scholarly journals Augmentation of modified Alvarado score with abdominal ultrasound in diagnosis of acute appendicitis

2020 ◽  
Vol 8 (1) ◽  
pp. 111
Author(s):  
Shipra Sharma ◽  
Ankit Soni ◽  
Sanjay Kumar ◽  
Manoj Poptani
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Abdominal Ultrasound ◽  
Laboratory Findings ◽  
Alvarado Score ◽  
Surgical Emergencies ◽  
Increased Sensitivity ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score ◽  
Sensitivity Specificity

Background: Acute appendicitis is one of the commonest surgical emergencies. But confirming the diagnosis of acute appendicitis is still a subjective issue for clinicians. Modified Alvarado score is based on clinical and laboratory findings which is scored upto 9. Management of 5 to 7 modified Alvarado score came under equivocal. Either may be conservative or operative.Methods: We augmented the modified Alvarado score with abdominal ultrasound in diagnosis of acute appendicitis.Results: Outcomes were evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and negative appendicectomy rate, results of our study are sensitivity 95.7%, specificity is 76.92%, PPV 93.75% and NPV 33.34%.Conclusions: Overall increased sensitivity, specificity, NPV and PPV of the augmented approach is useful for diagnosis of acute appendicitis which scored under 5-7 of modified Alvarado scoring system.

scholarly journals Augmentation of modified Alvarado score with abdominal ultrasound in diagnosis of acute appendicitis

2020 ◽  
Vol 7 (3) ◽  
pp. 853
Author(s):  
Manoj Poptani ◽  
Ankit Soni ◽  
Shipra Sharma ◽  
Sanjay Kumar
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Abdominal Ultrasound ◽  
Laboratory Findings ◽  
Alvarado Score ◽  
Surgical Emergencies ◽  
Increased Sensitivity ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score ◽  
Sensitivity Specificity

Background: Acute appendicitis is one of the commonest surgical emergencies. But confirming the diagnosis of acute appendicitis is still a subjective issue for clnicians. Modified Alvarado score is based on clinical and laboratory findings which is scored upto. Management of 5 to 7 modified Alvarado score came under equivocal. Either may be conservative or operative.Methods: We augmented the modified alvarado score with abdominal ultrasound in diagnosis of acute appendicitis.Results: Outcomes were evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and negative appendicectomy rate, results of our study are sensitivity 95.7%, specificity is 76.92%, PPV 93.75% and NPV 33.34%.Conclusions: Overall increased sensitivity, specificity, NPV and PPV of the augmented approach is useful for diagnosis of acute appendicitis which scored under 5-7 of modified alvarado scoring system.  

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.

scholarly journals Neutrophil-Lymphocyte Ratio Superior to Total Leukocyte and Neutrophil in Diagnosing Acute Appendicitis Using Alvarado Score

2020 ◽  
Vol 5 (6) ◽  
pp. 1388-1393
Author(s):  
Lesni Untono ◽  
Sigit Adi Prasetyo ◽  
Ignatius Riwanto
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Alvarado Score ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Modified Alvarado Score ◽  
Point Total ◽  
Sensitivity Specificity

Background: The diagnosis of acute appendicitis must be performed quickly and accurately to reduce the risk of negative appendectomy without increasing the risk of perforation. Objective: To analyze whether Neutrophil-Lymphocyte Ratio (NL-R) in the modified Alvarado score is more accurate in diagnosing acute appendicitis in comparison with total leukocyte and neutrophil. Method: This was a cross-sectional study and the data were collected from Telogorejo Hospital Semarang (Indonesia) from November 2018 until October 2019. The best cut-off point of NL-R for predicting acute appendicitis was provided through receiver operating characteristic (ROC) curve. NL-R was used to replace total leukocyte and neutrophil to form a modified Alvarado score. Area Under Curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the original Alvarado Score and modified Alvarado score were measured. Results: Sensitivity, specificity, positive predictive value, negative predictive value of the original Alvarado score are 100%, 84.6%, 91.3%, and 100% respectively with cut-off point total score of >4.5. Sensitivity, specificity, positive predictive value, negative predictive value of modified Alvarado score were 100%, 100%, 100%, and 100% respectively with cut-off point total score of >5.5. AUC modified Alvarado Score was 1.000 and AUC original Alvarado Score was 0.985. Conclusion: Modified Alvarado score diagnoses acute appendicitis more accurately than the original Alvarado Score.

