scholarly journals Comparison between Modified Alvardo Score & Pediatric Appendicitis Score in the Early Diagnosis and Management of Acute Appendicitis in Children

2017 ◽  
Vol 29 (1) ◽  
pp. 19-22
Author(s):  
Md Sajedul Haque ◽  
Md Shahid Karim
Keyword(s):  
Early Diagnosis ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring Systems ◽  
Inflammatory Cells ◽  
Negative Appendectomy ◽  
Sensitivity Specificity ◽  
Suspected Acute Appendicitis ◽  
Appendicitis Score ◽  
Better Than

Early diagnosis of acute appendicitis in children is a challenge for the pediatric surgeons. The objectives of this study were to compare the accuracy of Modified Alvardo Score (MAS) & Pediatric appendicitis Score (PAS) in the management of acute appendicitis in children, to make early diagnosis & treatment of acute appendicitis and to reduce morbidity of negative appendectomy or delayed appendectomy. It was a comparative prospective study. This study was carried out in Dhaka Shishu (Children) Hospital from January' 2004 to April '2005, a period of 16 months in the department of Pediatric Surgery. During this 16 months period, 106 patients with suspected acute appendicitis were admitted. Among these, 97 patients underwent surgery and 9 patients treated conservatively. Out of 97 patients, 90 specimens were sent for histological examination. Positive histological (Positive appendix) criteria of acute appendicitis required demonstration of acute inflammatory cells infiltration of the appendix wall. Only 85 histological reports were available finally & were included in this study. The sensitivity, specificity and diagnostic accuracy of MAS are 92.42%, 84.21% & 90.59% respectively. The sensitivity, specificity and diagnostic accuracy of PAS are 90.91%, 100% & 92.94% respectively. In these two scoring systems, the sensitivity, specificity and diagnostic accuracy are high. But in our study, PAS is better than the MAS regarding specificity & diagnostic accuracy.Medicine Today 2017 Vol.29(1): 19-22

scholarly journals A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective

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.

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

2017 ◽  
Vol 4 (8) ◽  
pp. 2806 ◽  
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.

A Comparison between the Diagnostic Accuracy of Alvarado and Tzanaki Scoring Systems in Acute Appendicitis

2021 ◽  
Vol 15 (12) ◽  
pp. 3175-3177
Author(s):  
Anum Iftikhar ◽  
Muhammad Arsalan ◽  
Sheeza Azaz ◽  
S H Waqar ◽  
Sajid Ali Shah ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Cross Sectional

Aim: To find out how accurate the Alvarado and Tzanaki scoring systems are in diagnosing acute appendicitis taking histopathology as gold standard. Methods: A cross-sectional prospective study was conducted from August 2019 to July 2020 at Department of General Surgery, Pakistan Institute of Medical Sciences Islamabad. Sixty patients were included, all of whom had appendectomies after a clinical diagnosis of acute appendicitis. Samples were submitted for histopathology, which was used as the gold standard for the definitive diagnosis of acute appendicitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and negative appendectomy rate of Alvarado and Tzanaki scoring systems was calculated using SPSS version 23. Results: The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Alvarado score at optimal cut-off threshold of ≥7.0, were calculated as 74%, 55%, 90%, 27% and 71.66% respectively. The cut-off threshold point of Tzanaki score was set at more than 8, which yielded a 94.11% sensitivity and an 88.88% specificity. The positive predictive value was 99.95% and the negative predictive value was 72.72%. The Alvarado and Tzanaki scoring systems had negative appendectomy rates of 9.5% and 2.04%, respectively. Conclusion: The Tzanaki scoring system has a better diagnostic accuracy for acute appendicitis as compared to the Alvarado score. Keywords: Acute appendicitis, Alvarado score, Tzanaki score

