A Comparative Study between Bedside Index for Severity in Acute Pancreatitis (BISAP) and Acute Physiology and Chronic Health Evaluation (APACHE-II) Scoring System in Assessing the Severity of Acute Pancreatitis at Bangalore Medical College and Research Institute, Bangalore, India

BACKGROUND Acute pancreatitis (AP) is an inflammatory disease of the pancreas, that results from intrapancreatic activation, release, and digestion of the organ by its own enzymes. The diagnosis of acute pancreatitis can be made when a patient presents with threefold elevated serum levels of amylase or lipase, abdominal pain and vomiting. In this study, we wanted to assess the severity of acute pancreatitis by using BISAP (Bedside index for severity in acute pancreatitis) and APACHE-II (Acute physiology and chronic health evaluation) scoring systems and compare the accuracy of BISAP scores with APACHE-II scores. METHODS A prospective study including 201 patients was conducted from April 2018 to March 2020 in Victoria Hospital, affiliated to BMCRI. RESULTS Among 201 AP patients, 129 were found to have mild acute pancreatitis (MAP), 72 were of severe acute pancreatitis (SAP), 192 survival cases, and 9 death cases. The larger the rating score, the higher the proportion of severe pancreatitis and mortality risk. Two kinds of scoring criteria; BISAP score points and Apache II score points compared in patients with MAP and SAP, In Apache II score to predict severity of organ failure, the sensitivity, specificity, positive predictive value, negative predictive value was 84.72 %, 93.02 %, 87.14 %, 91.60 % and area under the curve was 0.958 (P < 0.0001). In BISAP, the sensitivity, specificity, positive predictive value, negative predictive value was 90.28 %, 80.62 %, 72.22 %, 93.69 % and area under the curve was 0.917 (P < 0.0001). CONCLUSIONS Ability of APACHE II score prediction of AP in severity of organ failure and mortality are stronger than BISAP score, But APACHE II scoring system indicators were cumbersome, complicated assessment. BISAP scoring system is simple, economical, rapid and reliable, and it can effectively predict the severity and mortality of acute pancreatitis, and can be used as a preliminary screening method in accurate risk stratification and initiation of management accordingly at community health care, secondary health care and tertiary health care Hospitals. KEYWORDS Pancreatitis, Severity, Prediction, APACHE II and BISAP

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1061. Comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II Score and the Pitt Bacteremia Score to Predict Mortality in Methicillin-Resistant Staphylococcus aureus Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.898 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S317-S318 ◽

Cited By ~ 1

Author(s):

Sarah Jorgensen ◽

Evan J Zasowski ◽

Trang D Trinh ◽

Abdalhamid M Lagnf ◽

Sahil Bhatia ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Predictive Value ◽

Methicillin Resistant Staphylococcus Aureus ◽

Apache Ii ◽

Apache Ii Score ◽

Health Evaluation ◽

Research Support ◽

C Statistic ◽

Sensitivity Specificity ◽

Research Grant

Abstract Background Methicillin-resistant Staphylococcus aureus bloodstream infection (MRSA BSI) is associated with high morbidity and mortality. The prediction of outcomes may have a profound impact on clinical decision making and risk stratification. The Acute Physiology and Chronic Health Evaluation (APACHE) II Score and the Pitt Bacteremia Score (PBS) have been repeatedly described as independent predictors of mortality in MRSA BSI. The APACHE II is complex to calculate and many of the variables may not be pertinent to MRSA BSI. The PBS is a simple score using readily assessable variables. The comparative predictive performance of the two models in MRSA BSI has not been evaluated. Methods Retrospective, observational, singe-center cohort study in adults with MRSA BSI between 2008 and 2018. Patients who did not receive active therapy ≤72 hours of index culture were excluded. APACHE II and PBS were calculated using the worst physiological values recorded ≤24 hours of blood culture collection. Discriminatory ability for 30-day mortality was assessed using the c-statistic and was compared using the Hanley and McNeil method. The best cut-off point in each scoring system was determined using the Youden Index (J). Results A total of 455 patients were included. The median (IQR) PBS and APACHE II were 2 (0, 3) and 18 (11, 23), respectively. All-cause 30-day mortality was 16.3%. The c-statistic (95% CI) for the APACHE II vs. PBS in the overall cohort and stratified by ICU status were: 0.813 (0.763, 0.863) vs. 0.717 (0.653, 0.782), P = 0.0035; ICU 0.729 (0.610, 0.848) vs. 0.570 (0.442, 0.699), P = 0.026; and non-ICU 0.821 (0.761, 0.881) vs. 0.700 (0.614, 0.786),P = 0.0046, respectively. The APACHE II with the maximum J value was 21; sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for 30-day mortality were 81.08%, 72.97%, 36.81%, and 95.21%, respectively. The PBS with the maximum J value was 3; sensitivity, specificity, PPV, and NPV were 66.22%, 72.18%, 31.61%, and 91.67%, respectively. Conclusion The APACHE II was superior to the PBS in predicting 30-mortality in patients with MRSA BSI in the overall cohort and stratified by ICU status at BSI onset. Future research to develop a more practical scoring model with high discriminatory power is needed. Disclosures M. J. Rybak, Allergan: Consultant, Grant Investigator and Speaker’s Bureau, Research grant and Research support. Achaogen: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Bayer: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Melinta: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Merck: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Theravance: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Sunovian: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. Zavante: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support. NIAID: Consultant, Grant Investigator and Speaker’s Bureau, Consulting fee, Research grant and Research support.