scholarly journals Comparison of the Modified Alvarado Score and Ultrasonography for Diagnosing Acute Appendicitis

2021 ◽  
pp. 171-177
Author(s):  
S. Keerthana ◽  
. Vignaradj
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Care Center ◽  
Age Groups ◽  
Alvarado Score ◽  
Health Care Center ◽  
Modified Alvarado Score ◽  
Sensitivity Specificity

Background: Acute appendicitis can be diagnosed much accurately by using Modified Alvarado score and Ultrasound together in the clinical setting. Objectives: Comparison of the diagnostic accuracy of Modified Alvarado score and Ultrasonographic findings in acute appendicitis. Materials and Methods: A total of 200 patients of age group ranging from 4-65 years, both male and female, who visited the tertiary health care center with clinical features suggestive of acute appendicitis were randomly selected. Data from the patients regarding their Modified Alvarado score, ultrasonographic findings and histopathological reports were collected for the study. Statistical analysis was performed for the results of both Modified Alvarado score and Ultrasonographic findings in contrast to the pathology reports.  Results: The study included 200 patients, with maximum incidence of acute appendicitis seen in males (70.5%) and among 21-30 age groups (40.5%). The sensitivity, specificity of Modified Alvarado Score was 89.47% and 73.33%, with Positive Predictive Value, Negative Predictive Value and diagnostic accuracy being 40%, 73.33% and 45% respectively. Ultrasonography revealed 89.58% sensitivity, 15.62 % specificity, Positive predictive value and NPV were 75.88% and 50%, and diagnostic accuracy was 72%. The negative appendectomies rates accounted to 15%. Conclusion: It is advised that both Modified Alvarado score and Ultrasound can be used to together to diagnose acute appendicitis. This can be useful in decreasing the negative appendectomies and hence reduce the morbidity and mortality.

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.

scholarly journals Comparison of RIPASA and Alvarado score in diagnosing acute appendicitis

2019 ◽  
Vol 6 (3) ◽  
pp. 740
Author(s):  
Suraj S. Kagwad ◽  
P. Karuppasamy
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Cost Effective ◽  
Clinical History ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: Acute appendicitis is a common cause of abdominal pain and can be difficult to diagnose, especially during its early stages.  The diagnosis of acute appendicitis is based on clinical history, examination combined with investigations. The purpose of this study is to compare between the RIPASA score and Alvarado score in the diagnosis of acute appendicitis. The aim of the present study was to compare the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Alvarado and RIPASA score.Methods: The cases for the study will be sourced from cases admitted in SVMCH and RC, Puducherry during the period of November 2016 to June 2018.Results: Out of the 144 patients in our study 133 patients were diagnosed with acute appendicitis as per HPE report.As per our study, sensitivity, specificity, PPV, NPV of RIPASA and Alvarado scoring system is 96.2%, 57.1%, 97.7% and 44.4%; 81.9%,85.7%, 95.1% and 20%  respectively. The diagnostic accuracy of RIPASA score is 94.3 as compared to 82.1 of Alvarado score.Conclusions: The RIPASA scoring system is a promising and has good sensitivity, specificity and diagnostic accuracy when compared to Alvarado scoring for Asian Population.RIPASA scoring system is an easy and reliable, cost effective diagnostic tool which reduce negative appendicectomy rates and the expensive radiological investigations for the diagnosis of acute appendicitis.

scholarly journals Comparison of RIPASA and Alvarado scoring in the diagnosis of acute appendicitis and validation of RIPASA scoring

2019 ◽  
Vol 6 (3) ◽  
pp. 935
Author(s):  
Jeevan G. Sanjive ◽  
Ravi H. Ramaiah
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Operating Characteristic ◽  
Surgical Emergencies ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity ◽  
Higher Sensitivity

