Appraisal of Various Predictors for Complicated Appendicitis in Adults; A Comparative Study Between Complicated and Non-Complicated Appendicitis

2021 ◽  
Author(s):  
Ayad Ahmad Mohammed
Keyword(s):  
Acute Appendicitis ◽  
Complicated Appendicitis ◽  
General Surgeon ◽  
Alvarado Score ◽  
Delay Management ◽  
Chronic Appendicitis ◽  
Rebound Tenderness ◽  
Abdominal Emergency ◽  
And Gender ◽  
Wbc Count

Abstract Background: Acute appendicitis is the most common non traumatic surgical abdominal emergency, and is the first operation done by most of the general surgeon during their training period. The most important aspect in the management of acute appendicitis, is early diagnosis and intervention to avoid the development of complications.Patients and methods: This prospective study included 184 patients diagnosed with acute appendicitis who were grouped into complicated and non- complicated appendicitis. Both groups were compared to detect predictors for complicated appendicitis to prevent delay management. Results: About 82.6% of our patients were below 30 years (mean: 23.8 years) and 59.2% were females. Histopathology confirmed acute appendicitis in 86.5 %, chronic appendicitis in 12.5%, and normal appendix in 1.1%. About 81.5% have ALVARADO score equal or greater than 7. Complicated appendicitis was diagnosed in 23.37% of patients. There was a significant correlation between complicated appendicitis and gender, rebound tenderness, elevated temperature, elevated WBC, shift to left of WBC and Modified Alvarado Scoring (P values 0.000,0.002,0.001,0.000,0.000, and 0.006), other parameters showed no significant correlations. Conclusion: The rate of complicated appendicitis should be reduced to decrease the associated morbidity, the presence of rebound tenderness, fever, high WBC count and sift to left, a score of 7 or more by modified ALVAADO score, and male sex are highly suggestive. The presence of these factors mandates early and prompt intervention.

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 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 Increased incidence of complicated acute appendicitis after the first COVID-19 pandemic peak: Have patients a different attitude towards COVID-hospitals?

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
S Passoni ◽  
M Giuliani ◽  
M Arigoni
Keyword(s):  
Acute Appendicitis ◽  
Elective Surgery ◽  
Histopathological Examination ◽  
World Health Organisation ◽  
Complicated Appendicitis ◽  
World Health ◽  
Original Structure ◽  
Group A ◽  
Wbc Count ◽  
Complicated Acute Appendicitis

Abstract Objective The 11 March 2020 the World Health Organisation considered the COVID-19 Infection a pandemic disease. Between March and May 2020, the region of southern Switzerland was affected by the first pandemic peak, which was managed by dividing hospitals in Covid and non Covid facilities and by reducing elective surgery. At the end of the pandemic peak hospitals returned to their original structure but there was concern as to possible avoidance of former COVID facilities by patients because of fear of contracting of COVID-19 infection. For acute situations such as acute appendicitis, this could imply a delay of treatment. The aim of this retrospective study is to analyse the increment in incidence of complicated appendicitis in the post-pandemic period at our institution. Methods Clinical data of patients who underwent appendectomies in the period before and after the COVID-19 pandemic were analysed and compared. Diagnosis was based histopathological examination and/or on intra-operative or CT findings. Complicated appendicitis was defined as the presence of perforated or gangrenous appendicitis on histopathology or the presence of an abscess on CT scan. The incidence of complicated appendicitis, the time between onset of symptoms and patient admission (TOSA), the initial inflammatory blood tests and the complication rate was compared between the two periods. Results 79 patients were included in the study, 31 in the post-COVID-19 peak group (A), April - October 2020, and 48 in the pre-pandemic group (B), April - October 2019. Incidence of complicated appendicitis was significantly higher in group A (55% vs 14% p = 0.02). These findings correlate with a greater TOSA (mean time 35 hours vs 17 hours, p = 0.01) and higher inflammatory values in the initial blood test, (mean WBC count 14.8 G/l vs 12.9 G/l, p = 0.08 and mean CRP value 73 mg/l vs 43 mg/l, p = 0.01) in group A. Conclusion Our data show a clear increase of incidence of complicated acute appendicitis after the pandemic peak in our hospital. Indeed patients tended to wait longer to visit our emergency department after the pandemic peak. One explanation is a possible fear by the patients of contracting COVID-19 infection in a former COVID hospital. Management of surgical emergencies during and after a pandemic peak phase should take into account the fact that patients may wait longer to visit a doctor thus aggravating the degree of their disease.

scholarly journals A comparison of Tzanakis and Alvarado scoring system in the diagnosis of acute appendicitis

