Clinical and histopathological analysis of the patients undergoing appendectomy

Background: Acute appendicitis is one of the most common surgical emergencies, but the diagnosis is difficult even with the sophisticated diagnostic tools. The aim of this study is to analyze the clinical and histopathological features of acute appendicitis and to see how reliable the clinical scoring system modified Alvarado score in our setup.Materials and Methods: This was a retrospective observational study of patients who underwent appendectomy at KIST Medical College and Teaching Hospital during two years. The clinical characteristics of the patients in terms of modified Alvarado scoring were outlined. The diagnosis of acute appendicitis was confirmed by histopathological examination. The data were tabulated in MS-Excel and statistically analyzed using SPSS statistics software, version 21.Results: Among 118 patients, who underwent appendectomy, 69 were male and 49 were female with male to female ratio of 1.41:1 and mean age of 27.46±12.724 years.The clinical diagnosis of acute appendicitis was more likely (MAS 7-9) in 56 patients, less likely (4–6) in 44 patients and unlikely (MAS 1-3) in 18 patients. The highest incidence of acute appendicitis was observed in 19-40 years and the lowest incidence in 61 years or above. After histopathological examination, 52 patients out of 56 in the more likely group had acute appendicitis and 4 patients had non-inflamed appendices. 7 patients out of 62 in the less likely and unlikely groups had acute appendicitis and 55 patients had non-inflamed appendices. The overall negative appendectomy rate was 9.32 percent.Conclusion: Our clinical practice of using modified Alvarado score in the diagnosis of acute appendicitis is effective, easy and non-invasive.

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A Comparative Study of RIPASA Score and Modified Alvarado Score in Acute Appendicitis in Nepalese Population

Nepalese Medical Journal ◽

10.3126/nmj.v2i2.25369 ◽

2019 ◽

Vol 2 (2) ◽

pp. 224-228

Author(s):

Niroj Banepali ◽

Kamal Koirala ◽

Rupesh Mukhiya ◽

Rakesh Roshan Sthapit

Keyword(s):

Acute Appendicitis ◽

College Teaching ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Medical College ◽

Lower Specificity ◽

Negative Appendectomy Rate ◽

Modified Alvarado Score ◽

Ripasa Score

Introduction: Although acute appendicitis is a common surgical condition, its diagnosis can be elusive at times with misdiagnosis leading to serious complications. Various scoring systems have been developed to overcome this dilemma and the reported accuracies of these scores vary greatly.Materials and Methods: A retrospective review of charts was carried out to identify all patients admitted to KIST medical college teaching hospital from May 2015 to April 2016 with the diagnosis of acute appendicitis. A total of 120 cases that underwent surgery for suspected acute appendicitis were included. Modified Alvarado score and RIPASA scores were computed for each patient and the suggested cutoff values were used to find out the accuracy of these scores. Histopathological confirmation/report was considered as the standard for comparison.Results: A negative appendectomy rate of 11.67 % was observed (9.64 % for males and 16.22 % for females). Complicated appendicitis was found in 27.36% of patients. Modified Alvarado score had a sensitivity of 61.32 % and specificity of 71.43 % at a cut of value of 7. At cut off of > 7.5 for acute appendicitis, RIPASA score had a sensitivity of 97.17% and specificity of 57.14%. The accuracy of Modified Alvarado score was 62.5% while it was 92.5% for RIPASA score.Conclusions: RIPASA score demonstrated higher sensitivity and accuracy but lower specificity compared to the modified Alvarado score in our study group. More studies with larger sample size need to be carried out for further validation of this new score.

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Comparative study between clinical diagnosis using modified Alvarado score and ultrasound imaging in decreasing negative appendectomy rate

International Surgery Journal ◽

10.18203/2349-2902.isj20211295 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1185

Author(s):

Sayali S. Samudre ◽

Anil S. Munde

Keyword(s):

