VALIDAÇÃO DO ESCORE DE ALVARADO NO DIAGNÓSTICO DE APENDICITE AGUDA NOS PACIENTES DO HOSPITAL GERAL DE PALMAS: ANÁLISE RETROSPECTIVA DE 100 CASOS

2018 ◽  
Vol 5 (2) ◽  
pp. 25-28
Author(s):  
Luisa Coelho Milhomem ◽  
Luiz Antônio Gomes Amorim ◽  
Pedro Manuel González Cuellar
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Emergency Room ◽  
Sensitivity And Specificity ◽  
Diagnostic Method ◽  
Clinical Laboratory ◽  
Noninvasive Method ◽  
Alvarado Score ◽  
Cutoff Value ◽  
Suspected Diagnosis

RESUMO Objetivos: determinar a sensibilidade e especificidade do escore de Alvarado para o diagnóstico de apendicite aguda nos pacientes admitidos na emergência do Hospital Geral de Palmas. Métodos: o estudo foi realizado com a validação de método diagnóstico através do escore clínico-laboratorial para diagnóstico de apendicite aguda. A amostra estudada consistiu de 100 pacientes admitidos na emergência do HGP com dor abdominal e suspeita de apendicite aguda, no período de março a outubro de 2017. Os pacientes foram atendidos na emergência e avaliados quanto ao escore de Alvarado pelo cirurgião responsável, o residente de cirurgia e os internos. Resultados: tomando como ponto de corte o valor >7 pontos, encontramos uma sensibilidade de 71,05 % e especificidade de 84,93 %. Conclusões: o escore de Alvarado é um método pouco invasivo para diagnóstico, simples, rápido, que utilizando o ponto de corte >7 pontos, apresentou-se como um instrumento de alto valor na triagem dos nossos pacientes com suspeita diagnóstica de apendicite aguda. Palavras-chave: apendicite, diagnóstico, emergência. ABSTRACT Objectives: to determine the sensitivity and specificity of the Alvarado score for the diagnosis of acute appendicitis in patients admitted to the Emergency Hospital of Palmas. Methods: The study was performed with the validation of the diagnostic method through the clinical-laboratory score for the diagnosis of acute appendicitis. The sample consisted of 100 patients admitted to the emergency room of the HGP with abdominal pain and suspected of acute appendicitis, from March to October 2017. The patients were treated in the emergency room and evaluated for the Alvarado score by the surgeon in charge, the resident of surgery and the inmates. Results: taking as a cutoff value> 7 points, we found a sensitivity of 71.05% and specificity of 84.93%. Conclusions: The Alvarado score is a simple, fast, noninvasive method for diagnosis, which, using the cutoff point> 7 points was presented as a high-value instrument for the screening of our patients with suspected diagnosis of acute appendicitis. Keywords: appendicitis, diagnosis, emergency.

scholarly journals The use of ultrasonographic and Alvarado scores in evaluating abdominal pain suggestive of acute appendicitis

2017 ◽  
Vol 4 (2) ◽  
pp. 757 ◽  
Author(s):  
Jorge Fernández Álvarez ◽  
José Manuel Gómez López ◽  
Alberto M González Chávez ◽  
Benjamín Valente Acosta ◽  
Diego Abelardo Álvarez Hénandez ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Alvarado Score ◽  
Lower Quadrant ◽  
Efficient Alternative ◽  
Two Parameters ◽  
The Right ◽  
Right Lower Quadrant

Background: Ultrasonographic scores for appendicitis to determine if, combined with Alvarado scores, they can increase the sensitivity and specificity of the diagnosis of appendicitis.Methods: All cases of abdominal pain suggestive of appendicitis presented between 2013 and 2015 were analysed. An Alvarado score was obtained. All patients underwent ultrasound, and an ultrasonographic score was determined, including the appendicitis classical findings.Results: Two hundred and fifty-one patients with abdominal pain in the right lower quadrant were analysed. Appendicitis was confirmed in 211 (84%) patients. For these patients, the average Alvarado score was 7.95/10 (±1.25) vs. 5.7/10 (± 1.11) for patients who did not have appendicitis (p < 0.001). In patients with confirmed appendicitis, the average ultrasonographic score was 2.48/6 (± 1.06) vs. 0.6/6 (± 0.92) for patients who did not have acute appendicitis (p < 0.001). The ultrasonographic score has a sensitivity of 90% and a specificity of 87% with only two parameters. The combination of the Alvarado and ultrasonographic scores decreased the percentage of negative appendectomies to 2.36% and increased the area under the curve by 0.970.Conclusions: The sum of the Alvarado and ultrasonographic scores provides an efficient alternative for diagnosing abdominal pain suggestive of appendicitis and predicts which patients should undergo surgery with good certainty.

