scholarly journals Comparative study between clinical diagnosis using modified Alvarado score and ultrasound imaging in decreasing negative appendectomy rate

2021 ◽  
Vol 8 (4) ◽  
pp. 1185
Author(s):  
Sayali S. Samudre ◽  
Anil S. Munde
Keyword(s):  
Acute Appendicitis ◽  
Comparative Study ◽  
Ultrasound Imaging ◽  
Health Resources ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score ◽  
Operative Findings ◽  
Fitting In

Background: Acute appendicitis is the acute inflammation of appendix which is the most common cause of acute surgical emergencies. Appendicitis can mimic other pathologies. Removing normal appendix is an economical burden both on patients and health resources. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis.Methods: This was prospective comparative study carried out in 200 patients over the period of 2 years. Patients with clinical features of acute appendicitis and fitting in inclusion and exclusion criteria were selected. Detailed history was noted and clinical examination was done. Necessary investigations were done, modified Alvarado score was calculated and all were subjected to ultrasonography of abdomen and pelvis. Intra operative findings were noted about nature of appendix and histopathology findings were noted.Results: The sensitivity of ultrasound is 78.19% and specificity is 50%. The sensitivity of modified Alvarado scoring system is 78.7% and specificity is 25%. Negative appendicectomy rate in the study was 6%.Conclusions: Modified Alvarado score has slightly higher sensitivity and ultrasound imaging has higher specificity of in the diagnosis of acute appendicitis and in decreasing negative appendicectomy rates. Ultrasound imaging provides good supportive diagnosis in cases of low or equivocal modified Alvarado scores.

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

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.

scholarly journals Study of modified Alvarado score and ultrasound imaging with post - operative histopathology in diagnosis of acute appendicitis

2021 ◽  
Vol 5 (4) ◽  
pp. 91-96
Author(s):  
Dr. Nikhilesh Yalamanchili ◽  
Dr. Venkata Reddy Mortala ◽  
Dr. Rasaghnnnya Medasani ◽  
Dr. Rama Krishna Reddy Gade
Keyword(s):  
Acute Appendicitis ◽  
Ultrasound Imaging ◽  
Alvarado Score ◽  
Modified Alvarado Score

scholarly journals Role of modified Alvarado scoring system and USG abdomen in acute appendicitis: an overview

2017 ◽  
Vol 4 (12) ◽  
pp. 4029
Author(s):  
Rajkishore Singh ◽  
Rajiv Singh ◽  
Kulwant Singh
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Clinical Teaching ◽  
Research Centre ◽  
Medical Sciences ◽  
Alvarado Score ◽  
Major Procedure ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score

Background: Acute appendicitis is the most common cause of an ‘acute abdomen’ in young adults and, as such, the associated symptoms and signs have become a paradigm for clinical teaching. Appendicitis is sufficiently common that appendicectomy (termed appendectomy in North America) is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. In this study we correlate the usefulness of Modified Alvarado scoring system(MASS) and ultrasonography(USG) in management of acute appendicitis.Methods: The study was done on 60 patients of symptomatic appendicitis, requiring management accordingly, attending surgical OPD of People’s College of Medical Sciences(PCMS) and Research Centre, Bhopal, India from 1st October 2011 to 30th August 2013. The study includes 60 patients between 5-60 yrs of age. They were prospectively evaluated on admission using the modified Alvarado Score to determine whether or not they had acute appendicitis, all equivocal cases were subjected to ultrasonography examination. The score and ultrasonography were correlated with the operative and histological findings.Results: All 60 patients underwent surgery. The sensitivity of the modified Alvarado score was 89.65% and sensitivity of USG was 91.37%, out of 60 cases of acute appendicitis male were 36 and remaining 24 cases were female. So, it showed sex ratio of 36:24, 3:2 which correlate with literature and other studies. With use of both MASS and USG as diagnostic tool, out of 60 cases 57 cases were positive and with the help of histopathology, it was confirmed in 58 cases.Conclusions: The modified Alvarado scoring system is a good diagnostic indicator for acute appendicitis. It helps in minimizing the rates of negative appendicectomy. It can be used as an adjunct to surgical decision-making along with ultrasonography in doubtful cases. When combined, modified Alvarado score and ultrasonography can work very effectively in diagnosing acute appendicitis(AA) correctly and in reducing the number of negative appendicectomy.

