Sensitivity and specificity of clinical features used in Alvarado scoring system

Introduction: Alvarado score is one of the scoring systems for diagnosis of appendicitis. Objective: To assess the sensitivity and specificity of clinical features used in Alvarado score. Subjects and methods: A prospective study of 171 patients with pain in the right iliac fossa presenting to emergency at BPKIHS, Dharan, Nepal was conducted. The sensitivity and specificity of clinical features and lab parameters used in Alvarado score were evaluated comparing with final diagnosis based on operative and histopathological findings. Results: The sensitivity of clinical parameter were: migrating right iliac fossa pain- 99.1%, anorexia- 45.7%, nausea/vomiting- 73.7%, right iliac fossa tenderness- 100%, fever- 24.5%, rebound tenderness in right iliac fossa- 89.8%, leucocytosis (>10,000)- 84.7% and a neutrophilic shift to the left (>75%)- 68.6%. The specificity of clinical parameters were: migrating right iliac fossa pain- 45.3%, anorexia- 86.7%, nausea/vomiting- 54.7%, right iliac fossa tenderness- 1.8%, fever- 81.1%, rebound tenderness in right iliac fossa- 64.1%, leucocytosis (>10,000)- 83.1% and a neutrophilic shift to the left (>75%)- 71.6%.Conclusion: Migrating right iliac fossa pain, right iliac fossa tenderness and rebound tenderness in right iliac fossa had a high sensitivity, leucocytosis (>10,000) had both high sensitivity and high specificity. Thus, in our set up, use of Alvarado score appears helpful for diagnosis of appendicitis Keywords: Alvarado score; sensitivity; specificityDOI: 10.3126/hren.v9i1.4355Health Renaissance, 2011: Vol.9 No.1:12-14

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A comparative study of RIPASA and Alvarado score for the diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20204930 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4006

Author(s):

Praveena Suresh ◽

Rajan Janardhanan ◽

Deepak Paul

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Prospective Observational Study ◽

Iliac Fossa ◽

Scoring Systems ◽

Alvarado Score ◽

Medical College ◽

Right Iliac Fossa Pain ◽

Sensitivity Specificity ◽

Ripasa Score

Background: Acute appendicitis is a common problem and can be difficult to diagnose at time. There are many scoring systems to predict the diagnosis of acute appendicitis. The most commonly used scoring system is Alvarado scoring system but, it is far from perfect. In this study we compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system to Alvarado scoring system in correctly diagnosing acute appendicitis.Methods: This prospective observational study was conducted in the department of general surgery, Sree Gokulam Medical College and Research Foundation. It comprised of 60 consecutive patients who were admitted with suspicion of appendicitis who had right iliac fossa pain. RIPASA and Alvarado scoring was done and compared to histopathology after surgery. Sensitivity, specificity and accuracy was calculated.Results: Majority of the patients were below 30 years of age majority were males 36 (60%). When Alvarado score predicted appendicitis in 31 (51.77%) and RIPASA in 54 (90%). When the RIPASA score was >7.5 the sensitivity was 100%, specificity 67% and accuracy was 95%.Conclusions: RIPASA scoring system is more accurate to diagnose acute appendicitis especially when RIPASA score is >7.5. literatures.

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Evaluation of accuracy of four clinical scores and comparison with ultrasonography for diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20172108 ◽

2017 ◽

Vol 4 (6) ◽

pp. 1940

Author(s):

Prabhakar Subramaniyan ◽

Sandhya Padmanabhan Iyer

Keyword(s):

Acute Appendicitis ◽

Negative Predictive Value ◽

Predictive Value ◽

Imaging Techniques ◽

Iliac Fossa ◽

High Sensitivity ◽

Scoring Systems ◽

Abdominal Ultrasound ◽

Alvarado Score ◽

Operative Findings

Background: The vagaries of presentation and the variability of signs in acute appendicitis are such that even the most experienced surgeons may remove normal appendices or conserve those with perforation. Diagnostic scoring systems and imaging techniques may reduce the number of unnecessary appendectomies.Methods: 75 patients who presented with acute right Iliac fossa pain were analyzed using four different scoring systems. An abdominal ultrasound was also performed when necessary. The results of these scores, USG findings were compared to the intra operative findings and final histopathological report.Results: The Alvarado score had the best positive predictive value with high sensitivity. The Fenyo score was most sensitive for males, whereas the Teicher score was most sensitive for females. The Teicher score was the most specific. The Ohmann score had the highest negative predictive value. Ultrasonography showed a low sensitivity and specificity.Conclusions: There was a 24% negative appendicectomy rate in our study. The Alvarado score is ideal for borderline cases where a quick decision needs to be taken. Ohmann’s score can be used to rule out appendicitis in the casualty setting as it has the best negative predictive value. Fenyo and Teicher’s score with their high sensitivity can be used to reduce the number of negative appendicectomies.

