scholarly journals Accuracy of Alvarado Scoring System and Selective Computed Tomography in Diagnosis of Suspected Cases of Acute Appendicitis

2020 ◽  
Vol 1 (2) ◽  
pp. 01-11
Author(s):  
Abbas AR Mohamed ◽  
Safaa A Mobarki ◽  
Ashwag H Al Qabasani ◽  
Nusiba A Al Shingiti ◽  
Alaa A El Sayed
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Scoring System ◽  
Oral Contrast ◽  
Middle Group ◽  
Group A ◽  
Group B

Objective: To evaluate the diagnostic accuracy of combined Alvarado scoring system and selective computed tomography (CT) in the diagnosis of suspected cases of acute appendicitis. Material and methods: This study was conducted during the period March 2018 to January 2020 at Prince Mohammed bin Abdul-Aziz hospital (NGHA) in Al Madinah, KSA. It is a prospective study involving 100 consecutive patients attending the emergency department with right iliac fossa pain, excluding children below the age of 14 years and pregnant women. All patients were initially assessed by the Alvarado scoring system, and the result of each patient was recorded in a separate predesigned data sheath. Based on the patient's calculated Alvarado scores, patients were stratified into three groups: Group A (score ≤ 4), Group B (score 5-6), and group C (score ≥ 7). All patients in group A were discharged from the emergency department with instruction to return if their symptoms persist or get worse while all patients in group B had an abdominal multidetector CT scan (MDCT) with IV contrast and no oral contrast to help the diagnosis. Group C patients had surgery without further investigation. Alvarado scores were compared to intraoperative findings and histopathological examination of the removed appendix in those who were operated. The sensitivity, specificity, positive and negative predictive values of the scoring system in each group were calculated with special reference to the role of CT scan in improving the diagnostic accuracy of the scoring system in the middle group (group B). Result: 58 patients were male and 42 were female. Age range between 14 and 43 years with median age 24 years. Out of the 100 patients, 14 (8 males, 6 females) belonged to Group A, 23 (11 males, 12 females) to Group B and 63 (39 males, 24 females) to group C. Two patients from group A (one male and one female) were returned with worsening symptoms and subsequently operated for acute appendicitis. CT scan established the diagnosis of acute appendicitis in 16 out of the patients of group B with subsequent histological confirmation of acute appendicitis in 15 of them. Histopathology confirmed the diagnosis of acute appendicitis in 32 out of 63 patients of group C. Conclusion: Alvarado score has a high accuracy of ruling in and out acute appendicitis at the extremes of the score (≤7 and ≥4), however, the accuracy of the score to confirm or rule out acute appendicitis in the middle group (5 -6) is significantly low. Selective utilization of CT scan in patients in the middle of the score improves the diagnostic accuracy of the score and limits overutilization of CT scan in the other patients at the extremes of the score saving patients unnecessary exposure to radiation and health authorities’ time and cost without increasing the rate of negative appendectomy.

scholarly journals Diagnostic accuracy of acute appendicitis by comparing clinical judgment of surgeons and Alvarado scoring in suspected acute appendicitis

2021 ◽  
Vol 8 (9) ◽  
pp. 2725
Author(s):  
Ishory Bhusal ◽  
Chandra Shekhar Agarwal ◽  
Rakesh Kumar Gupta ◽  
Suresh Prasad Sah
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Clinical Judgment ◽  
Scoring System ◽  
Randomized Study ◽  
Tertiary Hospital ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Group A ◽  
Group B

Background: The Alvarado score is a clinical scoring system used in the diagnosis of acute appendicitis. The aim of the study was to compare the clinical judgment of surgeons and Alvarado score in diagnosing acute appendicitis within Nepalese people and to refine the score and suggest a new score to make a more accurate diagnosis of acute appendicitis.Methods: In this prospective, parallel-group, quasi-randomized study of patients presenting at a tertiary hospital in eastern Nepal with suspected appendicitis during 1 year were assigned in weekly alternation to either group A or group B. The group A patients were treated on the basis of their Alvarado score, and the group B patients based on the clinical judgment. The correctness of the methods was assessed by the final histology.Results: In this study, the mean age of patients in Alvarado group was 26.45 years and in clinical judgment was 28.68 years. The sensitivity, the specificity, the diagnostic accuracy, the positive predictive value and negative appendectomies in Alvarado group were 95.5%, 68.9%, 90.91%, 93.4% and 6.56% respectively whereas in clinical judgment group were 98.51%, 85.71%,496.4%, 97.04% and 3.59% respectively.Conclusions: This study showed clinical judgment to be more reliable in the diagnosis of acute appendicitis than the Alvarado score, but the score is a useful diagnostic aid, especially for young colleagues. The use of the new scoring system has become easier. It includes fewer criteria as well as an important and sensitive predictor: the ultrasound investigation.

