ALVARADO SCORING SYSTEM

Objectives: To evaluate the diagnostic accuracy (discrimination) andimplementation performance of Alvarado score. Study Design: Cross sectional study. Setting:Surgical Unit of Nishtar Hospital Multan under supervision of consultant Surgeons of Department.Period: 01 year from November 2016 to October 2017. Methodology: For quantitative variableslike age of patients Mean and SD was calculated, and frequency percentages were calculatedfor categorical data like gender. Negative appendectomy rate, positive predictive value,negative predictive value, sensitivity, specificity was calculated by using 2-2 contingency table.Results: Overall, 100% (n=300) patients enrolled in this study, both genders. Alvarado scoringat presentation, 15% (n=45) patients were categorized into Group I. 13% (n=39) patients wereincluded in Group II. While, 72% (n=216) were enrolled in Group III. Diagnostic test was positivein 223 patients. While, acute appendicitis was confirmed histo-pathologically in 160 patients.Gangrenous appendicitis observed in 3 patients. Chronic appendicitis, perforated appendicitis,appendicular abscess, no specific pathology, gangrenous intestine and salpingo-oophoritiswas observed as 31, 6, 9, 6, 3 and 5 respectively. There were 174 patients true positive, 49 werefalse positive, 59 were false negative and 18 were true negative. Sensitivity, specificity, negativepredictive value and negative predictive value were 74.68% 26.87%, 78.02% and 23.37%respectively. Conclusion: Alvarado scoring system is useful tool in diagnosis of appendicitisin pre-operative period which can be useful for surgeons at any level of health care. Accordingto our study observations Alvarado scoring system has better sensitivity 74.68% but specificity26.87% which shows that Alvarado scoring system is helpful in diagnosis of appendicitis but notmuch helpful in preventing negative laparotomies.

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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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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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A comparative study of RIPASA score and modified Alvarado score in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20195099 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3937

Author(s):

Waleed Yusif El Sherpiny

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Negative Appendectomy ◽

Alvarado Score ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Various diagnostic criteria have been described for diagnosing acute appendicitis. Of these, Alvarado score has been the most commonly used. The RIPASA score is a new diagnostic scoring system developed for the diagnosis of acute appendicitis and showed higher sensitivity, specificity and diagnostic accuracy as compared to Alvarado score. we want to compare prospectively Alvarado and RIPASA score by applying them to patients attending emergency department complaining of right iliac fossa pain that could probably be acute appendicitis.Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination of the removed appendix was taken as the gold standard for diagnosis of acute appendicitis.Results: Among (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 were 88.2%, 14.5%, 73.1%, 32%,and 68% 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 51.2%, 80 %, 91 %, 29%, and 57%, respectively. 87.5% of patients were correctly stratified by RIPASA under higher probability group while only 45% were classified by Alvarado as high probability.Conclusions: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, it can be applied for the diagnosis of acute appendicitis.

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Test of a Noninvasive Instrument for Measuring Hemoglobin Concentration

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300008527 ◽

1989 ◽

Vol 5 (4) ◽

pp. 659-667 ◽

Cited By ~ 14

Author(s):

Constanza I. Sanchez-Carrillo ◽

Teresita de Jesus Ramirez-Sanchez ◽

Marcela Zambrana-Castañeda- ◽

Beatrice J. Selwyn

Keyword(s):

Decision Making ◽

Negative Predictive Value ◽

Predictive Value ◽

False Negative ◽

Hemoglobin Concentration ◽

Reliability Test ◽

Intraobserver Variability ◽

Hemoglobin Content ◽

False Negatives ◽

Sensitivity Specificity

A colorimetric instrument for the noninvasive quantification of hemoglobin, designed using color shades resembling those observed in the conjunctiva, was tested. The instrument's colors are contrasted against the color of the conjunctiva to measure hemoglobin content. Sensitivity, specificity, negative predictive value, and false-negative value were estimated to test the instrument's accuracy; kappa coefficients were used to estimate inter- and intraobserver variability. Physician field evaluations of conjunctiva color for the screening of anemia, reported in the literature, have had sensitivities and specificities as high as 70%. Readings with the instrument demonstrated a 63% sensitivity, 72% specificity, and 38% false negatives for screening hemoglobin values of less than or equal to 13 g/dl. The interobserver kappa coefficients for three pairs of readers were good to excellent for the same hemoglobin screening value. Statistically significant differences were noted, however, between observers during the reliability test. The instrument can be used by unskilled personnel to improve their decision-making about whom to send for futher care or for supplementation with iron.