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MODIFIED ALVARADO SCORE IN CHILDREN WITH DIAGNOSIS OF APPENDICITIS

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201700010014 ◽

2017 ◽

Vol 30 (1) ◽

pp. 51-52 ◽

Cited By ~ 4

Author(s):

Mehran PEYVASTEH ◽

Shahnam ASKARPOUR ◽

Hazhir JAVAHERIZADEH ◽

Sepideh BESHARATI

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

High Sensitivity ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Rebound Tenderness ◽

Modified Alvarado Score ◽

Sensitivity Specificity

ABSTRACT Background: Appendicitis is one of the most common abdominal emergency. Some predictive scoring systems are recommended to decrease the rate of negative appendectomy. Aim: To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of modified Alvarado score in children who underwent appendectomy. Methods: Four hundred children with initial diagnosis of appendicitis were randomly selected from patients who underwent appendectomy. Modified Alvarado score was used for evaluation of the appendicitis, that was confirmed using histology. Results: Of modified Alvarado score components, anorexia; nausea and vomiting and rebound tenderness were significantly more common in children with positive appendectomy in contrast to patients with negative appendectomy. Sensitivity, specificity, positive predictive value, and negative predictive value for modified Alvarado score were: 91.3%; 38.4%; 87.7%; and 51.2% respectively. Conclusion: Alvarado score has high sensitivity but low specificity for diagnosis of acute appendicitis in children.

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A controlled study on the diagnostic accuracy of panoramic and peri-apical radiography for detecting furcation involvement

10.21203/rs.3.rs-41590/v2 ◽

2020 ◽

Author(s):

Gijsbrecht Jan Berghuis ◽

Jan Cosyn ◽

Hugo De Bruyn ◽

Geert Hommez ◽

Melissa Dierens ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Clinical Experience ◽

High Sensitivity ◽

High Specificity ◽

Weighted Kappa ◽

Time Frame ◽

Controlled Study ◽

Significant Difference ◽

Furcation Involvement

Abstract Background: The aim of this study was to determine diagnostic accuracy, sensitivity and specificity of panoramic and peri-apical radiography for detecting furcation involvement (1) and to evaluate the possible impact of clinical experience on these diagnostic parameters (2).Methods: Periodontitis patients in need of an implant were retrospectively selected. Inclusion criteria were the presence of a CBCT, panoramic and peri-apical radiograph of the site of interest within a one-year time frame. All furcation sites were classified on the basis of CBCT using Hamp’s index (1975). These data were considered gold standard. Ten experienced examiners and 10 trainees were asked to assess furcation involvement for the same defects on the basis of corresponding panoramic and peri-apical radiographs. Absolute agreement, Cohen’s weighted kappa, sensitivity and specificity were calculated. In addition, ROC-curves were constructed.Results: The study sample included 60 furcation sites in 29 multi-rooted teeth from 17 patients (10 females; mean age 62). On average 20/60 furcations were correctly classified on the basis of panoramic radiography, corresponding to weighted kappa of 0.209 indicative of slight agreement. Respective data for peri-apical radiography were 19/60 and 0.221. When recategorizing FI Grades into ‘no to limited FI’ (FI Grade 0 and I) and ‘advanced FI’ (FI Grade II and III), panoramic and peri-apical radiography showed low sensitivity (0.558 and 0.441, respectively), yet high specificity (0.791 and 0.790, respectively) for identifying advanced FI. Both showed diagnostic value given the area under the ROC-curve amounting to 0.79 and 0.69 for panoramic and peri-apical radiography, respectively. There was no significant difference between experienced periodontists and trainees (P = 0.257 versus P = 0.880).Conclusion: Panoramic and peri-apical radiography are relevant in the diagnosis of FI given high specificity. These are best combined with furcation probing showing high sensitivity. Clinical experience does not seem to improve the accuracy of a radiological diagnosis of furcation sites.Trial Registration: Patients were retrospectively registered.