scholarly journals Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis

2020 ◽  
Vol 19 (3-4) ◽  
pp. 109-119
Author(s):  
Senol Tahir ◽  
Andrej Nikolovski ◽  
Martina Ambardjieva ◽  
Petar Markov ◽  
Dragoslav Mladenovik ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Clinical Laboratory ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Simultaneous Application ◽  
Number Of Patients

Introduction. The diagnosis of acute appendicitis (AA), as the most common cause of acute abdominal pain, has changed in the past decade by introducing scoring systems in addition to the use of clinical, laboratory parameters, and radiological examinations. This study aimed to assess the significance of the four scoring systems (Alvarado, Appendicitis Inflammatory Response (AIR), Raya Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis) in the prediction of delayed appendectomy. Materials and methods. The study included 100 respondents, who were diagnosed with AA in the period from January 2018 to February 2019 and were also operated on. In addition to the clinical, laboratory, and ultrasonographic examinations, four scoring systems (Alvarado, AIR, RIPASA, and Tzanakis) were used to diagnose AA. According to the obtained histopathological (HP) findings, the patients were divided into 3 groups: timely appendectomy, delayed appendectomy and unnecessary appendectomy. Using the sensitivity and specificity of all 4 scoring systems, ROC analysis was performed to predict delayed appendectomy. Results. In the study that included 100 patients (58% men, 42% women), after the appendectomy was performed, the resulting HP showed that 74% had a timely appendectomy, while 16% had delayed and 10% had an unnecessary appendectomy. For the prediction of delayed appendectomy, the area under the ROC curve showed a value of 0.577 for the Alvarado score, 0.504 for the AIR, 0.651 for the RIPASA, and 0.696 for the Tzanakis. Sensitivity and specificity for the Alvarado score was 54% and 62%, for RIPASA 62.5% and 63.5%, for Tzanakis 69% and 60.8%, respectively. Combining the three scoring systems (Alvarado, RIPASA, and Tzanakis), the surface area under the ROC curve was 0.762 (95% CI 0.521–0.783), with a sensitivity of 85% and a specificity of 62%. Conclusion. In our study, the diagnostic accuracy of RIPASA and Tzanakis showed better results than Alvarado, while AIR cannot be used to predict delayed appendectomy in our population. However, the simultaneous application of all three scoring systems, RIPASA, Tzanakis and Alvarado, has shown much better discriminatory ability, with higher sensitivity and specificity, as opposed to their use alone. Combining scoring systems should help in proper diagnosis to avoid negative appendectomy, but additional studies with a larger number of patients are needed to support these results.

scholarly journals Comparison between AIR score and Alvarado score in cases of non-perforated and perforated acute appendicitis

2019 ◽  
Vol 6 (4) ◽  
pp. 1108
Author(s):  
Debabrata Gope ◽  
Anuradha Santosh Dnayanmote ◽  
Saurav Mahesh Thakkar ◽  
Akriti Rajkumar Tulsian ◽  
Shweta Achuthan Kutty ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Acute Abdominal Pain ◽  
Pathological Examination ◽  
Alvarado Score ◽  
Sensitivity Specificity ◽  
Higher Sensitivity

Background: Acute abdominal pain is a common complaint in the emergency department. Diagnostics of one of the most common pathologies behind acute abdominal pain, acute appendicitis, has radically changed over the last decades. There are several different diagnostic scores for suspected acute appendicitis. The Alvarado score being most widely known. Appendicitis Inflammatory Response (AIR) score was designed to overcome drawbacks of previous scores. This score incorporated the C-reactive protein value in its design and was developed and validated on a prospective cohort of patients with suspicion of acute appendicitis.Methods: Patients with pain in RIF were admitted. Scores were assessed, patients whose score was significant by either of the system were subjected for appendicectomy. The specimens of appendix were sent for histo-pathological examination (HPE). Post-operative histopathology report was correlated with the scores. Sensitivity, specificity, positive predictive value and negative predictive for AIR and Alvarado score were calculated.Results: For scores >4, AIR score has higher sensitivity and specificity. The negative predictive value (NPV) of AIR score was higher and the positive predictive value (PPV) of AIR score was also high. For scores >8, Alvarado score has higher sensitivity as compared to AIR score whereas AIR score has higher specificity as compared to Alvarado score. NPV of Alvarado score was higher while PPV of AIR score was higher.Conclusions: In this study AIR score had Alvarado score displaying higher sensitivity and specificity.