2019 ◽  
Vol 6 (6) ◽  
pp. 2080
Author(s):  
R. Anupriya ◽  
C. P. Ganesh Babu ◽  
K. V. Rajan
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Scoring System ◽  
Histopathological Examination ◽  
Cross Sectional Study ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Abdominal Emergency ◽  
Gandhi Medical College ◽  
Research Institute Hospital

Background: Appendicitis is the most common abdominal emergency worldwide. Lifetime risk of acute appendicitis is 8.6% and 6.7% for man and women respectively. Clinical examination is helpful in diagnosis of acute appendicitis in only 70-87% of the cases. To compare Tzanaki and Alvarado scoring system in diagnosing acute appendicitis.Methods: This was a prospective, comparative, cross-sectional study, which was conducted at the Mahatma Gandhi Medical College and Research Institute Hospital. Patients with acute appendicitis were included in the study. Relevant history, examination and laboratory investigations done. Patients were scored according to both Alvarado scoring system and Tzanakis scoring, and both were documented in the proforma. Sensitivity, specificity, positive predictive value, negative predictive value were assessed and compared for both scoring systems.Results: 70 patients were included in this study. 54.3% of patients have Tzanakis score more than 8. 35.7% of patients have Alvarado score more than 7. 82.9% of patients had evidence of appendicitis in histopathological examination. Tzanakis score: sensitivity– 65.52%, specificity- 100%, PPV–  100%, NPV– 37.50%, accuracy– 71.43%. Alvarado score: sensitivity– 36.21%, specificity– 66.67%, PPV- 84%, NPV– 17.78%, accuracy– 41.43%.Conclusions: Tzanakis scoring system is an effective scoring system in diagnosing acute appendicitis.

scholarly journals Validity of Alvarado Score in predicting disease severity and postoperative complication in pediatric acute appendicitis

2019 ◽  
Vol 2 (1) ◽  
pp. e000003 ◽  
Author(s):  
Patrick H Y Chung ◽  
Kanglin Dai ◽  
Zhen Yang ◽  
Kenneth K Y Wong
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Disease Severity ◽  
Complicated Appendicitis ◽  
Risk Scores ◽  
Median Score ◽  
Alvarado Score ◽  
Rebound Tenderness ◽  
Medium Risk ◽  
Operative Findings

BackgroundThis study evaluates the validity of Alvarado Score in predicting disease severity and the development of postoperative complications in pediatric appendicitis.MethodsThis is a retrospective, bicentered study on pediatric patients with emergency appendicectomy performed from 2006 to 2016. The relationship of Alvarado Score (low: 1–4, medium: 5–6, high: 7–10) and operative findings/complications was analyzed.ResultsA total of 316 patients were included and the median age on admission was 10.8 years. The overall median score was 8.0. 13.3%, 20.2%, and 66.5% of patients had low, medium, and high risk scores, respectively. 36.1% of patients had complicated appendicitis and the median score was comparable with that of the uncomplicated cases (7.0 vs 7.4, p=0.21). More complicated cases were found in the medium-risk group (high vs medium vs low=29.7% vs 61.4% vs 31.0%, p=0.01). Rebound tenderness had the highest positive predictive value (65%) for complicated appendicitis. Postoperative complications were found in 16.5% of patients with a higher median score (7.87 vs 5.8, p=0.01).ConclusionAlvarado Score does not predict disease severity but postoperative complication. Patients with medium risk score should also be treated promptly for the risk of having complicated disease. Rebound tenderness may be a signal for complicated appendicitis and should be properly examined.

scholarly journals Is Alvarado Score Helpful for Pediatrician in Diagnosis of Acute Appendicitis? Our Center Experience

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Sedigheh Rafiei Tabatabaei ◽  
Abdollah Karimi ◽  
Mohammad Nassiri ◽  
Leily Mohajerzadeh ◽  
Shahnaz Armin ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Pediatric Population ◽  
Scoring Systems ◽  
Cross Sectional Study ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Lower Quadrant ◽  
Suspected Appendicitis ◽  
Rebound Tenderness