Acute Appendicitis ◽

Comparative Study ◽

Ultrasound Imaging ◽

Health Resources ◽

Negative Appendectomy ◽

Alvarado Score ◽

Negative Appendicectomy ◽

Modified Alvarado Score ◽

Operative Findings ◽

Fitting In

Background: Acute appendicitis is the acute inflammation of appendix which is the most common cause of acute surgical emergencies. Appendicitis can mimic other pathologies. Removing normal appendix is an economical burden both on patients and health resources. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis.Methods: This was prospective comparative study carried out in 200 patients over the period of 2 years. Patients with clinical features of acute appendicitis and fitting in inclusion and exclusion criteria were selected. Detailed history was noted and clinical examination was done. Necessary investigations were done, modified Alvarado score was calculated and all were subjected to ultrasonography of abdomen and pelvis. Intra operative findings were noted about nature of appendix and histopathology findings were noted.Results: The sensitivity of ultrasound is 78.19% and specificity is 50%. The sensitivity of modified Alvarado scoring system is 78.7% and specificity is 25%. Negative appendicectomy rate in the study was 6%.Conclusions: Modified Alvarado score has slightly higher sensitivity and ultrasound imaging has higher specificity of in the diagnosis of acute appendicitis and in decreasing negative appendicectomy rates. Ultrasound imaging provides good supportive diagnosis in cases of low or equivocal modified Alvarado scores.

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A study on the clinical and sonological correlation in the diagnosis and management of acute appendicitis in a tertiary care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20192365 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2053

Author(s):

Keerthi Mudavath ◽

Thinagaran K.

Keyword(s):

Acute Appendicitis ◽

Scoring System ◽

Histopathological Examination ◽

Iliac Fossa ◽

Tertiary Care ◽

Negative Appendectomy ◽

Common Symptom ◽

Emergency Setting ◽

Alvarado Score ◽

Histopathological Findings

Background: Acute appendicitis is the most common acute surgical condition of the abdomen requiring early intervention. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. Alvarado score for diagnosis of acute appendicitis is easy and additional tools like sonography results in accurate diagnosis. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological findings and histopathological examination for the diagnosis of acute appendicitis.Methods: 100 cases of acute abdomen admitted in PES institute of medical sciences and research, Kuppam from December 2016 to June 2018 were included. Clinical examination was done and all patients were subjected to ultrasound abdomen examination and other relevant blood and imaging investigations.Results: Out of 100 patients 62 were males and 38 were Females. Most common symptom was pain in the right iliac fossa and patients with Alvarado Score 7 or > 7 subjected to USG followed by emergency appendectomy showed positive operative findings and histopathological findings. The overall specificity of abdominal USG in the diagnosis of acute appendicitis was 88.09% and sensitivity was 95.37%.Conclusions:The Alvarado scoring system combined with ultrasound can therefore be used as a cheap and less expensive useful, reliable and non invasive way of confirming acute appendicitis thus helps in reducing negative appendectomy rate. The overall accuracy of diagnosis of acute appendicitis goes up to 90% with positive histopathological findings.

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Alvarado Score: still relevant in diagnosis of acute appendicitis: a prospective study with histopathological correlation

International Surgery Journal ◽

10.18203/2349-2902.isj20172600 ◽

2017 ◽

Vol 4 (7) ◽

pp. 2123

Author(s):

Rushil Jain ◽

Vimal Jain ◽

Shalit Jolly

Keyword(s):

Acute Appendicitis ◽

Histopathological Examination ◽

Imaging Techniques ◽

Clinical History ◽

Negative Appendectomy ◽

Emergency Setting ◽

Likelihood Ratios ◽

Alvarado Score ◽

Predictive Values ◽

Negative Appendectomy Rate

Background: Acute appendicitis is the most common abdominal emergency. Although abdominal surgeons have been encountering the acute appendicitis for more than 100 years, prompt diagnosis is still elusive in order to reduce morbidity and to avoid serious complications. Present study was conducted to evaluate the usefulness of Alvarado score in diagnosing acute appendicitis and its role in minimizing the negative appendectomy rate and correlating the same with histopathological findings of appendectomy specimens.Methods: This prospective correlational study was conducted in the Department of General Surgery, Mata Chanan Devi Hospital, New Delhi for a period of one year from January 2014 to December2014.Complete clinical history of the patients was collected in a predesigned proforma. A complete physical and systemic examination was done for all patients. Based on the Alvarado scoring system the patients were divided into three categories. Category 1 (score ranging from 1-4), Category 2 (score ranging from 5-6), Category 3 (score ranging from 7-10). Specimen of removed appendix was sent for histopathological examination and clinically correlated those findings with Alvarado score. Sensitivity, specificity, positive negative likelihood ratios, positive and negative predictive values and negative appendectomy rate were calculated.Results: Out of 100 cases (56 males and 44 females) 15 belonged to category-I, 30 belonged to category-II and 55 belonged to category-III. Surgical procedures were done in 67 patients along with conservative management. Final diagnosis by histopathology was found in 58 cases. The sensitivity and specificity of Alvarado score was found to be 89.66% and 92.86% respectively. PPV and NPV of Alvarado score is 94.55% and 86.67% respectively. The negative appendectomy rate was 13.4%.Conclusions: Alvarado score is a simple non-invasive diagnostic procedure, which is reliable, safe, repeatable and economical, easy and can be used in emergency setting, without expensive and complicated supportive diagnostic tool in diagnosing acute appendicitis and thus still very much relevant in today’s modern era with availability of gamut of expensive imaging techniques.

