
Suspected Appendicitis ◽  
Presenting Symptoms

Background: The clinical diagnosis of acute appendicitis remains a challenge to surgeons. Different aids were introduced to improve the diagnostic accuracy. Among these modalities, ultrasonography is simple, easily available, non-invasive, convenient and cost effective. The aim of the study was to determine the validity of ultrasound in diagnosis of the acute appendicitis in those with clinically diagnosed patients.Methods: A cross sectional study was carried out in Al-Karama teaching hospital for thirty months from the period of 1st June 2016 to 1st December 2018. All patients with suspected appendicitis underwent clinical evaluation then sent for US. Results of surgeries, where relevant, were compared against US results. Positive and negative appendices on histopathology were regarded in accordance to the criteria which was negative appendectomy was defined as normal looking appendix and absence of acute inflammation on histopathology while positive cases included appendices showing acute inflammatory changes. Sensitivity, specificity and overall accuracy was calculated.Results: A total of 435 patients with suspected appendicitis, males 224 (51.49%) and females 211 (48.50%) were included in present study. There were no significant differences between patients with positive and negative histopathology findings regarding presenting symptoms. There was a significant association between (cough sign, localized tenderness sign and pointing sign) and patients with positive histopathology findings. Regarding to the validity results of ultrasound in comparison to histopathology findings were  accuracy 87.6%, sensitivity 87.8%, specificity 85.3%, positive predictive value 98.6% and negative predictive value 62.8%.Conclusions: The ultrasonography had a good accuracy, sensitivity and specificity in diagnosing acute appendicitis cases. Negative with ultrasonography results should be re-examined with different diagnostic technique like CT-scan.

scholarly journals A three year prospective study-suspected acute appendicitis: diagnostic accuracy of modified Alvarado score versus ultrasonography in adults

2017 ◽  
Vol 4 (12) ◽  
pp. 3924
Author(s):  
Murhari D. Gaikwad ◽  
Anand Auti ◽  
Avinash Magare
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Prospective Study ◽  
Predictive Value ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Modified Alvarado Score ◽  
Suspected Acute Appendicitis

Background: To evaluate and compare diagnostic accuracy of modified Alvarado score and ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis.Methods: A prospective study of the patients who underwent appendectomy for suspected acute appendicitis at IIMS and R Medical College and Noor Hospital Warudi, Badnapur, Dist. Jalna (Maharashtra). The clinical (radiological) and ultrasonography data of 760 patients with suspected appendicitis was collected between March 2014 to Feb. 2017. These patients were evaluated by modified Alvarado score and ultrasonographically, which was corrected with histopathological finding.Results: Out of 760 patients 69.34% had acute appendicitis 63.81% had modified Alvarado score≥7 and 58.28% patients were ultrasonographically positive. In present study modified Alvarado score has sensitivity of 89.37% specificity 93.99% positive predictive value 97.11%, negative predictive value 79.64%, diagnostic accuracy of 81.32%.Conclusions: Modified Alvarado score can be used effectively in clinical decision making. When compare with ultrasonography neither one is advantageous. However, additional information provided by ultrasonography improves diagnostic accuracy.

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

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.

scholarly journals Comparison of Tzanakis Score vs Alvarado Score in the Effective Diagnosis of Acute Appendicitis

2015 ◽  
Vol 12 (1) ◽  
pp. 48-50 ◽  
Author(s):  
BR Malla ◽  
H Batajoo
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Scoring System ◽  
Final Diagnosis ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Effective Diagnosis ◽  
Sensitivity Specificity

Background Acute appendicitis is the most frequent surgical emergency encountered worldwide. This study was conducted to compare the efficacy of Tzanakis score and Alvarado score in diagnosing acute appendicitis.Objectives The aim of this study is to compare the efficacy of Tzanakis scoring system with Alvarado scoring system in diagnosing AA.Methods This was a retrospective and nonrandomized observational study conducted in Dhulikhel hospital. It included 200 clinically diagnosed cases of acute appendicitis who underwent emergency open or laparoscopic appendectomy during the year 2012. Final diagnosis of acute appendicitis was based on histological findings given by pathologist.Results The sensitivity, specificity, positive predictive value and negative predictive value of Tzanakis score was 86.9%, 75.0, 97.5% and 33.3% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of Alvarado score was 76.0%, 75.0%, 97.2% and 21.4% respectively. Negative appendectomy was 8.0%. Conclusion Tzanakis scoring system is an effective scoring system in diagnosing acute appendicitis.Kathmandu University Medical Journal Vol.12(1) 2014: 48-50

scholarly journals DIAGNOSTIC EFFICACY OF MODIFIED ALVARADO SCORE OVER GRADDED COMPRESSION ULTRASONOGRAPHY

2013 ◽  
Vol 03 (03) ◽  
pp. 105-108
Author(s):  
Caren Dsouza ◽  
John Martis ◽  
Vinay Vaidyanathan
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Preoperative Diagnosis ◽  
Iliac Fossa ◽  
Diagnostic Efficacy ◽  
Alvarado Score ◽  
Predictive Values ◽  
Modified Alvarado Score ◽  
Sensitivity Specificity ◽  
Compression Ultrasonography

Abstract Background: Acute appendicitis is one of the commonest surgical emergencies. Despite a life time cumulative risk of nearly 7% its diagnosis remains a challenge. The risks of two primary outcomes must be balanced in the management of presumed appendicitis: perforation and misdiagnosis.The rate of misdiagnosis in certain populations is as high as 40%. Diagnostic aids like modified Alvarado score and ultrasonography can dramatically reduce the negative appendicectomies. Methods:Data was collected from 60 patients with complains of right iliac fossa pain over a period of 9 months to our hospital. All patients were categorised using the Alvarado score and Graded compression ultrasonography was done. The preoperative and histological findings were compared with the preoperative diagnosis. The collected data was analysed with regards to various parameters like sensitivity, specificity, predictive values and diagnostic accuracy. Results:In our study of 60 patients, 56 patients underwent appendicectomy out of which a histological confirmation of appendicitis was obtained for 50 patients, giving a negative appendicectomy rate of 12%.By taking a cut-off point of 7 for the Modified Alvarado score, a sensitivity of 97.56%, specificity of 66.67%, positive predictive value (PPV) of 95.23%, negative predictive value (NPV) of 80% and accuracy of 87.2% were calculated. Using the cut-off point of 6, a sensitivity of 90% specificity of 50%, PPV of 69.23%, NPV of 80% and accuracy of 55.56% were obtained. The sensitivity, specificity, PPV, NPV and accuracy rate of ultrasonography was 92.15%, 88.9%, 97.19%, 66.7% and 85%, respectively. Conclusion:The presence of a modified Alvarado score > 7 was found to be a dependable aid in the preoperative diagnosis of acute appendicitis. In cases where the score was negative or equivocal, ultrasonography greatly helped in the diagnosis thereby reducing the incidence of negative appendicectomies.

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