scholarly journals A computed tomography cadaveric study of the radiological anatomy of the patella: the size of the patella correlates with bone bridge between tunnels and R angles are introduced for safe tunnel drilling during MPFL reconstruction

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Vasileios Raoulis ◽  
Ioannis Tsifountoudis ◽  
Apostolos Fyllos ◽  
Michael Hantes ◽  
Michael-Alexander Malahias ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Statistical Significance ◽  
Mpfl Reconstruction ◽  
Fixation Technique ◽  
Radiological Anatomy ◽  
Anterior Cortex ◽  
Bone Bridge ◽  
Group A ◽  
Group B

Abstract Purpose To measure the safe range of angles during tunnel drilling and map ideal patella tunnel placement with the use of preoperative computed tomography (CT) scan and compare results after medial patellofemoral ligament (MPFL) reconstruction using a hardware-free patellar fixation technique with two semi-patellar tunnels between a) a free-hand technique, and b) its modification with the use of an anterior cruciate ligament (ACL) tibia aiming device. Methods CT scan was performed on 30 fresh-frozen cadaveric knees a) prior to any intervention and b) after MPFL reconstruction. For MPFL reconstruction, specimens were randomly allocated to 1) Group A, which consisted of knees operated with free-hand, hardware-free patellar fixation technique with two semi-patellar tunnels and 2) Group B, which consisted of knees operated on with a technique modification with the ACL tibia device. Patellar measurements L1 was the maximal patellar length. L2 was the minimum possible distance of placement for the upper tunnel from the proximal pole of the patella. The maximum bone bridge between tunnels was calculated as half of L1 minus the L2 distance (L1/2-L2). We also measured R1 and R2 angles at the proximal and distal tunnel that represent safe angles at the entry point during tunnel drilling (without breaching the anterior cortex or articular cartilage). Results Preoperatively, mean L1 was 3.45 cm (range 3.05–4.52). Mean L2 was 0.62 cm (range 0.49–0.89). The mean maximum possible bone bridge between tunnels (L1/2-L2) was 1.1 cm (range 0.77–1.58). R1 was 6.050 (range 4.78–7.44), R2 was 6.640 (range 4.57–9.03), and their difference reached statistical significance (p = 0.03). Postoperatively, in group A, in 4 out of 15 patellas, multiple attempts were made during tunnel drilling in order to avoid anterior cortex or cartilage breaching. In group B, all tunnels were correctly drilled with the first attempt. Bone bridge between tunnels was significantly shorter postoperatively (0.93 cm, p < 0.01). Conclusion Small-size patellae correlate with short maximum bone bridge between tunnels, which makes anatomic, double-bundle, hardware-free patella fixation, with two semi-patellar tunnels MPFL reconstruction challenging. Furthermore, R angles create a narrow window to avoid intraoperative breaching, rendering the use of the ACL tibia device an extremely useful instrument. Level of evidence II

scholarly journals Effectiveness of Dual Antibacterial Therapy and Effectiveness of Recommendation Criteria as a Diagnostic Tool in Children with Uncomplicated Acute Appendicitis

2020 ◽  
Vol 18 (1) ◽  
pp. 31-35
Author(s):  
Liene Taurina ◽  
Zane Liepina ◽  
Astra Zviedre ◽  
Arnis Engelis ◽  
Aigars Petersons
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Antibacterial Therapy ◽  
Moderate Correlation ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Group A ◽  
Group B ◽  
Uncomplicated Acute Appendicitis ◽  
Suspected Acute Appendicitis

