scholarly journals ALVARADO SCORE AND C-REACTIVE PROTEIN PREDICTOR OF SEVERITY IN ACUTE APPENDICITIS- AN INSTITUTION BASED STUDY

2016 ◽  
Vol 3 (102) ◽  
pp. 5636-5640
Author(s):  
Priya Radhakrishnan ◽  
Vysakh Chandra ◽  
Ramesan Chayampurath
Keyword(s):  
Acute Appendicitis ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein

scholarly journals Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Ademola Olusegun Talabi ◽  
Tewogbade Adeoye Adedeji ◽  
Oludayo Adedapo Sowande ◽  
Olusanya Adejuyigbe
Keyword(s):  
Acute Appendicitis ◽  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
C Reactive Protein ◽  
Blood Cell Count ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Wbc Count

Abstract Background The diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis. Results The ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001. Conclusion Alvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

scholarly journals Diagnostic accuracy of combining C-Reactive protein and Alvarado Score among 2-to-20-year-old patients with acute appendicitis suspected presenting to Emergency Departments

2021 ◽  
Author(s):  
Kinda Altali Alhames ◽  
Francisco Javier Martín-Sánchez ◽  
Pedro Ruiz-Artacho ◽  
Francisco Javier Ayuso ◽  
Victoria Trenchs ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Emergency Departments ◽  
Low Risk ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Old Patients ◽  
Reactive Protein ◽  
Surgical Data ◽  
Suspected Acute Appendicitis

Objective. Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. Materials and methods. This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. Results. A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0). Conclusions. CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.

Predictive value of C-reactive protein with Alvarado score in acute appendicitis

2013 ◽  
Vol 84 (5) ◽  
pp. 335-336 ◽  
Author(s):  
Siva Thirumallai ◽  
Suraj Ruwan Wijesuriya ◽  
Andrew Mitchell ◽  
Luc Delriviere
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein

Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort

2016 ◽  
Vol 34 (2) ◽  
pp. 189-192 ◽  
Author(s):  
Mohamed Zouari ◽  
Mohamed Jallouli ◽  
Hamdi Louati ◽  
Rim Kchaou ◽  
Rahma Chtourou ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein

scholarly journals Laboratory Tests in Addition to the Alvarado Score in the Management of Acute Appendicitis in School-Age Children

2019 ◽  
Vol 73 (4) ◽  
pp. 379-386
Author(s):  
Astra Zviedre ◽  
Arnis Eņģelis ◽  
Pēteris Tretjakovs ◽  
Irisa Zīle ◽  
Aigars Pētersons
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Laboratory Tests ◽  
School Age Children ◽  
School Age ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Serum Cytokines ◽  
Tnf Α

Abstract The aim of the study was to determine whether the Alvarado score (AS) together with laboratory tests could be used to distinguish patients with acute appendicitis (AA) from acute mesenteric lymphadenitis (AML). Fifty-seven patients (7–18 years) with suspected AA were included in the prospective study (October 2010 – October 2013). Thirty-one patients underwent surgery for AA and 26 were not treated surgically and were diagnosed AML on ultrasonography. AS, white blood cell count (WBC), C – reactive protein (CRP) and serum cytokines (EGF, IL-10, IL-12(p70), IL-1β, IL-4, IL-6, IL-8, IL-17, MCP-1, TNF-α) were obtained on admission and were compared between groups. Mean age of the 57 patients was 12.9 (SD 3.2). Accuracy (AR) for AS ≥ 7 alone was 73.7% for AA. Modified AS with certain serum cytokines seemed to be a reliable tool for initial differential diagnosis between AA and AML in school-age children. Based on these results, AS ≥ 7, WBC ≥ 10.7 × 103/µL and serum IL-6 ≥ 4.3 pg/mL assessed altogether will yield more sensitivity for AA. Also for further advanced diagnostics, we propose to take into account the serum IL-6, IL-8, MCP-1, CRP cut-off levels in the differential diagnosis between complicated and uncomplicated AA to decide whether the treatment should be conservative or surgical.

scholarly journals CLINICOPATHOLOGICAL STUDY OF ACUTE APPEDDICITIS WITH SPECIAL REFERENCE TO THE ROLE OF WBC COUNT, C-REACTIVE PROTEIN (CRP), USG AND ALVARADO SCORE IN DIAGNOSIS

2020 ◽  
pp. 59-61
Author(s):  
Md. Mushir Reyaz ◽  
Kumari Pallavi ◽  
C. M. Narayan ◽  
Debarshi Jana
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Scoring System ◽  
Iliac Fossa ◽  
The Other ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Right Iliac Fossa Pain ◽  
Wbc Count

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 140 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of WBC count, C-Reactive protein (CRP), USG and Alvarado scoring system and were subsequently operated, were included in the present study in our institute. Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients.Most of the patients of acute appendicitis presented with more than one of above symptoms. The most common presenting symptom was right iliac fossa pain affecting 96.19% of cases (migratory 62.86% and non-migratory 33.33%), followed by anorexia (78.10%) and nausea (66.67%). The other symptoms were fever (65.71%), vomiting (46.67%), constipation (28.57%), right sided flank pain (22.86%), dysurea (19.05%), suprapubic pain (15.24%), diarrhoea (14.29%) and generalized abdominal pain (13.33%) in decreasing order of frequency. Right iliac fossa pain was the most common presentation in non-appendicitis group, followed by anorexia. There was no significant difference in symptoms among these two groups.In this study 54.29% of patients with acute appendicitis had Alvarado score between 7 – 8 and 34.29% of patients with acute appendicitis had Alvarado score between 9 – 10. On the other hand majority of the patients of non-appendicitis group had a score below 7. 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.

scholarly journals Predictive value of total leucocyte count (TLC), bilirubin and C-reactive protein in the diagnosis of gangrenous and perforated appendicitis.