scholarly journals Predictive Value of Alvarado Score and Ultrasound in the Diagnosis of Acute Appendicitis (A prospective study

2021 ◽  
Vol 62 (4) ◽  
pp. 99-103
Author(s):  
Waleed Saadi Ahmed ◽  
Salah M. Tajer ◽  
Hend M. Sayaly
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Signs And Symptoms ◽  
Cost Effective ◽  
General Surgeon ◽  
Emergency Ward ◽  
Alvarado Score ◽  
Combined Application ◽  
Abdominal Emergencies ◽  
A Prospective Study

Background:  Acute appendicitis is the commonest non traumatic cause of acute abdominal pain that needs surgical management .Alvarado score and ultrasonographies are the most cost effective, easy and available aids for diagnosis. The aim of the study was determining   the reliability of Alvarado score and ultrasound in the diagnosis of acute appendicitis. Results: The study was applied with 100 cases with different types of abdominal pain at presentation with 51 males and 49 females .The sensitivity was97.3% ,specificity 90%, and accuracy  89 of combined usage of Alvarado score and U/S findings preoperatively. Patients and method:  A prospective non-interventional study including patients admitted with suggestive history with signs and symptoms of acute appendicitis to the surgical emergency ward of Baghdad teaching hospital from July 1st 2017 to Feb 10th 2018, Alvarado score calculated and ultrasonography done for each patient enrolled in this study, then to be followed for intraoperative findings. Conclusions: Combined application of Alvarado score and U/S has sensitivity 94.1% ,specificity 90% and accuracy 89% . In our medical facility and emergency ward, acute appendicitis remains as one of the top acute abdominal emergencies needing surgery in patients presenting with atypical clinical finding. So diagnosis becomes difficult. So Alvarado score along with ultrasound findings are useful for increasing the reliability in emergency department for  accurate diagnosis of acute appendicitis therefore there should be training for the use of U/S by emergency physician and general surgeon in the diagnosis of acute appendicitis in order to decrease the rate of negative appendectomies .  

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.

Abdominal Tuberculosis in Ahmadi, Kuwait: A Clinico-Pathological Review

1998 ◽  
Vol 28 (3) ◽  
pp. 137-139 ◽  
Author(s):  
Naser UAMA Abdul-Ghaffar ◽  
Ibrahim Tarif Ramadan ◽  
Amin Ali Marafie
Keyword(s):  
Young Adults ◽  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Intestinal Obstruction ◽  
Diagnostic Method ◽  
Abdominal Tuberculosis ◽  
Presenting Symptoms ◽  
Clinical Presentations ◽  
Pathological Review ◽  
Antituberculous Chemotherapy

For studying abdominal tuberculosis (TB) in Ahmadi, files of all patients admitted to our hospital with abdominal TB over 15 years (1981–1996) were reviewed. Nineteen patients are reported here. Young adults were predominant in our study. The non-Arab Asians were the most frequently affected group in relation to their population in Ahmadi, and Kuwaitis were the least frequently affected group. Abdominal pain, sweating, anorexia and fever were the most frequent presenting symptoms. Ascites and intestinal obstruction were the most frequent clinical presentations. Two patients presented with acute appendicitis and one patient had tuberculous pancreatitis. Abdominal lymph nodes, peritoneum, ileum and caecum were the most frequently affected abdominal structures. We found laparoscopy very helpful in the diagnosis of abdominal TB and we recommend it as the diagnostic method of choice. All our patients responded well to antituberculous chemotherapy. It should be kept in mind that abdominal TB still affects the indigenous and expatriate population of Kuwait.

scholarly journals A study of correlation between clinical, radiological and pathological diagnosis of appendicitis: a retrospective analytic study

2018 ◽  
Vol 5 (9) ◽  
pp. 3011
Author(s):  
Prabhu R. ◽  
Vijayakumar C. ◽  
Balagurunathan K. ◽  
Senthil Velan M. ◽  
Kalaiarasi R. ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Scoring System ◽  
Acute Abdominal Pain ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Radiological Finding ◽  
Clinical Signs ◽  
Emergency Setting ◽  
Alvarado Score