scholarly journals Clinical and histopathological analysis of the patients undergoing appendectomy

2018 ◽  
Vol 8 (2) ◽  
pp. 1337-1340
Author(s):  
Kamal Koirala ◽  
Shiva Raj KC ◽  
Ganesh Simkhada ◽  
Rupesh Mukhiya ◽  
Nisheem Pokharel ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Diagnostic Tools ◽  
Histopathological Analysis ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Female Ratio ◽  
Medical College ◽  
Clinical Scoring ◽  
Modified Alvarado Score

Background: Acute appendicitis is one of the most common surgical emergencies, but the diagnosis is difficult even with the sophisticated diagnostic tools. The aim of this study is to analyze the clinical and histopathological features of acute appendicitis and to see how reliable the clinical scoring system modified Alvarado score in our setup.Materials and Methods: This was a retrospective observational study of patients who underwent appendectomy at KIST Medical College and Teaching Hospital during two years. The clinical characteristics of the patients in terms of modified Alvarado scoring were outlined. The diagnosis of acute appendicitis was confirmed by histopathological examination. The data were tabulated in MS-Excel and statistically analyzed using SPSS statistics software, version 21.Results: Among 118 patients, who underwent appendectomy, 69 were male and 49 were female with male to female ratio of 1.41:1 and mean age of 27.46±12.724 years.The clinical diagnosis of acute appendicitis was more likely (MAS 7-9) in 56 patients, less likely (4–6) in 44 patients and unlikely (MAS 1-3) in 18 patients. The highest incidence of acute appendicitis was observed in 19-40 years and the lowest incidence in 61 years or above. After histopathological examination, 52 patients out of 56 in the more likely group had acute appendicitis and 4 patients had non-inflamed appendices. 7 patients out of 62 in the less likely and unlikely groups had acute appendicitis and 55 patients had non-inflamed appendices. The overall negative appendectomy rate was 9.32 percent.Conclusion: Our clinical practice of using modified Alvarado score in the diagnosis of acute appendicitis is effective, easy and non-invasive.

scholarly journals Acute Appendicitis in Children: Comparison of clinical diagnosis versus modified Alvarado score system

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Mukhtar Hussain ◽  
Muhammad Kashif ◽  
Shafiq Ahmad ◽  
Haroon Khurshid Pasha
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
False Positive ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Score System ◽  
Pain Abdomen ◽  
Group I ◽  
Negative Appendectomy Rate ◽  
Modified Alvarado Score

Objective: To compare the accuracy of clinical diagnosis of Acute Appendicitis with that of Alvarado Score System in Children. Design: A Prospective and Comparative Study. Patients and Duration of Study: Department of Pediatric Surgery, Nishtar Medical College & Hospital, Multan from January 200I to June 2002. All patients of pain abdomen with suspicion of acute appendicitis were included in study. Subjects and methods: 92 patients were admitted with pain abdomen, After preliminary history and examination sixty were suspected of acute appendicitis. A Detailed history, clinical examination and relevant investigations were done. These patients were divided in two equal groups of 30 each. In group-I all the findings were entered on Performa based on the indicants of modified Alvarado Score. Later on their Score was calculated according to the assigned weight-age of each indicant. Twenty-eight patients were submitted for Surgery having Alvarado Score of >7. In group-II patients were clinically evaluated by one of the consultant to declare the diagnosis of Acute Appendicitis or otherwise. Twenty-nine out of 30 were submitted for surgery in this group. Three cases turned out to be of mesenteric lymphadenitis confirmed on Ultrasonography. The diagnosis of Acute Appendicitis was further confirmed by Histopathology of appendix after removal. Hence the accuracy of both methods was compared. Results: The diagnostic accuracy of Alvarado Score was 85.71% with false positive or negative appendectomy rate of 14.29% while the accuracy of clinical diagnosis was 93.01% with false positive or negative appendectomy rate of 6.99%.

scholarly journals Comparative Study of Diagnostic Accuracy of Modified Alvarado Score and Ultrasonography in Acute Appendicitis