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Ovarian Malignancy Prediction by Gatot Purwoto (GP) Score, Risk Malignancy Index (RMI), and Frozen Section in Young Age

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v2i3.399 ◽

2016 ◽

Author(s):

Liva Wijaya

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Frozen Section ◽

Diagnostic Value ◽

Young Age ◽

Ovarian Malignancy ◽

Aged Patients ◽

Sensitivity Specificity ◽

Additional Value

Objective: To know the diagnostic value of a scoring system taken before surgery and frozen section in young-aged patients with suspected malignancy. Using that result, we can also investigate whether frozen section gives additional value to clinical scoring system. Method: This study is a diagnostic test. This study was carried out by accessing RSCM’s medical record from 2006-2011. From 437 patients suspected of ovarian malignancy, we included 157 patients due to age. Result: Diagnostic value of GP score are 77%, 49%, 61%, 68%, 63%, while RMI are 69%, 49%, 58%, 45%, 59%, (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy respectively). Diagnostic value of frozen section in patients with suspected malignancy using GP score >4 are 81.7%, 87.2%, 90.7%, 75.6%, 83%, while in patients with RMI 200 are 81%, 87%, 89%, 77%, 83% (sensitivity, spesificity, positive predictive value, negative predictive value, and accuracy respectively). Conclusion: Gatot Purwoto score and RMI have good diagnostic value in proving malignancy in young age. Its predictive value will be increased by frozen section. [Indones J Obstet Gynecol 2014; 3: 157-161] Keywords: frozen section, gatot purwoto score, ovarian malignancy, RMI, young age

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

International Surgery Journal ◽

10.18203/2349-2902.isj20180430 ◽

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.

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

Kathmandu University Medical Journal ◽

10.3126/kumj.v12i1.13638 ◽

2015 ◽

Vol 12 (1) ◽

pp. 48-50 ◽

Cited By ~ 3

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

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Correlation of Ultrasound and RIPASA Scoring System in the Diagnosis of Acute Appendicitis

International Journal of Medicine and Surgery ◽

10.15342/ijms.v5ir.193 ◽

2018 ◽

Vol 5 ◽

Author(s):

Anand Rai Bansal ◽

Suvendu Sekhar Jena ◽

Sanjeev Kumar

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Study Design ◽

Predictive Value ◽

Scoring System ◽

Negative Appendicectomy ◽

Low Sensitivity ◽

Sensitivity Specificity

Objective: Correlation of Ultrasound and RIPASA scoring system in the diagnosis of acute appendicitis. Study Design: 50 patients presenting to emergency underwent ultrasound and evaluation as per RIPASA scoring system followed by emergency appendicectomy. The sensitivity, specificity, positive and negative predictive value calculated for each goups. Results: The sensitivity, specificity, Positive Predictive Value and Negative Predictive Value for ultrasound were 75.51%, 100%, 100% and 7.69% respectively and that for RIPASA scoring system were 93.9%, 100% 100% and 25% respectively. The negative appendicectomy rate was 2%. Conclusion: RIPASA scoring system may be used for correctly diagnosing acute appendicitis but low sensitivity of ultrasound precludes its routine use and may be used as a complementary tool in diagnosing acute appendicitis. Keywards: Acute Appendictis, RIPASA, Ultrasound.