Background: Acute appendicitis is the most common cause of acute abdominal pain in young adults requiring emergency surgery. Appendicectomy is the most frequently performed surgery. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. A combination of clinical signs and symptoms with laboratory findings in many scoring systems are suggesting the probability of appendicitis and the possible subsequent management pathway. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological finding and histopathological examination for the diagnosis of acute appendicitis.Methods: A retrospective study was conducted in the department of general surgery in a tertiary care centre in South India. Total of 237 patients with acute abdominal pain were included and evaluated with the clinical Alvarado scoring system, radiological finding with (USG/CT abdomen) and histopathological examination for the diagnosis of acute appendicitis. The data was collected and analyzed retrospectively.Results: Of the 237 patients, 164 patients were male (69.1%) and rest is female. The correlation of the Alvaroda score with histopathological findings in groups with score > 7 and ≤7 the correlation of Alvarado score and the ultrasound findings were comparable between the study groups. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score >7 was 72.99%. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score ≤7 was decreased to 27%.Conclusions: The diagnostic accuracy of clinical features is far better than radiological investigations in the diagnosis of acute appendicitis. Therefore, it is concluded that it is better to use radiological investigations only to confirm the diagnosis of acute appendicitis rather to diagnose it.

scholarly journals Double acute appendicitis: cecal and epiploic; literature review of a case report

2020 ◽  
Vol 8 (12) ◽  
pp. 4512
Author(s):  
Camilo Levi Acuna Pinzon ◽  
Jose Luis Chavaria Chavira ◽  
Jefferson Fabian Nieves Condoy ◽  
Claudia Ortiz Ledesma
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Acute Appendicitis ◽  
Blood Test ◽  
Unusual Case ◽  
Surgical Intervention ◽  
Simultaneous Presentation ◽  
Pelvic Cavity ◽  
Initial Blood ◽  
Suspected Diagnosis

Acute cecal appendicitis and appendagitis are two entities due to the inflammation of the cecal and epiploic appendix respectively. A case of a 34-year-old woman is presented, who is admitted for abdominal pain. Initial blood test and ultrasonography were not conclusive, subsequently with clinical deterioration, surgical intervention was required which noted acute appendicitis and appendicitis that were removed. This is an extremely unusual case, since the simultaneous presentation of these two entities has not been widely described and demonstrates the importance of exploring the abdominal and pelvic cavity in patients with suspected diagnosis of acute appendicitis.

scholarly journals Watch What You Swallow!—A Rare Cause of Not So Rare Entity Presenting to the Emergency Room

2019 ◽  
Vol 02 (01) ◽  
pp. 049-052
Author(s):  
Pratik Mukherjee ◽  
Daniel Wu Peng ◽  
Ashish Chawla
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Foreign Body ◽  
Acute Appendicitis ◽  
Emergency Room ◽  
Complete Recovery ◽  
Foreign Body Ingestion ◽  
Rare Entity ◽  
Inflammatory Changes

AbstractForeign-body ingestion is a rare cause for acute appendicitis. The authors report a case of a 48-year-old man who presented with abdominal pain for 3 days. Computed tomography (CT) revealed a foreign body in the appendix with peri-appendicular inflammatory changes. The patient underwent a successful appendectomy with complete recovery.

scholarly journals Actynomicosis of the abdomen mimicking acute appendicitis

2019 ◽  
Vol 6 (10) ◽  
pp. 3822
Author(s):  
David Molina Davila ◽  
Francisco Terrazas Espitia ◽  
Alejandro Corona Figueroa ◽  
Jose Donis Hernandez ◽  
Jimena Gonzalez Cal Y. Mayor
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Tract ◽  
Acute Appendicitis ◽  
Emergency Room ◽  
Laparoscopic Appendectomy ◽  
Acute Onset ◽  
Antimicrobial Treatment ◽  
Human Infection ◽  
Commensal Flora ◽  
Sulfur Granules

Bacteria of the genus Actinomyces are non-spore-forming filamentous, Microaerophilic or strict anaerobic, Gram-positive bacilli, mainly belonging to the human commensal flora of the oropharynx, gastrointestinal tract, and urogenital tract; Actynomicosis israelii is most frequently isolated in human infection by this bacteria (90% of the cases), and is a very rare, generally a polymicrobial granulomatous infection which affects the cervicofacial (55% of all cases), abdominopelvic (22%) and thoracic (15%) regions, causing formation of abscesses, woody fibrosis and sinus discharge of characteristic sulfur granules. We present the case of a 42 year old patient with no prior medical history who presented to the emergency room with acute onset abdominal pain in the lower right quadrant, leukocytosis and neutrophilia, as well as ultrasonographic images which suggested acute appendicitis, the patient underwent laparoscopic appendectomy and cultures of abscesses surrounding the appendix were positive for A. israelii, which was also isolated in the histopathological specimen. The patient underwent antimicrobial treatment with ampicilin-sulbactam for a three month period postoperatively.

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