SummaryIntroductionAcute appendicitis (AA) – acute inflammation and infection of the appendix – is one of the most common cause for abdominal surgery in pediatrics. Appendectomy has been the gold standard since 1735, but in recent years there have been several studies that investigate antibacterial therapy for uncomplicated acute appendicitis. In 2016 new recommendations for suspected AA were implemented in emergency department setting of Children's Clinical University Hospital (CCUH).Aim of the StudyTo evaluate whether diagnostic criteria for patients with a suspected acute appendicitis is effective as a diagnostic tool and to evaluate whether dual antibacterial therapy is safe and effective as first line treatment for children with diagnosis of uncomplicated acute appendicitis in CCUH.Material and methodsA retrospective study was made in CCUH from January 2017 to December 2017. Patients aged 7 to 18 with suspected uncomplicated acute appendicitis were identified and data were collected from an internal hospital management system and patients’ medical records. Patients were divided into two groups – A and B. In group A were patients who met the criteria of uncomplicated AA, and in group B – patients who met the criteria of complicated AA. Both groups received ampicillin and metronidazole. For statistical analysis IBM SPSS Statistics 22 program was used.ResultsFrom 98 patients majority were boys (51% (n=50)) with mean age 12.6 years. As a result of antibacterial therapy clinical condition improved in 93% (n=89) of patients who were discharged without surgery. 7 patients did not improve and underwent surgery within 48 hours after admission, another 2 had elective appendectomy. There was a significant positive moderate correlation between C–reactive protein (CRP), white blood cell count (WBC), basophil granulocytes (BASO) and appendix diameter at admisson and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p<0.001 vs. r=0.41, p=0.017 vs. r=0.51, p=0.013). In group A (68% (n=67)) there was a significant positive moderate correlation between CRP, WBC and appendix diameter at admission and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p<0.001 vs. r=0.51, p=0.013). In group B (30% (n=31)) 7 patients underwent appendectomy and 2 patients received a broad spectrum antibacterial therapy prior to elective appendectomy. There is evidence of significant association between ALVARADO score (p=0.004), rebound tenderness (p<0.001), WBC (p=0.004), CRP (p<0.001) and stage in which appendicitis has progressed to.ConclusionsAntibiotic-alone treatment may be a safe and effective initial management choice in children with uncomplicated acute appendicitis. However, to fully evaluate effectiveness of antibacterial therapy and diagnostic criteria, further follow–up research is needed.A normal C–reactive protein value does not rule out uncomplicated acute appendicitis, therefore it can not act as a single marker to diagnose AA or to differentiate between complicated and uncomplicated AA.Recommendations of treatment of UCAA are acceptable for use in emergency department as they act as a unified tool that allows pediatricians and pediatric surgeons to quickly assess suspected acute appendicitis.

The role of computed tomography in the management of peritonsillar abscess

1992 ◽  
Vol 107 (6_part_1) ◽  
pp. 727-732 ◽  
Author(s):  
Kalpesh S. Patel ◽  
Shireen Ahmad ◽  
Gerard O'leary ◽  
Michael Michel
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Needle Aspiration ◽  
Peritonsillar Abscess ◽  
Clinical Criteria ◽  
Patient Morbidity ◽  
Group A ◽  
Radiologic Investigation ◽  
Group B

Twenty-four patients who fulfilled the clinical criteria for peritonsillar abscess (PTA) were randomized into two groups over a 6-month period. Group A ( n = 13) underwent CT with contrast, whereas group B ( n = 11) was managed without radiologic Investigation. In group A, CT with contrast enabled differentiation of PTA from peritonsillar cellulitis in all 13 cases (100%) and demonstrated abscesses in 11 patients (85%), thereby allowing drainage at first attempt. Two patients with peritonsillar cellulitis were successfully managed with antibiotics only. In group B, all patients underwent needle aspiration. In seven patients (64%), pus was found after needle aspiration at first attempt and In one patient after needle aspirations at two locations. In three patients (27%), no pus was found after needle aspirations at three different locations. We conclude that CT enhances diagnostic accuracy, obviating unnecessary drainage procedures, and reduces patient morbidity.

scholarly journals ROLE OF CT SCAN IN DIAGNOSIS OF ACUTE APPENDICITIS

2019 ◽  
Vol 3 (5) ◽  
Author(s):  
Saurabh . ◽  
Deepak Meena ◽  
G. L. Meena
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Predictive Value ◽  
Contrast Material ◽  
Spiral Ct ◽  
Daily Routine ◽  
Suspected Acute Appendicitis

Background: To evaluate the diagnostic accuracy of the spiral-CT in patients with clinically suspected acute appendicitis. Methods: Appendiceal spiral-CT was performed in 50 patients (21 women and 29 men) with clinically suspected acute appendicitis. Scans were obtained from the L4 level to the symphysis pubis using 5 mm collimation without i.v., oral, or rectal contrast material. Prospective diagnoses based on CT findings were compared with histopathological results Results: In our study appendix diameter test sensitivity was 97.56%, specificity was 77.78 %, positive predictive value was 95.27%, negative predictive value was 87.50% and diagnostic accuracy was 94.00%. Conclusion: The accuracy of computed tomography in diagnosing acute appendicitis was high. The results emphasize the role of computed tomography as an accurate modality in daily routine diagnostics for acute appendicitis in all clinical emergency settings. Key words: Appendicitis, CT scan, Accuracy.

scholarly journals An effect of the COVID-19 pandemic: Significantly more complicated appendicitis due to delayed presentation of patients!