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A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective

Journal of Lumbini Medical College ◽

10.22502/jlmc.v6i2.264 ◽

2018 ◽

Vol 6 (2) ◽

Author(s):

Suman Baral ◽

Neeraj Thapa ◽

Raj Kumar Chhetri ◽

Rupesh Sharma

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Sensitivity Specificity

Introduction: Various diagnostic criteria have been described for acute appendicitis. For decades the most commonly used one has been Alvarado score. RIPASA scoring system has also been developed for Asian population which has shown highest sensitivity and diagnostic accuracy. This study aimed to compare these two diagnostic criteria in Nepalese population attending a tertiary center. Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination was taken as the gold standard for diagnosis. Statistical analysis was done using McNemar's test as applicable. Results: Ninety nine (90 %) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 94.5%, 27.27 %, 92.16 %, 37.5 %, 88.18% and 7.84% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 71.72%, 72.73 %, 95.95 %, 22.22%, 71.82 %, and 4.05 % respectively. 94.5% of patients were correctly stratified by RIPASA under higher probability group while only 71.8 % were classified by Alvarado (p value= 0.0001). Conclusion: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, this method can be applied in Nepalese setting for the diagnosis of acute appendicitis.

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Qualitative analysis of contrast-enhanced ultrasound in the diagnosis of small, TR3–5 benign and malignant thyroid nodules measuring ≤1 cm

British Journal of Radiology ◽

10.1259/bjr.20190923 ◽

2020 ◽

Vol 93 (1111) ◽

pp. 20190923

Author(s):

Xin Li ◽

Feng Gao ◽

Fan Li ◽

Xiao-xia Han ◽

Si-hui Shao ◽

...

Keyword(s):

Positive Predictive Value ◽

Qualitative Analysis ◽

Negative Predictive Value ◽

Predictive Value ◽

Diagnostic Performance ◽

Thyroid Nodules ◽

Area Under The Curve ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Sensitivity Specificity

Objective: To evaluate the performance of contrast-enhanced ultrasound in the diagnosis of small, solid, TR3–5 benign and malignant thyroid nodules (≤1 cm). Methods: From January 2016 to March 2018, 185 thyroid nodules from 154 patients who underwent contrast enhanced ultrasound (CEUS) and fine-needle aspiration or thyroidectomy in Shanghai General Hospital were included. The χ2 test was used to compare the CEUS characteristics of benign and malignant thyroid nodules, and the CEUS features of malignant nodules assigned scores. The total score of the CEUS features and the scores of the above nodules were evaluated according to the latest 2017 version of the Thyroid Imaging Reporting and Data System (TI-RADS). The diagnostic performance of the two were compared based on the receiver operating characteristic curves generated for benign and malignant thyroid nodules. Results: The degree, enhancement patterns, boundary, shape, and homogeneity of enhancement in thyroid small solid nodules were significantly different (p＜0.05). No significant differences were seen between benign and malignant thyroid nodules regarding completeness of enhancement and size of enhanced lesions (p＞0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the TI-RADS classification TR5 in diagnosis of malignant nodules were 90.10%, 55.95%, 74.59%, 72.22%, and 82.46%, respectively (area under the curve [AUC]=0.738; 95% confidence interval[CI], 0.663–0.813). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the total score of CEUS qualitative analysis indicators were 86.13%, 89.29%, 87.57%, 90.63%, and 84.27% respectively (AUC = 0.916; 95% CI, 0.871–0.961). Conclusion: CEUS qualitative analysis is superior to TI-RADS in evaluating the diagnostic performance of small, solid thyroid nodules. Qualitative analysis of CEUS has a significantly higher specificity for diagnosis of malignant thyroid nodules than TI-RADS. Advances in knowledge: The 2017 version of TI-RADS has recently suggested the malignant stratification of thyroid nodules by ultrasound. In this paper we applied this system and CEUS to evaluate 185 nodules and compare the results with pathological findings to access the diagnostic performance.

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Role of acute physiology and chronic health evaluation II scoring system in risk stratification and management of small bowel perforations

International Surgery Journal ◽

10.18203/2349-2902.isj20202381 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1776

Author(s):

Sanjana Kumar ◽

Jainendra K. Arora ◽

Sunil Kumar Jain

Keyword(s):

Small Bowel ◽

Mortality Rate ◽

Scoring System ◽

Chronic Health Evaluation ◽

Apache Ii ◽

Apache Ii Score ◽

Health Evaluation ◽

Double Blind ◽

Chronic Health ◽

Significant Difference

Background: Despite the surgical treatment, sophisticated intensive care units, latest generation antibiotics and a better understanding of pathophysiology, the morbidity and mortality rate of perforation peritonitis are still high. Patients are usually managed by subjective decision of surgeon based on which mortality is very high.Methods: This was a double-blind observational study conducted over a period of 18 months on 50 patients with small bowel perforations. Based on the acute physiology and chronic health evaluation (APACHE) II score at presentation, patients were triaged into 3 groups: group 1 (score ≤10), group 2 (score 11 to 20) and group 3 (score >20). Study population was managed by the subjective decision of the operating surgeon who was blinded off the APACHE II score of patients. Hence removing the possibility of bias and observing a correlation between surgical outcome and APACHE II score of the patient.Results: Patients with higher APACHE II score (>10) were more likely to undergo exteriorization of bowel. Length of hospital stay was also found to be increased with an increase in score. APACHE II score of 10 was found to predict mortality with significant difference between 2 groups. Below this score the mortality was 0% and above this score the mortality rate rose to 31.25%.Conclusions: APACHE II can be used as a reliable and uniform scoring system as its assessment at presentation in patients of small bowel perforations provides an insight to their surgical management as well as predicting overall outcome.