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Role of endoscopy in suspicion of atrophic gastritis with and without intestinal metaplasia in comparison to histopathology

Acta Gastro Enterologica Belgica ◽

10.51821/84.1.208 ◽

2021 ◽

Vol 84 (1) ◽

pp. 9-17

Author(s):

H Ibrahim ◽

A Shams El-Deen ◽

ZA Kasemy ◽

M Saad ◽

AA Sakr

Keyword(s):

Atrophic Gastritis ◽

Intestinal Metaplasia ◽

Sensitivity And Specificity ◽

Chronic Gastritis ◽

Gastrointestinal Symptoms ◽

High Sensitivity ◽

High Specificity ◽

Poor Correlation ◽

Gastric Lesions ◽

Low Sensitivity

Background and study aims : Atrophic gastritis (AG) and intestinal metaplasia (IM) are established premalignant gastric lesions. Many studies documented a poor correlation between esophagogastroduodenoscopy (EGD) and histopathological (HP) findings of precancerous gastric lesions. The aim was to bridge the gap between endoscopy and HP in detection of chronic gastritis, AG and IM. Patients and methods : a prospective single-center study involved 150 patients with endoscopic criteria of gastric lesions with upper gastrointestinal symptoms referred for upper GI endoscopy met the endoscopic criteria and classified according to HP of biopsies from targeted gastric lesions into chronic gastritis (GI), AG(GII) or IM(GIII). We correlated the endoscopic criteria of the 3 groups with the HP results. Results : (73males & 75 females) with ages ranged17-75 years and mean± SD was 41.96 ± 15.95. GI, GII &GIII were [42 patients (28%),82 patients (54.7%) and 26 patients (17.3%)], respectively. Diffuse gastric mottling was more common in GI (74.3%, P<0.001), visible submucosal vessels, gastric atrophy predominated in GII (75.6, 82.3 & 73.1% (P 0.005,0.4 & <0.01)), respectively. Whitish raised lesions were more specific in GIII (85.7%) (P<0.001). The sensitivity and specificity of endoscopic suspicion of chronic gastritis were (86&88% in GI), (87&85% in GII) and (54% &100% in GIII) (p-0.001). The logistic regression model for risk factors was χ2= 25.74 and 49.32, p < 0.001. Conclusion : Conventional endoscopy has high sensitivity and specificity for suspicion of chronic gastritis and AG, but low sensitivity and very high specificity for IM. Targeted biopsies may be valuable with image enhanced techniques.

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Sensitivity and specificity of loss of heterozygosity analysis for the classification of rare germline variants in BRCA1/2: results of the observational AGO-TR1 study (NCT02222883)

Journal of Medical Genetics ◽

10.1136/jmedgenet-2020-107353 ◽

2020 ◽

pp. jmedgenet-2020-107353

Author(s):

Jan Hauke ◽

Philipp Harter ◽

Corinna Ernst ◽

Alexander Burges ◽

Sandra Schmidt ◽

...

Keyword(s):

Loss Of Heterozygosity ◽

Sensitivity And Specificity ◽

False Negative ◽

High Sensitivity ◽

High Specificity ◽

Germline Variants ◽

Variants Of Unknown Significance ◽

Link Type ◽

Registration Number ◽

Low Sensitivity

Variant-specific loss of heterozygosity (LOH) analyses may be useful to classify BRCA1/2 germline variants of unknown significance (VUS). The sensitivity and specificity of this approach, however, remains unknown. We performed comparative next-generation sequencing analyses of the BRCA1/2 genes using blood-derived and tumour-derived DNA of 488 patients with ovarian cancer enrolled in the observational AGO-TR1 trial (NCT02222883). Overall, 94 pathogenic, 90 benign and 24 VUS were identified in the germline. A significantly increased variant fraction (VF) of a germline variant in the tumour indicates loss of the wild-type allele; a decreased VF indicates loss of the variant allele. We demonstrate that significantly increased VFs predict pathogenicity with high sensitivity (0.84, 95% CI 0.77 to 0.91), poor specificity (0.63, 95% CI 0.53 to 0.73) and poor positive predictive value (PPV; 0.71, 95% CI 0.62 to 0.79). Significantly decreased VFs predict benignity with low sensitivity (0.26, 95% CI 0.17 to 0.35), high specificity (1.0, 95% CI 0.96 to 1.00) and PPV (1.0, 95% CI 0.85 to 1.00). Variant classification based on significantly increased VFs results in an unacceptable proportion of false-positive results. A significantly decreased VF in the tumour may be exploited as a reliable predictor for benignity, with no false-negative result observed. When applying the latter approach, VUS identified in four patients can now be considered benign. Trial registration numberNCT02222883.