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Screening of Extended-Spectrum β-Lactamases (ESBL)-producing Klebsiella pneumoniae with ChromID ESBL Media

The Indonesian Biomedical Journal ◽

10.18585/inabj.v10i3.430 ◽

2018 ◽

Vol 10 (3) ◽

pp. 217-21

Author(s):

Emy Noerwidayati ◽

Andaru Dahesihdewi ◽

Osman Sianipar

Keyword(s):

Likelihood Ratio ◽

Predictive Value ◽

Clinical Laboratory ◽

False Negative ◽

Clinical Isolates ◽

True Negative ◽

Nasal Sinus ◽

Negative Results ◽

Extended Spectrum ◽

Sensitivity Specificity

BACKGROUND: Klepsiella pneumoniae, one of clinical isolates, is frequently found causative agent of hospital acquired infection. Currently, K. pneumoniae is found as extended-Spectrum β-lactamases (ESBL) producer, allowing it to become multidrugresistant. A clinical laboratory with limited facility needs a valid, reliable, inexpensive and simple laboratory test to control its infection and antimicrobial-resistancy. The aim of this study is to evaluate the diagnostic performance of a ESBL media to detect ESBL-producing K. pneumoniae.METHODS: An independent and blind comparative study of ChromID ESBL media and Double Disc Synergy Test (DDST) was conducted for detecting the clinical isolate of ESBL-producing K. pneumoniae. Clinical isolates of K. pneumoniae collected from the Clinical Laboratory of Dr. Sardjito Hospital were isolated.RESULTS: There were 103 clinical isolates of K. pneumoniae, which were isolated from urine, pus, blood, stool, cerebrospinal fluid, sputum, drain liquid, nasal sinus liquid, gastric wash, bronchi liquid, injury liquid and nasal swab. The number of true positive, true negative, false positive and false negative results were 74, 18, 9 and 2, respectively. Meanwhile, the sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive result and likelihood ratio for negative result of the new ESBL media were 97.4%, 66.7%, 89.2%, 90%, 2.9 and 0.03, respectively.CONCLUSION: Since the new ESBL media and DDST results were similar, so the new ESBL media could be used for screening patients with clinical presentation that indicating a high suspicious of ESBL-producing bacteria.KEYWORDS: K. pneumoniae, ChromID ESBL, DDST, ESBL, sensitivity

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The D-Dimer Test for Deep Venous Thrombosis: Gold Standards and Bias in Negative Predictive Value

Clinical Chemistry ◽

10.1373/49.4.570 ◽

2003 ◽

Vol 49 (4) ◽

pp. 570-574 ◽

Cited By ~ 21

Author(s):

John T Philbrick ◽

Steven Heim

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Negative Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

English Language ◽

False Negative ◽

True Negative ◽

Language Studies ◽

D Dimer

Abstract Background: Because venous ultrasound (US) fails to fully image the calf veins, there is the potential for US gold standard studies to classify patients with calf deep venous thrombosis (DVT) in the nondiseased category, causing bias in test index calculations. A false increase in negative predictive value (NPV) is especially likely because calf DVT false-negative tests will be counted in the numerator along with the true-negative tests in NPV calculations. We verified the presence and magnitude of this bias for the d-dimer test. Methods: We abstracted data on overall (calf and thigh) and thigh-only test sensitivity, specificity, and NPV from the six English language studies published between March 1995 and October 2001 that compared d-dimer to a gold standard (GS) capable of imaging both thigh and calf veins and that also stratified results by thigh and calf location. Thigh specificity and NPV were calculated classifying calf DVT patients as free of disease. Results: The six studies included 81–214 participants and provided 26 comparisons of 16 different d-dimer assays to the GS. Thigh sensitivity was higher than overall sensitivity in 22 of 26 comparisons (range, −0.3 to 8.6); thigh specificity was lower than overall specificity in all comparisons (range, −0.7 to −7.8); and thigh NPV was higher than overall NPV in 22 of 26 comparisons and unchanged in 4 comparisons (range, 0.0–9.2). NPV was >95% in 20 of the thigh results but >95% in only 8 of the overall results. Conclusions: Different GS can produce clinically significant differences in test indices. Care must be taken in interpreting DVT studies that evaluate d-dimer as a rule-out test and that use US as a GS, because missed calf DVT can falsely increase the NPV.

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Missed Abstracts

10.1055/s-0039-1685395 ◽

2016 ◽

Keyword(s):

