EVALUATION OF THE PERTINENCE OF MODIFIED ALVARADO SCORE IN THE DIAGNOSIS OF SUSPECTED ACUTE APPENDICITIS

2021 ◽  
pp. 68-70
Author(s):  
Debasish Ray ◽  
Nipun Roy ◽  
Subikash Biswas ◽  
Ashim Mandal ◽  
Debarshi Jana
Keyword(s):  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Surgical Removal ◽  
Lower Abdomen ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Surgical Emergencies ◽  
Grade 3 ◽  
Modified Alvarado Score ◽  
Suspected Acute Appendicitis

INTRODUCTION:Appendicitis remains one of the most common surgical emergencies faced by surgeons during his surgical practice. The rst formal description of Acute Appendicitis as a disease entity and its natural process, along with common clinical features and recommendation for its prompt surgical removal was done by Reginald Heber Fitz in 1886 in Harvard University1.AIMS AND OBJECTIVES: This study is aimed to evaluate the pertinence of modied Alvarado score in the diagnosis of suspected acute appendicitis. To look for the effectiveness of Modied Alvarado Score in clinical practice for diagnosis of acute appendicitis by correlating the score with operative and histopathological ndings. MATERIALS AND METHODS:Patients admitted in the inpatient department with pain right lower abdomen especially right iliac fossa tenderness, suspected appendicitis in the department of General Surgery, College of Medicine& JNM Hospital, Kalyani. 6 MONTHS from the period of institutional ethical committee clearance. RESULTS: A MODIFIED ALVARADO SCORE of 6 has been obtained in most of the participants (26.87%), followed by higher Modied Alvarado Score scores of 7, 8 and 9 in 25%, 18.75% and 17.5% respectively. Only about 11.88% participants have a score less than 6.Most of the participants, a little less than two-third of them had a MODIFIED ALVARADO SCORE grade 3, almost one-third had a grade 2 and only 5.6% belonged to grade 1 group.

scholarly journals A three year prospective study-suspected acute appendicitis: diagnostic accuracy of modified Alvarado score versus ultrasonography in adults

2017 ◽  
Vol 4 (12) ◽  
pp. 3924
Author(s):  
Murhari D. Gaikwad ◽  
Anand Auti ◽  
Avinash Magare
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Prospective Study ◽  
Predictive Value ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Modified Alvarado Score ◽  
Suspected Acute Appendicitis

Background: To evaluate and compare diagnostic accuracy of modified Alvarado score and ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis.Methods: A prospective study of the patients who underwent appendectomy for suspected acute appendicitis at IIMS and R Medical College and Noor Hospital Warudi, Badnapur, Dist. Jalna (Maharashtra). The clinical (radiological) and ultrasonography data of 760 patients with suspected appendicitis was collected between March 2014 to Feb. 2017. These patients were evaluated by modified Alvarado score and ultrasonographically, which was corrected with histopathological finding.Results: Out of 760 patients 69.34% had acute appendicitis 63.81% had modified Alvarado score≥7 and 58.28% patients were ultrasonographically positive. In present study modified Alvarado score has sensitivity of 89.37% specificity 93.99% positive predictive value 97.11%, negative predictive value 79.64%, diagnostic accuracy of 81.32%.Conclusions: Modified Alvarado score can be used effectively in clinical decision making. When compare with ultrasonography neither one is advantageous. However, additional information provided by ultrasonography improves diagnostic accuracy.

sTREM-1 assessment as a diagnostic biomarker for suspected acute appendicitis in children

2019 ◽  
Author(s):  
Tal Taraboulos Klein ◽  
Elkana Kohn ◽  
Baruch Klin ◽  
Tomer Ziv-Baran ◽  
Eran Kozer ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Complete Blood Count ◽  
Surrogate Marker ◽  
Serum Levels ◽  
Alvarado Score ◽  
Suspected Appendicitis ◽  
Reactive Protein ◽  
Significant Difference ◽  
History Of ◽  
Suspected Acute Appendicitis

Abstract Background The typical history of acute appendicitis is observed in less than 60% of cases. Therefore, searching for a surrogate marker is mandatory. Our goal was to determine whether the soluble triggering receptor expressed on myeloid cells (sTREM-1) is an efficient biomarker for acute appendicitis. Methods sTREM-1 serum levels were measured in addition to carrying out routine diagnostic tests (urine dipstick, complete blood count and C- reactive protein) in children admitted to the Emergency Department with suspected appendicitis. Statistical analysis was performed in order to examine whether sTREM-1 was a significant predictor of appendicitis. Results Fifty three of 134 children enrolled in the study were diagnosed with appendicitis. There was no significant difference in serum sTREM-1 levels (p=0.111) between children with or without appendicitis. Leukocytes, neutrophils and CRP were significantly elevated in the appendicitis group (p<0.001). The appendix diameter was significantly larger and the Alvarado score significantly higher in the appendicitis group (p<0.001). Conclusion serum sTREM-1 is not a good marker for acute appendicitis. Customary tests in addition to a proper patient history and physical examination are still the most effective methods to diagnose acute appendicitis.

scholarly journals DIAGNOSTIC EFFICACY OF MODIFIED ALVARADO SCORE OVER GRADDED COMPRESSION ULTRASONOGRAPHY

2013 ◽  
Vol 03 (03) ◽  
pp. 105-108
Author(s):  
Caren Dsouza ◽  
John Martis ◽  
Vinay Vaidyanathan
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Preoperative Diagnosis ◽  
Iliac Fossa ◽  
Diagnostic Efficacy ◽  
Alvarado Score ◽  
Predictive Values ◽  
Modified Alvarado Score ◽  
Sensitivity Specificity ◽  
Compression Ultrasonography