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ACUTE APPENDICITIS

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.03.1465 ◽

2016 ◽

Vol 23 (03) ◽

pp. 241-245

Author(s):

Javeria Farid ◽

Rizwanullah Junaid Bhambhro ◽

Sohail Soomro

Keyword(s):

Abdominal Pain ◽

Postoperative Complications ◽

Acute Appendicitis ◽

Epigastric Pain ◽

Iliac Fossa ◽

University Hospital ◽

Cross Sectional ◽

Clinical Pattern ◽

Rebound Tenderness ◽

Right Iliac Fossa Pain

Objectives: To determine the clinical presenting pattern and postoperativecomplications of acute appendicitis. Study design: Observational and cross-sectional study.Setting: Isra university hospital Hyderabad. Period: 7 months. Methodology: All the patientsabove 12 years of age and both genders male/female after diagnosis of acute appendicitishad integrated in the study. Complete clinical pattern and postoperative complications hadrecorded. Results: Symptoms/sign nausea, vomiting, anorexia, rebound tenderness, fever,constipation, diarrhea and leukocytosis were noted with the percentage 98.0%, 65.0%, 95.0%,90.0%, 85.0%, 58.0%, 30.0% and 89.0% respectively. Paraumblical pain was noted in 50.0%of the cases, right iliac fossa pain was in the 99.0%, epigastric pain was seen in 61.0% and theother abdominal pain was noted in the 39.0%. Postoperative complications found in 33.0% ofthe cases and majority was seen wound infection. Conclusion: In the conclusion of this studyclinical features nausea, vomiting, anorexia, rebound tenderness, fever, and leukocytosis wereseen as most common and the most important postoperative complication is infection whichprobably created with the uncompleted sterilization.

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Performance and Implementation Evaluation of the Abbott BinaxNOW Rapid Antigen Test in a High-throughput Drive-through Community Testing Site in Massachusetts

10.1101/2021.01.09.21249499 ◽

2021 ◽

Author(s):

Nira R. Pollock ◽

Jesica R. Jacobs ◽

Kristine Tran ◽

Amber Cranston ◽

Sita Smith ◽

...

Keyword(s):

Sensitivity And Specificity ◽

High Throughput ◽

Point Of Care ◽

High Sensitivity ◽

High Specificity ◽

Molecular Testing ◽

Rt Pcr ◽

Asymptomatic Children ◽

Testing Site ◽

Very High

AbstractBackgroundRapid diagnostic tests (RDTs) for SARS-CoV-2 antigens (Ag) that can be performed at point-of-care (POC) can supplement molecular testing and help mitigate the COVID-19 pandemic. Deployment of an Ag RDT requires an understanding of its operational and performance characteristics under real-world conditions and in relevant subpopulations. We evaluated the Abbott BinaxNOW™ COVID-19 Ag Card in a high-throughput, drive-through, free community testing site in Massachusetts (MA) using anterior nasal (AN) swab RT-PCR for clinical testing.MethodsIndividuals presenting for molecular testing in two of seven lanes were offered the opportunity to also receive BinaxNOW testing. Dual AN swabs were collected from symptomatic and asymptomatic children (≤ 18 years) and adults. BinaxNOW testing was performed in a testing pod with temperature/humidity monitoring. One individual performed testing and official result reporting for each test, but most tests had a second independent reading to assess inter-operator agreement. Positive BinaxNOW results were scored as faint, medium, or strong. Positive BinaxNOW results were reported to patients by phone and they were instructed to isolate pending RT-PCR results. The paired RT-PCR result was the reference for sensitivity and specificity calculations.ResultsOf 2482 participants, 1380 adults and 928 children had paired RT-PCR/BinaxNOW results and complete symptom data. 974/1380 (71%) adults and 829/928 (89%) children were asymptomatic. BinaxNOW had 96.5% (95% confidence interval [CI] 90.0-99.3) sensitivity and 100% (98.6-100.0) specificity in adults within 7 days of symptoms, and 84.6% (65.1-95.6) sensitivity and 100% (94.5-100.0) specificity in children within 7 days of symptoms. Sensitivity and specificity in asymptomatic adults were 70.2% (56.6-81.6) and 99.6% (98.9-99.9), respectively, and in asymptomatic children were 65.4% (55.6-74.4) and 99.0% (98.0-99.6), respectively. By cycle threshold (Ct) value cutoff, sensitivity in all subgroups combined (n=292 RT-PCR-positive individuals) was 99.3% with Ct ≤25, 95.8% with ≤30, and 81.2% with ≤35. Twelve false positive BinaxNOW results (out of 2308 tests) were observed; in all twelve, the test bands were faint but otherwise normal, and were noted by both readers. One invalid BinaxNOW result was identified. Inter-operator agreement (positive versus negative BinaxNOW result) was 100% (n = 2230/2230 double reads). Each operator was able to process 20 RDTs per hour. In a separate set of 30 specimens (from individuals with symptoms ≤7 days) run at temperatures below the manufacturer’s recommended range (46-58.5°F), sensitivity was 66.7% and specificity 95.2%.ConclusionsBinaxNOW had very high specificity in both adults and children and very high sensitivity in newly symptomatic adults. Overall, 95.8% sensitivity was observed with Ct ≤ 30. These data support public health recommendations for use of the BinaxNOW test in adults with symptoms for ≤7 days without RT-PCR confirmation. Excellent inter-operator agreement indicates that an individual can perform and read the BinaxNOW test alone. A skilled laboratorian can perform and read 20 tests per hour. Careful attention to temperature is critical.