Ct Scan ◽

Negative Predictive Value ◽

Predictive Value ◽

False Negative ◽

High Sensitivity ◽

Carcinoma Cervix ◽

Figo Staging ◽

Guided Biopsy ◽

Pre Treatment ◽

Sensitivity Specificity

Aim: To compare the findings of CT scan pelvis and cystoscopy findings of bladder involvement in carcinoma cervix in VIEW of revised FIGO staging and to demonstrate the accuracy of CT scan for pretreatment diagnosis of bladder involvement. Methods: A prospective and comparative study was conducted in the department of Obstetrics and Gynaecology, Rajindra hospital Patiala on a number of 100 patients of carcinoma cervix who underwent both cystoscopy and CT scan pelvis to ascertain bladder involvement. Cystoscopy guided biopsy proven cases of bladder involvement were taken as true cases of bladder involvement in the study and the results of both modalities were analysed and compared. Results: Out of 100 patients of carcinoma cervix, 28 patients showed bladder involvement on CT scan pelvis and 6 patients were proven as positive cases on cystoscopic guided bladder biopsy. The true positives in the study were 6 cases. True negatives were 94 cases. 22 patients were false positive on CT scan findings and there were no false negative patients for bladder involvement on CT scan pelvis findings in the study. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT scan pelvis for bladder involvement were 100%, 76.60%, 21.43%, 100% and 78% respectively. CT scan pelvis was able to detect all cases of bladder involvement which came positive cystoscopy guided biopsy as well. Conclusions: With the revised FIGO staging which has given optional status to both CT scan and cystoscopy for bladder involvement in patients of carcinoma cervix, CT scan can be used as the preliminary modality for detective bladder involvement in patients of carcinoma cervix. The high sensitivity and negative predictive value of CT scan helps choose which patients should undergo cystoscopy and helps in better and more efficient pre-treatment evaluation of patients with carcinoma cervix for bladder involvement.

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Clinico sonological and laboratory co-relation with histopathology of acute appendicitis to develop new diagnostic scoring system (Yash scoring system)

International Surgery Journal ◽

10.18203/2349-2902.isj20173211 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2556 ◽

Cited By ~ 3

Author(s):

Yashwant R. Lamture ◽

Harshal Ramteke ◽

R. K. Shinde ◽

Vinay V. Shahapurkar ◽

Varsha P. Gajbhiye

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Imaging Techniques ◽

Scoring Systems ◽

Negative Appendectomy ◽

Predictive Values ◽

Prospective Comparison

Background: Of the many scoring systems currently available, the modified Alvarado scoring system (MASS) is the most widely employed, because of its ability to reduce negative appendectomy rate (NAR). Unfortunately, this system is more accurate in western population. In spite of the advances in the diagnostic and imaging techniques NAR have not decreased much. This clearly indicates the need of development of new diagnostic scoring system so we have developed new diagnostic scoring system (Yash Score). The objective of this study was to develop and study diagnostic accuracy of new diagnostic scoring system (Yash scoring system) for acute appendicitis.Methods: A prospective comparison YSS and MASS was done on 418 patients. Depending on clinical judgement appendicectomy was done. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for YSS and MASS were calculated using SPSS 17.0 statistical software for statistical analysis and compared using Chi-square test.Results: The sensitivity and specificity of YSS was found to be 99.48 per cent and 92.86 percent respectively. The sensitivity and specify of MASS was 52.05 per cent and 100 per cent respectively. The positive predictive value and negative predictive value of YSS was 99.48 per cent and 92.86 per cent respectively. Negative and positive predictive values of MASS were 13.02% and 100% respectively.Conclusions: Comparison in between YSS and MASS in the present study shows significant statistical difference.

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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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Sensitivity and Specificity of Gene Xpert in the Diagnosis of Spinal Tuberculosis: A Prospective Controlled Clinical Study

Global Spine Journal ◽

10.1177/2192568219858310 ◽

2019 ◽

Vol 10 (5) ◽

pp. 553-558

Author(s):

Anil M. Solanki ◽

Saumyajit Basu ◽

Amitava Biswas ◽

Subhendu Roy ◽

Aditya Banta

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Spinal Tuberculosis ◽

False Negative ◽

High Sensitivity ◽

Control Group ◽

Surgical Biopsy ◽

True Negative

Study Design: Prospective matched cohort study Objective: To evaluate the sensitivity and specificity of Gene Xpert in the diagnosis of spinal tuberculosis. Methods: From January 2016 to August 2018, Gene Xpert results were prospectively studied in 68 patients of clinicoradiologically suspected spinal tuberculosis (STB) and a control group (CG) of 92 patients, all of whom underwent computed tomography–guided/C-arm-guided/open surgical biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value are obtained using standard equations. Results: Out of 68 cases of STB, Gene Xpert was positive in 62 (true positive: 62/68) and negative in 6 (false negative: 6/68). Gene Xpert was negative for all 92 cases of CG (true negative: 92/92, false positive 0/92). Thus, in our series, sensitivity of Gene Xpert is 91.18%, specificity is 100%, positive predictive value is 100%, and negative predictive value is 93.88%. Out of all cases of STB, 62/68 (91.18%) were Gene Xpert positive, but only 35/64 (54.69%) was acid-fast bacilli (AFB) culture positive and 53/60(88.33%) was histopathologically conclusive of TB. Also, Gene Xpert was positive in 7/7 (100%) cases of STB in which histopathology were inconclusive and 25/29 (86.21%) cases of STB in which AFB culture was negative. Conclusion: In STB, Gene Xpert clearly outperforms AFB culture and histopathology due to its high sensitivity and specificity apart from being rapid in diagnosis. Hence it is justified to diagnose spinal tuberculosis by Gene Xpert though histopathology is confirmative and AFB culture remains the gold standard.

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