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Comparative study of Amsel’s criteria and Nugent scoring for diagnosis of bacterial vaginosis in a tertiary care hospital, Nepal

BMC Infectious Diseases ◽

10.1186/s12879-021-06562-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rajshree Bhujel ◽

Shyam Kumar Mishra ◽

Santosh Kumar Yadav ◽

Kesang Diki Bista ◽

Keshab Parajuli

Keyword(s):

Positive Predictive Value ◽

Bacterial Vaginosis ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Vaginal Discharge ◽

Care Hospital ◽

Gold Standard Method ◽

Abnormal Vaginal Discharge ◽

Sensitivity Specificity

Abstract Background The most common pathological cause of abnormal vaginal discharge in reproductive-aged women is bacterial vaginosis (BV). Amsel’s criteria and Nugent scoring systems are commonly employed approaches for the diagnosis of BV. Despite the Nugent scoring system being the gold standard method for diagnosing BV, Amsel’s criteria are generally preferred in clinical setup owing to the fact Nugent scoring requires considerable time and expert microscopist. This study was conducted to determine the diagnostic value of Amsel’s criteria by comparing it with the Nugent scoring system. Methods This was a descriptive cross-sectional study conducted at Tribhuvan University Teaching Hospital, Nepal from October 2016 to September 2017. Vaginal specimens were collected from a total of 141 women presenting with abnormal vaginal discharge. The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were calculated, and each component of Amsel’s criteria was compared to the Nugent scoring system. Results The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were 50%, 98.2%, 87.5%, and 88.8% respectively. The clue cells showed 100% specificity and vaginal discharge with pH > 4.5 had 89.3% sensitivity while compared with Nugent’s scoring system. Conclusions Amsel’s criteria can be used as an adjunct method to Nugent scoring for the diagnosis of BV in the hands of skilled manpower in resources limited countries. The presence of clue cell and positive whiff test of Amsel’s criteria shows good match with Nugent’s score.

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Comparison of bedside index of severity in acute pancreatitis (BISAP) and acute physiology and chronic health evaluation (APACHE II) score in assessing severity of acute pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20175409 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4054

Author(s):

S. K. Pattanaik ◽

V. Arvind Kumar ◽

Ajax John

Keyword(s):

Acute Pancreatitis ◽

Sensitivity And Specificity ◽

Roc Curve ◽

Scoring System ◽

Scoring Systems ◽

Apache Ii ◽

High Rate ◽

Apache Ii Score ◽

Average Hospital ◽

Female Ratio

Background: Acute Pancreatitis (AP) is one among the major diseases in the surgery wards with high rate of mortality. In spite of many scoring systems introduced to grade the severity of AP for optimal and timely management, mortality rate is still in a high pace. The aim of this study is to compare BISAP scoring system and APACHE II scoring system for accuracy and easiness in predicting the severity and mortality of AP and to deliver appropriate and timely intervention.Methods: The first 100 patients with AP in the year 2016 (January to August) were studied prospectively by calculating APACHE II score and BISAP score. According to Revised Atlanta classification severe AP was ascertained and the sensitivity and specificity of both scoring systems were assessed from chi square table. By using ROC curve accuracy and diagnostic value of two scoring systems were compared.Results: 100 patients with an age ranging from 20 to 80 years with a mean of 41.18 and male female ratio of 10.1:1 were studied. 95% of the patients presented with a symptom of abdominal pain and 49 out of 100 were having alcoholism as etiology. The average hospital stay of the patients was 12.03 days. Four patients died out of 11 severe AP and rest 89 were grouped into mild AP. BISAP score more than or equal to three have 64.2% chance of severe AP and was statistically significant in predicting the severity of AP. Areas under curve of the ROC curve after depicting the sensitivity and specificity of BISAP scores for severity and mortality were 0.90 and 0.96 respectively. APACHE II scores more than or equal to nine have 23.8% chance of severe AP and was statistically significant in predicting severity of AP. When sensitivity and specificity of APACHE II score were charted in ROC curve, areas under curve were 0.853 and 0.75 for severity and mortality in AP respectively.Conclusions: Compared to APACE II, BISAP is better scoring system in predicting both severity and mortality of AP on considering accuracy and easiness.

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