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0249171
Author(s):  
Marie Burgard ◽  
Floryn Cherbanyk ◽  
Konstantinos Nassiopoulos ◽  
Sonaz Malekzadeh ◽  
François Pugin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Length Of Hospital Stay ◽  
Patient Characteristics ◽  
Complicated Appendicitis ◽  
Delayed Presentation ◽  
Duration Of Symptoms ◽  
Initial Symptoms ◽  
Group A ◽  
Group B

Aims of the study The novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID-19 pandemic. Methods We retrospectively analyzed all data collected from a multi-center database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre- and postoperative patient characteristics were evaluated. Results A total of 306 patients were included in this evaluation. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017–2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms (symptoms > 48h in 61% and 26%, p < 0,001), the intervention time (77 vs 61 minutes, p = 0,002), length of hospital stay (hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment (antibiotics > 3 days in 36% and 24% p = 0.001). Conclusions The COVID-19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.

scholarly journals Comparison of RIPASA and Alvarado scoring in the diagnosis of acute appendicitis and validation of RIPASA scoring

2019 ◽  
Vol 6 (3) ◽  
pp. 935
Author(s):  
Jeevan G. Sanjive ◽  
Ravi H. Ramaiah
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Operating Characteristic ◽  
Surgical Emergencies ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity ◽  
Higher Sensitivity

Background: Acute appendicitis is one of the most common surgical emergencies. A delay in performing an appendicectomy in order to improve the diagnostic accuracy increases the risk of appendicular perforation and sepsis. We prospectively compared and validated RIPASA to Alvarado scoring system when applied to an Indian population.Methods: This study included all the patients presented in General Surgery and The Emergency Department of Manipal Hospital, Bangalore diagnosed to have acute appendicitis from October 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendicectomy and receiver operating characteristic (ROC) curve of the RIPASA and Alvarado scoring system were derived using SPSS statistical software.Results: 75 patients were included in the study. Using the RIPASA scoring system, 97.1% of patients who actually had acute appendicitis were correctly diagnosed, compared to only 52.85% when using the Alvarado scoring system. The sensitivity and the specificity of the RIPASA scoring system is 97.14% and 60% respectively. The diagnostic accuracy of RIPASA scoring system is 94.67% and that of Alvarado scoring system is 52%. The results indicate that the RIPASA scoring system is a better diagnostic tool for the diagnosis of acute appendicitis (p<0.001).Conclusions: It is observed that the RIPASA scoring system has higher sensitivity and higher specificity compared to Alvarado scoring. It also has higher diagnostic accuracy and consequently, it has low negative appendicectomy rate. It can be concluded that the RIPASA scoring can be effectively conducted for the better evaluation of acute appendicitis.

scholarly journals An effect of the COVID-19 pandemic: significantly more complicated appendicitis due to delayed presentation of patients!

2021 ◽  
Author(s):  
Marie Burgard ◽  
Floryn Cherbanyk ◽  
Konstantinos Nassiopoulos ◽  
Sonaz Malekzadeh ◽  
François Pugin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Appendicitis ◽  
Length Of Hospital Stay ◽  
Patient Characteristics ◽  
Complicated Appendicitis ◽  
Delayed Presentation ◽  
Duration Of Symptoms ◽  
Initial Symptoms ◽  
Group A ◽  
Group B

AbstractAIMS OF THE STUDYThe novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID-19 pandemic.METHODSWe retrospectively analyzed all data collected from a multi-center database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre- and postoperative patient characteristics were evaluated.RESULTSA total of 306 patients were included in this evaluation. Sixty-five patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017–2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms (symptoms > 48h in 61% and 26%, p < 0,001), the intervention time (77 vs 61 minutes, p = 0,002), length of hospital stay (hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment (antibiotics > 3 days in 36% and 24% p = 0.001).CONCLUSIONSThe COVID-19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.

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