The Value of Scoring Systems for the Diagnosis of Acute Appendicitis

2015 ◽  
Vol 87 (2) ◽  
Author(s):  
Dominik A. Walczak ◽  
Dariusz Pawełczak ◽  
Agata Żółtaszek ◽  
Rajmund Jaguścik ◽  
Wojciech Fałek ◽  
...  
Keyword(s):  
Data Analysis ◽  
Acute Appendicitis ◽  
Hospital Admission ◽  
Diagnostic Accuracy ◽  
Scoring Systems ◽  
Diagnostic Value ◽  
Accurate Diagnosis ◽  
Normal Appendix ◽  
Detailed Medical History ◽  
Suspected Acute Appendicitis

AbstractAccurate diagnosis of acute appendicitis (AA) is still a problem and is not always easy, even for experienced surgeons. Studies have shown that 20 to 30% of the appendices removedwere normal. Therefore, various scoring systems have been developed to aid in the diagnosis of doubtful cases and reduce the number of unnecessary appendectomies.The aim of this study was to assess the diagnostic value of different scoring systems in acute appendicitis.Material and methods. The study involved 94 patients who underwent laparotomy due to suspected acute appendicitis. Medical examination at hospital admission was performed by a resident and a general surgery specialist. The probability of AA was evaluated using six different scoring systems: Alvarado, Fenyo, Eskelinen, Ohman, Tzankis, and RIPASA. The resident calculated the results in individual systems. The decision to perform the operation was taken by a specialist surgeon who did not know the results.Results. Normal appendix was removed in 26% of cases. Eskelinen, RIPASA and Alvarado systems showed highest sensitivity (99%, 88% and 85%, respectively). Tzankis and Fenyo systems showed highest specificity (62% and 50%, respectively).Conclusions. Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis

scholarly journals A Comparative Study of Raja Isteri Pengiran Anak Saleha and Alvarado Scores to Diagnose Acute Appendicitis

2021 ◽  
Vol 19 (1) ◽  
pp. 111-114
Author(s):  
Uttam Pachya ◽  
Sita Ram Shrestha ◽  
Yagya Raj Pokharel ◽  
Ambika Thapa
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Asian Population ◽  
Final Diagnosis ◽  
Negative Appendectomy ◽  
Microsoft Excel ◽  
Alvarado Score ◽  
Generalized Peritonitis ◽  
Sensitivity Specificity

Background: Acute Appendicitis is a clinical diagnosis with atypical presentation in young, elderly, females, genitourinary and gynecological conditions. Delayed appendectomy increases the risk of appendicular perforation, sepsis morbidity and mortality. Literature reports as high as 20-40% negative appendectomy. Raja Isteri Pengiran Anak Saleha score has come with higher sensitivity and diagnostic accuracy than Alvarado score in Asian population. This study aims to compare RIPASA and Alvarado score for diagnostic accuracy.Methods: Appendectomy patients at Patan Hospital from April to September 2014 were compared on raja isteri pengiran anak saleha (cut-off value 7.5 out of 15) and Alvarado score (cut-off value 7 out of 10). Final diagnosis was histopathology based. Microsoft Excel and SPSS 17 were used for analysing sensitivity, specificity and diagnostic accuracy of both scores. The study included patients who underwent appendectomy with histopathology report and excluded those with conservative management, generalized peritonitis, appendicular lump and abscess.Results: There were 88 appendectomy patients with median age 26 (18.25, 35) years, and male 52 (59.1%). Negative appendectomy was 10 (11.36%). Sensitivity and specificity of Raja Isteri Pengiran Anak Saleha 98.71% and 80.00% respectively, and for Alvarado 52.56% and 70%.The Raja Isteri Pengiran Anak Saleha score had statistically significant sensitivity (p=0.000). Positive Predictive value, Negative Predictive Value and diagnostic accuracy were 97.46%, 88.89% and 96.6% for RIPASA and 93.18%, 15.19% and 54.4% for Alvarado respectively.Conclusions: The Raja Isteri Pengiran Anak Saleha score had better diagnostic accuracy compared to Alvarado score for diagnosis of Acute Appendicitis.Keywords: Acute appendicitis; alvarado score; RIPASA score

scholarly journals Diagnostic Role of C- Reactive protein in Acute Appendicitis

2020 ◽  
Vol 16 (4) ◽  
pp. 246-251
Author(s):  
Ashis Pun ◽  
Amit Dhungana ◽  
Ramjee Bastola
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
White Blood Count ◽  
Negative Appendectomy ◽  
C Reactive Protein ◽  
Accuracy Rate ◽  
Reactive Protein ◽  
Diagnostic Role ◽  
Sensitivity Specificity