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Acute Appendicitis in Children: Comparison of clinical diagnosis versus modified Alvarado score system

Annals of King Edward Medical University ◽

10.21649/akemu.v10i1.1152 ◽

2016 ◽

Vol 10 (1) ◽

Author(s):

Mukhtar Hussain ◽

Muhammad Kashif ◽

Shafiq Ahmad ◽

Haroon Khurshid Pasha

Keyword(s):

Acute Appendicitis ◽

Clinical Diagnosis ◽

False Positive ◽

Negative Appendectomy ◽

Alvarado Score ◽

Score System ◽

Pain Abdomen ◽

Group I ◽

Negative Appendectomy Rate ◽

Modified Alvarado Score

Objective: To compare the accuracy of clinical diagnosis of Acute Appendicitis with that of Alvarado Score System in Children. Design: A Prospective and Comparative Study. Patients and Duration of Study: Department of Pediatric Surgery, Nishtar Medical College & Hospital, Multan from January 200I to June 2002. All patients of pain abdomen with suspicion of acute appendicitis were included in study. Subjects and methods: 92 patients were admitted with pain abdomen, After preliminary history and examination sixty were suspected of acute appendicitis. A Detailed history, clinical examination and relevant investigations were done. These patients were divided in two equal groups of 30 each. In group-I all the findings were entered on Performa based on the indicants of modified Alvarado Score. Later on their Score was calculated according to the assigned weight-age of each indicant. Twenty-eight patients were submitted for Surgery having Alvarado Score of >7. In group-II patients were clinically evaluated by one of the consultant to declare the diagnosis of Acute Appendicitis or otherwise. Twenty-nine out of 30 were submitted for surgery in this group. Three cases turned out to be of mesenteric lymphadenitis confirmed on Ultrasonography. The diagnosis of Acute Appendicitis was further confirmed by Histopathology of appendix after removal. Hence the accuracy of both methods was compared. Results: The diagnostic accuracy of Alvarado Score was 85.71% with false positive or negative appendectomy rate of 14.29% while the accuracy of clinical diagnosis was 93.01% with false positive or negative appendectomy rate of 6.99%.

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Usefulness of Modified Alvarado Score in Diagnosis of Acute Appendicitis in Adults

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v14i4.16257 ◽

2015 ◽

Vol 14 (4) ◽

pp. 336-338

Author(s):

Hari Pada Mondal ◽

Md. Hadiuzzaman ◽

Chandranath Mukhopadhyay ◽

Shibram Chattopadhyay ◽

Sajal Kumar Biswas ◽

...

Keyword(s):

Acute Appendicitis ◽

Positive Predictive Value ◽

Predictive Value ◽

Scoring System ◽

Medical Science ◽

Clinical Signs ◽

Negative Appendectomy ◽

Alvarado Score ◽

Negative Appendectomy Rate ◽

Modified Alvarado Score

Background: Definitive diagnosis of acute appendicitis preoperatively is sometimes difficult. Failure to make a diagnosis is the main reason for persistent rate of morbidity and mortality. Various scoring systems are devised to aid diagnosis of acute appendicitis. In some studies the modified Alvarado score was helpful, reliable and practical in minimizing unnecessary appendectomy. Objective: The purpose of this study was to evaluate the usefulness of modified Alvarado score for the diagnosis of acute appendicitis. Materials and Method: A prospective study of 89 adult patients, admitted with abdominal pain suggestive of acute appendicitis, from July 2011 to June 2012, was conducted. Data including clinical signs and symptoms and laboratory findings were recorded in modified Alvarado score record form. All 89 patients underwent appendectomy. Final diagnosis was confirmed by histopathological examination. Reliability of scoring system was assessed by negative appendectomy rate and positive predictive value. Results: Out of 89 patients who underwent appendectomy, 85 had acute appendicitis on histopathology. Positive predictive value was 95.5% and negative appendectomy rate was 4.5%. 52.8% had score 7 or above and 47.2% had score less than 7. From score it is difficult to predict which patient warranted appendectomy and who may be safely observed or discharged. Conclusions: Diagnosis of acute appendicitis remains mainly clinical evaluation and it is more helpful than modified Alvarado scoring system in adults.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.336-338