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Evaluation of RNA extraction free method for detection of SARS-COV-2 in salivary samples for mass screening for COVID-19

10.1101/2021.03.15.21253570 ◽

2021 ◽

Author(s):

Sally A. Mahmoud ◽

Esra Ibrahim ◽

Subhashini Ganesan ◽

Bhagyashree Thakre ◽

Juliet G Teddy ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Gold Standard ◽

Rna Extraction ◽

High Sensitivity ◽

High Specificity ◽

Cost Effective ◽

Kappa Coefficient ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Good Percentage

AbstractIn this current COVID - 19 pandemic, there is a dire need for cost effective and less time-consuming alternatives for SARS-COV-2 testing. The RNA extraction free method for detecting SARS-COV-2 in saliva is a promising option, this study found that it has high sensitivity (85.34%), specificity (95.04%) and was comparable to the gold standard nasopharyngeal swab. The method showed good percentage of agreement (kappa coefficient) 0.797 between salivary and NPS samples. However, there are variations in the sensitivity and specificity based on the RT-PCR kit used. The Thermo Fischer-Applied biosystems showed high sensitivity, PPV and NPV but also showed higher percentage of invalid reports. Whereas the BGI kit showed high specificity, better agreement (kappa coefficient) between the results of saliva and NPS samples and higher correlation between the Ct values of saliva and NPS samples. Thus, the RNA extraction free method for salivary sample serves as an effective alternative for SARS-CoV 2-testing.

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Comparison of the appendicitis inflammatory response and Alvarado scoring systems in the diagnosis of acute appendicitis in children

Journal of Medicine and Life ◽

10.25122/jml-2020-0031 ◽

2021 ◽

Vol 14 (1) ◽

pp. 75-80

Author(s):

Mohammad Vaziri ◽

◽

Nahid Nafissi ◽

Fariba Jahangiri ◽

...

Keyword(s):

Inflammatory Response ◽

Acute Appendicitis ◽

Sensitivity And Specificity ◽

Scoring System ◽

Scoring Systems ◽

Final Diagnosis ◽

Multicentric Study ◽

Generalized Peritonitis ◽

History Of ◽

Rule Out

Our objective was to compare the diagnostic accuracy of Alvarado and appendicitis inflammatory response (AIR) scoring systems among children suspected of acute appendicitis concerning their postoperative outcomes. During a two-year period, a prospective multicentric study was carried in the selected hospitals of Iran. All children who were admitted with the diagnosis of acute appendicitis were enrolled in the study. However, patients suffering from generalized peritonitis or those who had a history of abdominal surgery were excluded. Before decision-making, each patient’s score according to two appendicitis scoring systems was calculated. The clinical outcomes and diagnosis of patients were then compared to the results of each scoring system. For those patients who were a candidate for surgery, the final diagnosis of acute appendicitis was made by histopathology. Patients were divided into a high- and low-risk group according to scoring systems outcomes. Among the patients with a low score for appendicitis, the AIR scoring system had a sensitivity and specificity of 95% and 74%, respectively, which was more promising in comparison to that of the Alvarado system (90% and 70%, respectively). Regarding the patients at higher risk of acute appendicitis, none of the scoring systems provided reliable results since both systems showed sensitivity and specificity of less than 50%, which was not sufficient to distinguish patients who are a candidate for surgery. AIR and Alvarado scoring systems are not accurate models to predict the risk of acute appendicitis among children; however, the AIR system could be used as a reliable material to rule out the acute appendicitis diagnosis.

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