 Introduction: Acute appendicitis is the common surgical disease however, accurate diagnosis and exclusion of acute appendicitis always remains challenge to the surgeons. Although diagnoses rely mostly on clinical examination but C- reactive protein (CRP) can be of valuable armamentarium. Hence, this study was conducted to find the diagnostic role of C-reactive protein in Acute Appendicitis Methods: A retrospective cross sectional study was conducted among 100 respondents in the Department of Surgery, Bharatpur Hospital from September 2019 to August 2020. Ethical approval was taken from the Institutional Review Committee (IRC) Bharatpur Hospital. Statistical analysis was done by using SPSS version 16 using descriptive statistics. Results: Total of 100 patients was included in study with mean age 31 years old.Out of which 60% were male and 40% were female. CRP value was raised (>6) in 87 (87%) cases and normal in 13(13%) cases. Among those with raised CRP, three patients had normal appendix histopathologically and 57 had uncomplicated appendicitis and 27 had complicated appendicitis histopathologically with sensitivity, specificity, positive predictive value and diagnostic accuracy rate of 95.45 %, 75 %, 96.55 % and 93% respectively. When white blood count (WBC) and CRP level were combined with HPE findings, its sensitivity, specificity and diagnostic accuracy rate were 100%, 80% and 93.83 % respectively. Conclusions: CRP improves the diagnostic accuracy of Acute appendicitis. The adjunct use of CRP and leucocyte count can effectively reduce the negative appendectomy rate.

scholarly journals Comparison of Alvarado score and pediatric appendicitis score for clinical diagnosis of acute appendicitis in children—a prospective study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Muhammad Adil Iftikhar ◽  
Sajid Hameed Dar ◽  
Usman Ali Rahman ◽  
Maliha Javaid Butt ◽  
Mohammad Sajjad ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Correct Diagnosis ◽  
Scoring Systems ◽  
Alvarado Score ◽  
Symptoms And Signs ◽  
Appendicitis Score

Abstract Background Acute appendicitis is the most common surgical condition of children. Differential diagnosis of an acutely inflamed appendix in children includes a vast variety of diseases which can present with the same symptoms and signs as acute appendicitis. It is an important factor for delay in diagnosis. Many scoring systems are being used to reach a diagnosis within time and to reduce the rate of negative appendectomies. The purpose of this study was to compare both scoring systems (Alvarado and pediatric appendicitis scoring system) and to know which one is better to establish an early correct diagnosis of acute appendicitis in pediatrics, thus decreasing the morbidity and burden on hospital resources. Although many studies had been completed at the international level for comparing both of these scoring systems, the pediatric population in our region was still awaiting such an effort. So a prospective cohort study was designed. A total of 180 patients were recruited with 95% confidence level and 5% margin of error. Every enrolled patient was awarded clinical scores according to both the Alvarado scoring system and the pediatric appendicitis scoring system. Patients having a score of 7 or more by both scoring systems were considered “seven or more than seven group” and their appendectomies were performed and histopathology reports were reviewed. Patients having a score of 7 in one system and less than 7 in the other/both were considered “less than seven group” and were admitted in the ward for further clinical evaluation and observation. Results At cutoff 7, the Alvarado score showed a sensitivity of 85.5%, specificity of 70%, PPV of 96.5%, NPV of 33.3%, and diagnostic accuracy of 84.11% while the pediatric appendicitis score showed a sensitivity of 93.8%, specificity of 70%, PPV of 96.8%, NPV of 53.8, and diagnostic accuracy of 91.59%. Conclusion The pediatric appendicitis score (PAS) is superior in diagnosing acute appendicitis in the pediatric population than the Alvarado score as indicated by the values of diagnostic accuracy. So it can be a good diagnostic tool for pediatric patients presenting with clinical symptoms and signs of appendicitis.