Background: Many problems in the diagnosis of patients with suspected appendicitis have led to the design of clinical scoring systems. In children, diagnostics tools for appendicitis are more critical. Younger patients, diagnostic challenges become more. Practical scoring systems are useful without any particular material and necessitate novel ability. Objectives: However, in spite of the reported outstanding consequences, these scoring systems are not employed regularly. Methods: In this cross-sectional study performed from October 2016 to October 2017, ten provinces out of the 31 provinces in Iran were randomly selected. A total of 631 patients referring to the hospitals with the suspicion of acute appendicitis were assessed. Related variables such as age, sex, right lower quadrant (RLQ) pain, migration of pain to RLQ, nausea, and presence of vomiting, anorexia, tenderness in RLQ and guarding, presence of rebound tenderness, and degree of fever were taken from recorded files by pediatricians. Alvarado scoring system was used for included cases to assess the accuracy of this test for diagnosis of appendicitis in our centers. Results: The mean age of eligible patients was 9.3 ± 3.21 years ranged from 3 years to 18 years, and 380 (60.5%) were male. Using the Alvarado score system in this study, considering the cut-off point value of 7 to decide for operation, the positive predictive value (PPV) showed 32.6%, and negative predictive value (NPV) was 76.73%, with a sensitivity of 44.05% and, specificity of 66.95%. There were statistically no significant correlations among the scoring of the Alvarado and diagnosis of AA (P < 0.05). Regarding receiver operator characteristic curves (ROC), the area under curve (AUC) was 0.58 (0.54 to 0.63) for Alvarado. The AUC was very low, so there was no value for the diagnosis of appendicitis. According to the findings of the present study, the cut-off point of 4.5 is suggested for the diagnosis of acute appendicitis in children with a sensitivity of 73% and specificity of 58%. Conclusions: Although the Alvarado scores supply obviously practical diagnostic information in the management of pediatric population with supposed appendicitis, this method delivers no adequate PPV for clinical practice as a safe way for determining necessary operation.

scholarly journals Study of the association of serum procalcitonin with leukocytosis in predicting complicated acute appendicitis

2020 ◽  
Vol 7 (7) ◽  
pp. 2300
Author(s):  
Thana Ram Patel ◽  
Amit Jain ◽  
Lakshman Agarwal ◽  
Vakta Ram Choudhary ◽  
Dinesh Bijarniya
Keyword(s):  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Complicated Appendicitis ◽  
Protein Levels ◽  
Reactive Protein ◽  
Level Measurement ◽  
Wbc Count ◽  
Operative Findings ◽  
Age Range ◽  
Complicated Acute Appendicitis

Background: Delay in the diagnosis of complicated appendicitis and its treatment results in an increased rate of postoperative morbidity, mortality and hospital stay. The diagnosis of appendicitis rests on a combination of signs of inflammation such as fever, pain and tenderness; leukocytosis, and elevated C-reactive protein levels, interleukin-6 (IL6) and procalcitonin. Raised level of serum procalcitonin in bacterial infection has been used to further improve the diagnosis of complicated AA.Methods: One-hundred ten patients of appendicitis confirmed by intra-operative findings and final pathologist report, who underwent appendectomy consisting 25 women (22.73%) and 85 men (77.27%) with a mean age of 25 years (age range 15-55 years) were included in this study. Serum procalcitonin value was measured by chemi E411 Cobas method (chemilumiscent immunoassay system) using the B.R.A.H.M.S PCT kit. Serum PCT level >0.5 ng/ml was consider as risk for progression to severe systemic disease.Results: At a 0.5 ng/dl cut-off value of PCT, the sensitivity and specificity of PCT level measurement for acute complicated appendicitis prediction was 90% and 97.14% respectively. Association between WBC count and PCT value shows the sensitivity and specificity in 40 case of acute complicated appendicitis prediction was 86% and 75% respectively.Conclusions: Both the higher PCT values and leukocytosis correlates well with  infectious post-operative complications for acute appendicitis and it can help to carry out timely surgical intervention which is highly recommended in complicated appendicitis(correlates PCT >0.5 ng/dl).

scholarly journals Alvarado Score System, how useful is in Emergency Department? Some consideration about it.

2019 ◽  
Author(s):  
Agron Dogjani ◽  
Kastriot Haxhirexha ◽  
Arben Gjata ◽  
Sabina Dogjani ◽  
Hysni Bendo
Keyword(s):  
Acute Appendicitis ◽  
Hospital Admissions ◽  
Iliac Fossa ◽  
University Hospital ◽  
Alvarado Score ◽  
Score System ◽  
Male Predominance ◽  
Abdominal Emergency ◽  
Emergency Procedures ◽  
Emergency Doctor