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MODIFIED ALVARADO SCORE

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.04.2956 ◽

2010 ◽

Vol 17 (04) ◽

pp. 546-550

Author(s):

SYED WARIS ALI SHAH ◽

CHAUDHRY AHMED KHAN ◽

SIKANDER ALI MALIK ◽

AHMED WAQAS ◽

AJMEL MUNIR TARRAR ◽

...

Keyword(s):

Acute Appendicitis ◽

Histopathological Examination ◽

Military Hospital ◽

P Value ◽

Alvarado Score ◽

Group I ◽

Significant Difference ◽

Group Ii ◽

Negative Appendicectomy ◽

Modified Alvarado Score

objective: To compare the frequency of inflamed appendix in suspected patients of acute appendicitis having Modified Alvarado Score (MAS) of 7 or more with patients having MAS of 6 or below. Design: Comparative cross sectional study. Place and duration of study: The study was carried out at Surgical Departments of Combined Military Hospital (CMH) and Military Hospital (MH) Rawalpindi from April 2006 to April 2007. Material and Methods: This study involved 100 patients who were operated with provisional diagnosis of acute appendicitis. Preoperatively MAS of each patient was calculated and the patients were divided in two groups. Group-I had MAS of 7 or more while Group-II had MAS of 6 or below. Postoperatively appendices of all the patients were sent for histopathological examination and its result regarding presence or absence of acute appendicitis was then compared with MAS of respective group. Results: (a) Group-I:- A total of 72 patients with 64(88.9%) positive inflamed appendices on histology. Negative appendicectomy rate 8(11.1%), (b) Group-II:- A total of 28 patients with 8(28.6) positive inflamed appendices. Negative appendicectomy rate 20(71.4%). There is statistical significant difference of positive appendicectomy rate between two groups with (p-value<0.001). Conclusion: Frequency of inflamed appendix is more in patients having MAS of seven orabove. The number of negative appendicectomies can be reduced by using MAS in clinical practice.

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Diagnosis and management of acute appendicitis by Alvarado scoring with ultrasonography as supportive tool

International Surgery Journal ◽

10.18203/2349-2902.isj20173423 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2806 ◽

Cited By ~ 1

Author(s):

Chenna Krishna Reddy Chada ◽

Srikrishna Malepati ◽

Jithendra Kandati ◽

Sreeram Satish

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Open Appendectomy ◽

Scoring Systems ◽

Negative Appendectomy ◽

Alvarado Score ◽

Predictive Values ◽

Female Ratio ◽

Male Predominance ◽

Sensitivity Specificity

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Delay in management results in complications and misdiagnosis results in negative appendectomy. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. Alvarado score for diagnosis of acute appendicitis is an easy, affordable and diagnostic which has been evaluated early with variable reports. In cases with equivocal score, additional tools like sonography may provide a reliable result in accurate diagnosis of acute appendicitis. Objective of the study was to determine the diagnostic accuracy of Alvarado score and ultrasonography in diagnosis of acute appendicitis. To determine the sensitivity, specificity and predictive values of ultrasonography in cases operated with histopathological correlation.Methods: A prospective observational study was conducted at our hospital by department of general surgery for a period of six months. All suspected cases of appendicitis were scored by Alvarado score and cases with>5 were performed additional USG for further evaluation. All the cases of appendicitis that underwent surgery were further confirmed by histopathological correlation with USG and clinical Alvarado score.Results: A total of 200 cases were enrolled with male predominance (57.5%) and mean age of study group was 34.26±8.64 years and male to female ratio of 1.3:1.69% of cases presented with Alvarado score of 7 and above, while 21% of cases with 5-6. Migratory pain in RIF was the commonest symptom and tenderness RIF was the most common sign.160 cases (80%) were operated totally with 75% cases lap appendectomy and 25% cases by open appendectomy. USG was performed on 160 cases and 146 were positive and 14 were negative whereas histopathologically 142 cases were confirmed as Acute appendicitis. The sensitivity, specificity, PPV and NPV of USG is 97.18%, 55.56%, 94.52% and 71.43%. The accuracy of USG is 92.5.Conclusions: Acute appendicitis is first and foremost a clinical diagnosis with scoring systems and imaging being necessary adjuncts in equivocal cases. USG is an easily available tool in diagnosis of acute appendicitis. Application of USG as adjunct tool to Alvarado scoring improves the diagnostic accuracy.