2014 ◽  
Vol 13 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Dr. Satyajeet Kr Singh ◽  
Dr. Kunal Kr Singh ◽  
Dr. Chitrangada Singh ◽  
Prof. Dr Subrata Nag
Keyword(s):  
Acute Appendicitis ◽  
Comparative Study ◽  
Diagnostic Accuracy ◽  
Alvarado Score ◽  
Modified Alvarado Score

scholarly journals A Comparative Study of RIPASA Score and Modified Alvarado Score in Acute Appendicitis in Nepalese Population

2019 ◽  
Vol 2 (2) ◽  
pp. 224-228
Author(s):  
Niroj Banepali ◽  
Kamal Koirala ◽  
Rupesh Mukhiya ◽  
Rakesh Roshan Sthapit
Keyword(s):  
Acute Appendicitis ◽  
College Teaching ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Medical College ◽  
Lower Specificity ◽  
Negative Appendectomy Rate ◽  
Modified Alvarado Score ◽  
Ripasa Score

Introduction: Although acute appendicitis is a common surgical condition, its diagnosis can be elusive at times with misdiagnosis leading to serious complications. Various scoring systems have been developed to overcome this dilemma and the reported accuracies of these scores vary greatly.Materials and Methods: A retrospective review of charts was carried out to identify all patients admitted to KIST medical college teaching hospital from May 2015 to April 2016 with the diagnosis of acute appendicitis. A total of 120 cases that underwent surgery for suspected acute appendicitis were included. Modified Alvarado score and RIPASA scores were computed for each patient and the suggested cutoff values were used to find out the accuracy of these scores. Histopathological confirmation/report was considered as the standard for comparison.Results: A negative appendectomy rate of 11.67 % was observed (9.64 % for males and 16.22 % for females). Complicated appendicitis was found in 27.36% of patients. Modified Alvarado score had a sensitivity of 61.32 % and specificity of 71.43 % at a cut of value of 7. At cut off of > 7.5 for acute appendicitis, RIPASA score had a sensitivity of 97.17% and specificity of 57.14%. The accuracy of Modified Alvarado score was 62.5% while it was 92.5% for RIPASA score.Conclusions: RIPASA score demonstrated higher sensitivity and accuracy but lower specificity compared to the modified Alvarado score in our study group. More studies with larger sample size need to be carried out for further validation of this new score.

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 MODIFIED ALVARADO SCORE

2010 ◽  
Vol 17 (04) ◽  
pp. 546-550
Author(s):  
SYED WARIS ALI SHAH ◽  
CHAUDHRY AHMED KHAN ◽  
SIKANDER ALI MALIK ◽  
AHMED WAQAS ◽  
AJMEL MUNIR TARRAR ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Examination ◽  
Military Hospital ◽  
P Value ◽  
Alvarado Score ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score

objective: To compare the frequency of inflamed appendix in suspected patients of acute appendicitis having Modified Alvarado Score (MAS) of 7 or more with patients having MAS of 6 or below. Design: Comparative cross sectional study. Place and duration of study: The study was carried out at Surgical Departments of Combined Military Hospital (CMH) and Military Hospital (MH) Rawalpindi from April 2006 to April 2007. Material and Methods: This study involved 100 patients who were operated with provisional diagnosis of acute appendicitis. Preoperatively MAS of each patient was calculated and the patients were divided in two groups. Group-I had MAS of 7 or more while Group-II had MAS of 6 or below. Postoperatively appendices of all the patients were sent for histopathological examination and its result regarding presence or absence of acute appendicitis was then compared with MAS of respective group. Results: (a) Group-I:- A total of 72 patients with 64(88.9%) positive inflamed appendices on histology. Negative appendicectomy rate 8(11.1%), (b) Group-II:- A total of 28 patients with 8(28.6) positive inflamed appendices. Negative appendicectomy rate 20(71.4%). There is statistical significant difference of positive appendicectomy rate between two groups with (p-value<0.001). Conclusion: Frequency of inflamed appendix is more in patients having MAS of seven orabove. The number of negative appendicectomies can be reduced by using MAS in clinical practice.

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