2019 ◽  
Vol 26 (12) ◽  
pp. 2173-2178
Author(s):  
Muhammad Najam Iqbal ◽  
Shahbaz Ahmad ◽  
Abdullah Saeed ◽  
Muhammad Imran Shah ◽  
Muhammad Zahid Imtiaz Dogar ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Perforated Appendicitis ◽  
Serum Total Bilirubin ◽  
Suspected Case ◽  
C Reactive Protein ◽  
Alvarado Score ◽  
Reactive Protein ◽  
Gangrenous Appendicitis ◽  
Perforated Appendix

Acute appendicitis is the most common cause of acute abdomen. Most of the cases are diagnosed on history, clinical examination and raised TLC but gangrenous and perforated appendicitis are difficult to diagnose. The TLC, Serum bilirubin and C‑reactive protein (CRP) have been shown to indicate perforation in appendicitis. Objectives: The purpose of this study was to evaluate the role of TLC, hyperbilirubinemia and CRP in the diagnosis of perforated appendix and surgery should be planned. Study Design: Prospective study. Setting: Department of Surgery in Sheikh Zayed Medical College Rahim Yar Khan. Period: 12 months from November 2017 to October 2018. Material & Methods: This study consisted of patients admitted with the clinical suspicion of acute appendicitis. ALVARADO score was calculated. 120 patients with ALVARADO score more than 6 and histologically diagnosed appendicitis were finally included in the study. A proforma was filled which included patients name, age, sex, duration of pain, TLC count, C-Reactive protein (CRP) level and serum total bilirubin level and diagnosis of appendicitis (acute appendicitis, gangrenous appendicitis and perforated appendicitis. Patients were divided into 3 groups. Group A comprised of patients with features of simple appendicitis (AA), Group B Gangrenous appendicitis (GA) and group C Perforated appendicitis (PA). Results: There were 81 patients of acute appendicitis, 13 patients of gangrenous appendicitis and 26 patients of perforated appendicitis. TLC was raised in 13 patients of AA, 10 patients of gangrenous appendicitis and 24 patients of perforated appendicitis. Hyperbillirubinemia (>1mg/dl) was present in 9 patients of GA and 20 patients of PA. Raised C-Reactive protein level (>5mg) was present in 10 patients of GA and 21 patients of PA. There was significant correlation of raised TLC, hyperbillirubinemia and C-reactive protein in gangrenous and perforated appendicitis and p value was less than 0.05. Predictive value of bilirubin in GA and PA was 56.25 % and 74.04 %respectively. Predictive value of C Reactive Protein in GA and PA was 41.66 and 60 respectively. Predictive value of TLC in GA and PA was 43.47 and 60.86 respectively. Conclusion: All the patients who present with pain in right iliac fossa, lower abdominal tenderness and rigidity, Alvarado score>7, raised TLC, CRP and hybillirubinemia are the suspected case of perforated appendix and should be aggressively resuscitated and operated.

scholarly journals Evaluation of using Alvarado score and C-reactive protein in diagnosing acute appendicitis in children

2010 ◽  
Vol 67 (8) ◽  
pp. 644-648
Author(s):  
Ana Kostic ◽  
Andjelka Slavkovic ◽  
Zoran Marjanovic ◽  
Jelica Madic ◽  
Marijana Krstic ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Scoring Systems ◽  
C Reactive Protein ◽  
Diagnostic Challenge ◽  
Alvarado Score ◽  
Predictive Values ◽  
Reactive Protein ◽  
Group I ◽  
Group Ii

Background/Aims. Acute appendicitis (AA) remains a diagnostic challenge in children, despite ongoing researches. With an aim to facilitate making diagnosis of AA many scoring systems have been created; among them Alvarado score is the most popular. C-reactive protein (CRP) has proven significance for diagnosing AA in adults, but not in children. The aim of this study was to evaluate significance of Alvarado score, as well as CRP values, in making diagnosis of AA in children. Methods. This prospective six-month study was performed on 257 patients under the age of 15, admitted for acute abdominal pain in the Clinic of Pediatric Surgery and Orthopedics in the Clinical Centre of Nis. Alvarado score and CRP values were determined on admission and compared with final diagnosis on discharge. The patients were divided into two groups: group I - non operated patients with abdominal pain (n = 184) and group II - operated on patients for appendectomy (n = 73). Results. Values of Alvardo score were statistically significantly different between groups (group I: 4.9 ? 1.21, group II: 8.55 ? 1.32). Also, our results showed significantly high values of CRP measured in operated children (group I: 8.17 ? 4.7 mg/L, group II: 38 ? 26 mg/L). Values of validity parameters for Alvarado score were: sensitivity 90%, specifity 80%, positive predictive values 87%; for CRP 95%, 70% and 80%, respectively. Conclusion. Alvarado score and CRP are very useful adjuvant diagnostic tool for AA to a less experienced surgeon. High values of Alvarado score and CRP cannot be ignored neither at the same time, used as the sole diagnostic method for discriminating children with AA.

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