scholarly journals The validity and utility of combining ultrasonography with different clinical scores in diagnosis of acute appendicitis

2019 ◽  
Vol 6 (4) ◽  
pp. 1084
Author(s):  
Ritika Agarwal ◽  
Abhinav Agarwal ◽  
Ashvini Kumar ◽  
Mukesh Kumar
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring Systems ◽  
Abdominal Ultrasonography ◽  
Significant Difference ◽  
Clinical Scoring ◽  
History Of ◽  
Study Population ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: There are no controlled studies combining the use of either of the scores- Modified Alvarado, RIPASA or AIRS with ultrasonography. This study was conducted to evaluate the diagnostic accuracy of the existent clinical scoring systems in combination with ultrasound imaging in the diagnosis of acute appendicitis in our patients.Methods: All patients with clinical diagnosis of acute appendicitis and who underwent emergency appendectomy were included in the study. A detailed history of presenting illness was elicited and clinical examination, relevant blood investigations and abdominal ultrasonography were done. All patients were scored according to MAS, RIPASA and AIRS. Histopathology was taken as the gold standard.Results: The study included 118 patients. From our study population, 107 had acute appendicitis on histopathology. There was no statistically significant difference between the accuracy of MAS and RIPASA and both were equally good in diagnosing acute appendicitis as far as the diagnostic accuracy is concerned. Combined MAS, Combined RIPASA and Combined AIRS were obtained after combining ultrasonography findings with MAS, RIPASA score and AIRS respectively. The diagnostic accuracy, sensitivity, specificity, PPV and NPV for Combined MAS were 96.6%, 99.1%, 72.7%, 97.2% and 88.9% respectively, for combined RIPASA were 95.8%, 99.1%, 63.6%, 96.4% and 87.5% respectively and for combined AIRS was 96.6%, 99.1%,72.7%, 97.2%, 88.9% respectively.Conclusions: If ultrasonography is used in conjunction with current clinical scoring systems then the diagnostic accuracy is enhanced. Therefore, USG should be done in all cases being evaluated for acute appendicitis; irrespective of the score being used.

scholarly journals Max appendicitis score: a new diagnostic score for diagnosing acute appendicitis

2017 ◽  
Vol 4 (9) ◽  
pp. 3067
Author(s):  
Vidur Jyoti ◽  
Akhilesh Kumar ◽  
Preeti Yadav ◽  
Vaibhav Kapoor
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Scoring Systems ◽  
Cost Effective ◽  
Alvarado Score ◽  
Diagnostic Score ◽  
Negative Appendicectomy ◽  
Appendicitis Score

Background: Scoring systems are valuable and valid for discriminating between acute appendicitis and nonspecific abdominal pain. Alvarado scoring is classical and different modifications of Alvarado score have been introduced but none is ideal and negative appendicectomy rate is still high. The aim of the study is to design a more reliable scoring system which is cost effective, simple, easy to learn, high accuracy, which can be applied by any doctor at any health care facility.Methods: Retrospective study of 160 patients hospitalized with abdominal pain suggestive of acute appendicitis and subsequently operated over a period of 5 year from January 2012 to January 2017 at Max Super Speciality Hospital, Gurgaon.Results: In the present study based on six clinically most significant variables, a diagnostic accuracy of 96.25% was achieved while the same was 85% for classical Alvardo Score. This significantly increased the diagnostic accuracy and lowered the negative appendicectomy rate.Conclusions: Max Appendicitis Score is perfect scoring system for diagnosing appendicitis, it can be specially very handy in peripheral health centers where radiological facilities are sparse.

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

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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