Background: Acute appendicitis is one of the most common surgical emergencies. A delay in performing an appendicectomy in order to improve the diagnostic accuracy increases the risk of appendicular perforation and sepsis. We prospectively compared and validated RIPASA to Alvarado scoring system when applied to an Indian population.Methods: This study included all the patients presented in General Surgery and The Emergency Department of Manipal Hospital, Bangalore diagnosed to have acute appendicitis from October 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendicectomy and receiver operating characteristic (ROC) curve of the RIPASA and Alvarado scoring system were derived using SPSS statistical software.Results: 75 patients were included in the study. Using the RIPASA scoring system, 97.1% of patients who actually had acute appendicitis were correctly diagnosed, compared to only 52.85% when using the Alvarado scoring system. The sensitivity and the specificity of the RIPASA scoring system is 97.14% and 60% respectively. The diagnostic accuracy of RIPASA scoring system is 94.67% and that of Alvarado scoring system is 52%. The results indicate that the RIPASA scoring system is a better diagnostic tool for the diagnosis of acute appendicitis (p<0.001).Conclusions: It is observed that the RIPASA scoring system has higher sensitivity and higher specificity compared to Alvarado scoring. It also has higher diagnostic accuracy and consequently, it has low negative appendicectomy rate. It can be concluded that the RIPASA scoring can be effectively conducted for the better evaluation of acute appendicitis.

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 comparative study of RIPASA score and ALVARADO score in diagnosis of acute appendicitis

2018 ◽  
Vol 5 (3) ◽  
pp. 796
Author(s):  
Vamsavardhan Pasumarthi ◽  
C. P. Madhu
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Roc Curve ◽  
Predictive Value ◽  
Scoring System ◽  
Alvarado Score ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: The RIPASA Score is a new diagnostic scoring system developed for the diagnosis of Acute Appendicitis which showed higher sensitivity, specificity and diagnostic accuracy compared to ALVARADO Score, particularly when applied to Asian population. Not many studies have been conducted to compare RIPASA and ALVARADO scoring systems. Hence, author want to compare prospectively Alvarado and RIPASA score by applying them to the patients attending the hospital with right iliac fossa pain that could probably be acute appendicitis.Methods: A prospective analysis of 116 cases admitted with RIF pain during a 2 years period was performed. Patients between 15-60 years were scored as per Alvarado and RIPASA scoring system. Histopathological reports of the cases were collected and compared with the scores. ROC curve area analysis was performed to examine diagnostic accuracy of RIPASA and ALVARADO scores.Results: The sensitivity of ALVARADO score is estimated to be 52.08 for a cut off of 6. The specificity is 80%, positive predictive value is 92.59, negative predictive value is 25.81. The Diagnostic accuracy of ALVARADO scoring is found to be 56.9. The sensitivity, specificity, positive predictive value and negative predictive values of RIPASA scoring system are 75%, 65%, 91.14%, 35.14%. The diagnostic accuracy of RIPASA score is 73.28.Conclusions: The difference in the diagnostic accuracy between ALVARADO and RIPASA scoring system is significant indicating that the RIPASA score is a much better diagnostic tool for the diagnosis of acute appendicitis. When the ROC curve was observed the area under the curve is high for RIPASA scoring system.

scholarly journals COMPARISON OF ALVARADO SCORE AND RIPASA SCORE IN THE ACCURATE DIAGNOSIS OF ACUTE APPENDICITIS IN COMBINED MILITARY HOSPITAL RAWALPINDI

2021 ◽  
Vol 71 (5) ◽  
pp. 1519-23
Author(s):  
Muhammad Majid ◽  
Rasikh Maqsood ◽  
Muhammad Ali ◽  
Muhammad Ayub Ashraf Malhi ◽  
Zaki Hussain ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Military Hospital ◽  
Alvarado Score ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
Sensitivity Specificity ◽  
Ripasa Score

Objective: To determine the diagnostic accuracy of Alvarado score and the RIPASA score for acute appendicitis using histopathology as a gold standard. Study Design: Cross sectional validation study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2018. Methodology: A total number of 270 patients were included in the study presenting with pain right iliac fossa to the Accident and Emergency department. Surgeons and Seniors Residents in Surgery on call in the Accident and Emergency Department. Combined Military Hospital, Rawalpindi, scored the patients with suspicion of acute appendicitis with Alvarado Score and RIPASA score simultaneously. After appendectomy of these patients, the removed appendix was sent for histopathology to confirm whether it was normal or inflamed. A 2x2 table was used for calculating sensitivity, specificity and diagnostic accuracy of the RIPASA score and Alvarado Score. The two scoring systems were then compared for diagnostic accuracy. Results: In our study, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of RIPASA score and Alvarado score for diagnosing acute appendicitis were 92.1%, 62.1%, 95.2%, 48.6%, 88.9% and 72.6%, 68.9%, 95.1%, 23.2%, 72.2% respectively. Conclusion: The diagnostic accuracy of RIPASA score was more than that of Alvarado score in diagnosing acute appendicitis.

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