Abstract Background; “Acute Appendicitis” is one of the most usual causes of emergency hospital admissions and appendectomy is one of the most common emergency procedures performed in the contemporary medicine. This study aims to identify the Alvarado Score System as a simplified tool for the emergency doctor in the abdominal emergency in general and for the Acute Appendicitis in particular. Materials and methods; The study is of retrospective character and includes 130 cases presented with abdominal Pain in University Hospital Centre” Mother Theresa” Tirana, Albania, in the period 1 April 2019 - 30 May 2019 from which 100 allegedly suspected with “Appendicitis Acute”. Results; Gender distribution has a slight male predominance. The predominant age group was 14-21 years old. The most frequent clinical data has been the tenderness in right iliac fossa. In our study 3% of cases belonged to the group 1-4 Alvarado points, 17% of the cases belonged to the group 5-6 Alvarado points and 80% of the cases belonged to the group 7-10 Alvarado points. Conclusions; In underdeveloped or developing countries where the decision to operate depends on clinical judgment, the Alvarado Score can serve as a precise and consistent tool to exclude Acute Appendicitis. Alvarado Score can also serve the emergency doctor as a tool with predictive value in the abdominal emergency. Key Words: Acute Appendicitis, appendectomy, Alvarado Score

scholarly journals Evaluation of Clinical Alvarado Scoring System and CT Criteria in the Diagnosis of Acute Appendicitis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Idil Gunes Tatar ◽  
Kerim Bora Yilmaz ◽  
Alpaslan Sahin ◽  
Hasan Aydin ◽  
Melih Akinci ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Acute Abdominal Pain ◽  
Imaging Modality ◽  
Signs And Symptoms ◽  
Study Patient ◽  
Abdominal Ct ◽  
Alvarado Score ◽  
Patient Demographics ◽  
Wbc Count

Aim. The aim was to evaluate the clinical Alvarado scoring system and computed tomography (CT) criteria for the diagnosis of acute appendicitis.Material and Methods. 117 patients with acute abdominal pain who underwent abdominal CT were enrolled in this retrospective study. Patient demographics, clinical Alvarado scoring, CT images, and pathologic results of the patients were evaluated.Results. 39 of the 53 patients who were operated on had pathologically proven acute appendicitis. CT criteria of appendiceal diameter, presence of periappendiceal inflammation, fluid, appendicolith, and white blood cell (WBC) count were significantly correlated with the inflammation of the appendix. The best cut-off value for appendiceal diameter was 6.5 mm. The correlation between appendiceal diameter and WBC count was 80% (P=0.01<0.05). The correlation between appendiceal diameter and Alvarado score was 78.7% (P=0.01<0.05).Conclusion. Presence of CT criteria of appendiceal diameter above 6.5 mm, periappendiceal inflammation, fluid, and appendicolith should prompt the diagnosis of acute appendicitis. Since patients with acute appendicitis may not always show the typical signs and symptoms, CT is a helpful imaging modality for patients with relatively low Alvarado score and leukocytosis and when physical examination is confusing.

scholarly journals Mean Platelet Volume/Platelet Count Ratio as a Diagnostic Marker in Children with Acute Appendicitis

2021 ◽  
Author(s):  
İnanç Karakoyun ◽  
Mustafa Onur Öztan
Keyword(s):  
Platelet Count ◽  
Acute Appendicitis ◽  
Mean Platelet Volume ◽  
Diagnostic Value ◽  
Complicated Appendicitis ◽  
C Reactive Protein ◽  
Platelet Volume ◽  
Reactive Protein ◽  
Uncomplicated Appendicitis ◽  
Wbc Count

Objective: The objective of this research was to evaluate the diagnostic value of mean platelet volume/platelet count (MPV/PC) ratio in pediatric acute appendicitis. Methods: This retrospective study included a total of 310 patients, 176 in the uncomplicated appendicitis group, 80 in the complicated appendicitis group, and 54 in the nonspecific abdominal pain (NSAP) group. C-reactive protein (CRP) level, white blood cell (WBC) count, absolute neutrophil count (ANC), MPV, PC, and MPV/PC ratio were compared between the groups. Results: WBC and ANC levels differed significantly between the groups (P<0.001 in all pairwise comparisons). CRP levels in the complicated appendicitis group were higher than in the NSAP and uncomplicated appendicitis groups (P<0.001 for both comparisons). There was a negative correlation between MPV and PC (r= -0.434, P<0.001). Both PC and MPV/PC ratio were able to distinguish cases of complicated appendicitis from NSAP (P=0.047 and P=0.045, respectively) and from cases of uncomplicated appendicitis (P=0.010 and P=0.045, respectively). Areas under the ROC curve for CRP, WBC, ANC, MPV, PC, and MPV/PC ratio were 0.640, 0.690, 0.727, 0.553, 0.541, and 0.546, respectively. Conclusion: According to the results of our study, MPV/PC ratio can be used in addition to the conventional markers to discriminate cases of complicated appendicitis.

Sign in / Sign up

Export Citation Format

Share Document