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Assessment of the accuracy of using the combination of modified alvarado score and abdominal ultrasound in acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20173678 ◽

2017 ◽

Vol 4 (9) ◽

pp. 2997

Author(s):

Anita Samraj ◽

Dharun Kumar S.

Keyword(s):

Acute Appendicitis ◽

Histopathological Examination ◽

Iliac Fossa ◽

Diagnostic Delay ◽

Abdominal Ultrasound ◽

The Body ◽

Total Leucocyte Count ◽

Alvarado Score ◽

Combined Use ◽

Modified Alvarado Score

Background: Appendix is a worm shaped blind tube of varying length (2-25) cm opening into the caecum 2cm below the ileocaecal valve in posteromedial valve. It is the only organ in the body that has no constant position. Incidence of acute appendicitis parallels that of lymphoid development with peak incidence in early adulthood. It is rare before the age of two. Before puberty the incidence of acute appendicitis is equal in both sexes. But after puberty there is a slight male preponderance. The objective of this study was to evaluate assessment of accuracy of the combined use of modified Alvarado scoring system and ultrasound in the diagnosis of acute appendicitis.Methods: Around 136 patient’s acute appendicitis were subjected to estimation of total leucocyte count and plain x-ray abdomen after thorough history evaluation and clinical examination before surgery. Alvarado score was found in all cases. All of them were operated on the day of admission itself and preoperative findings were noted. All appendicectomy specimens were subjected to histopathological examination (HPE).Results: Acute appendicitis is the most common surgical abdominal emergency in our hospital. Acute appendicitis is more common in males and the commonest age group affected is 21 - 30 years. Right iliac fossa pain is the most common presenting symptom followed by nausea/vomiting. In diagnosis of acute appendicitis Alvarado score has a high diagnostic value (82.5%).Conclusions: The combined use of modified Alvarado score with ultrasonogram done in patients with equivocal or low Alvarado score is useful in identifying the missed-out cases thereby preventing diagnostic delay and its attendant complications. Appendices that appear to be normal on macroscopic inspection may show features of acute appendicitis on histopathologic examination.

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Evaluation of combined use of modified Alvarado score and Ultrasound in predicting acute appendicitis: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20184628 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3594

Author(s):

Nirajan Kansakar ◽

P. N. Agarwal ◽

Rajdeep Singh ◽

Anurag Mishra ◽

Jyoti Kumar ◽

...

Keyword(s):

Acute Appendicitis ◽

Predictive Value ◽

Accurate Diagnosis ◽

Negative Appendectomy ◽

Chi Square ◽

Diagnostic Laboratory ◽

Alvarado Score ◽

Cross Sectional ◽

Exact Test ◽

Modified Alvarado Score

Background: Appendicitis is notorious in its ability to simulate other conditions and accurate diagnosis is imperative for preventing complications of appendicitis on one hand and avoiding negative appendectomy on other. Despite extraordinary advances in modern radiography imaging and diagnostic laboratory investigations, the accurate diagnosis of acute appendicitis remains an enigmatic challenge.Methods: We evaluated 32 patients with features suggestive of acute appendicitis between September 2013 to March 2015. It was a cross-sectional observational study that included modified Alvarado score (MAS) and ultrasound (USG) in predicting appendicitis and correlated both these individually as well as combined, with histopathological findings. Statistical analysis was done by Chi-square test with Yates correction, Fischer’s exact test and unpaired Students’ t test.Results: Ultrasound was found to be more sensitive (74.19%) and accurate (75.0%) as compared to MAS (41.94% and 43.75% respectively). The specificity and positive predictive value (PPV) were similar in both the parameters (100% each). Also, when both the MAS and Ultrasound were combined in predicting acute appendicitis, the sensitivity, negative predictive value and accuracy increased to 80.64%, 14.29% and 81.25% respectively with specificity and PPV being the same as when MAS and USG were considered individually.Conclusions: It is advised that both modified Alvarado score and ultrasound whenever available should be used to predict acute appendicitis to increase the number of positive cases and reduce negative appendectomy and hence reduce the morbidity and mortality.

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