Abstract Background: Acute appendicitis is one of the commonest surgical emergencies. Despite a life time cumulative risk of nearly 7% its diagnosis remains a challenge. The risks of two primary outcomes must be balanced in the management of presumed appendicitis: perforation and misdiagnosis.The rate of misdiagnosis in certain populations is as high as 40%. Diagnostic aids like modified Alvarado score and ultrasonography can dramatically reduce the negative appendicectomies. Methods:Data was collected from 60 patients with complains of right iliac fossa pain over a period of 9 months to our hospital. All patients were categorised using the Alvarado score and Graded compression ultrasonography was done. The preoperative and histological findings were compared with the preoperative diagnosis. The collected data was analysed with regards to various parameters like sensitivity, specificity, predictive values and diagnostic accuracy. Results:In our study of 60 patients, 56 patients underwent appendicectomy out of which a histological confirmation of appendicitis was obtained for 50 patients, giving a negative appendicectomy rate of 12%.By taking a cut-off point of 7 for the Modified Alvarado score, a sensitivity of 97.56%, specificity of 66.67%, positive predictive value (PPV) of 95.23%, negative predictive value (NPV) of 80% and accuracy of 87.2% were calculated. Using the cut-off point of 6, a sensitivity of 90% specificity of 50%, PPV of 69.23%, NPV of 80% and accuracy of 55.56% were obtained. The sensitivity, specificity, PPV, NPV and accuracy rate of ultrasonography was 92.15%, 88.9%, 97.19%, 66.7% and 85%, respectively. Conclusion:The presence of a modified Alvarado score > 7 was found to be a dependable aid in the preoperative diagnosis of acute appendicitis. In cases where the score was negative or equivocal, ultrasonography greatly helped in the diagnosis thereby reducing the incidence of negative appendicectomies.

scholarly journals Modified Alvarado Scoring System in the Diagnosis of Acute Appendicitis

1970 ◽  
Vol 5 (1) ◽  
pp. 18-20 ◽  
Author(s):  
David Bibhutosh Talukder ◽  
AKM Zafrullah Siddiq
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Scoring Systems ◽  
Histopathological Diagnosis ◽  
Alvarado Score ◽  
Diagnostic Modality ◽  
Female Patients ◽  
Surgical Emergencies ◽  
Modified Alvarado Score ◽  
A Prospective Study

Acute appendicitis is one of the common surgical emergencies. Different scoring systems are there in use to diagnose appendicitis. The purpose of this study was to evaluate the diagnostic accuracy of the modified Alvarado scoring system in clinical practice for acute appendicitis. A prospective study was conducted on 100 patients hospitalized with abdominal pain suggestive of acute appendicitis and were subsequently operated, from July 2005 to June 2008 at Bangladesh Rifles (BDR) hospital, Dhaka. Both male and female patients from 7 years to 55 years of age were enrolled in the study. Preoperatively, modified Alvarado score was assigned to all, and the results were compared with operative and histopathological diagnosis. Out of 100 operated patients 84 were diagnosed as a case of acute appendicitis on the basis of histopathological report. Patients with modified Alvarado score of 8-10, 5-7 and 1-4 have the accuracy of 95%, 78%, and 0% respectively. In the higher score group the accuracy is more and acceptable. Lower score group should be kept under observation. Score sensitivity is more in male than female patients. This scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimize unnecessary appendicectomy.Key Words: Alvarado scoring system, Acute appendicitis.   doi: 10.3329/jafmc.v5i1.2845 JAFMC Bangladesh. Vol 5, No 1 (June) 2009 pp.18-20

scholarly journals A comparative study on RIPASA and modified Alvarado score in the diagnosis of acute appendicitis in tertiary care hospital

2021 ◽  
Vol 8 (3) ◽  
pp. 944
Author(s):  
Kodenge Raghavendra Rao ◽  
D. Navya Sesha Harika ◽  
Suragani V. Narayana ◽  
Vinodh Kumar K. S. ◽  
Chavala Pavan Kumar Yadav ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Iliac Fossa ◽  
Tertiary Care ◽  
Scoring Systems ◽  
Care Hospital ◽  
Alvarado Score ◽  
Modified Alvarado Score ◽  
Sensitivity Specificity ◽  
Ripasa Score

Background: Acute Appendicitis is common surgical emergencies with a lifetime prevalence of approximately 1 in 7. Despite advances in diagnosis and treatment; acute Appendicitis is still associated with morbidity (10%) and mortality (1-5 %). Presentations of acute Appendicitis can mimic various acute medical and surgical conditions, and the diagnosis is predominantly a clinical one-different scoring systems used for aiding in early diagnosis of Acute Appendicitis and its prompt management. Alvarado score and RIPASA score are the most popular ones. So we retrospectively applied and compared Alvarado and RIPASA score in the diagnosis of acute Appendicitis in Indian population.Methods: In this study, we compared RIPASA score and Alvarado scoring system retrospectively by applying to 74 patients. This study period from November 2018 to March 2020. Both scores were calculated for patients presented with right iliac fossa pain. Sensitivity, specificity, positive predictive value (PPV), negative predictive (NPV), diagnostic accuracy for RIPASA and Alvarado system was calculated.Results: The sensitivity and specificity of the Alvarado score were 85.07% and 57.14% respectively. The sensitivity & specificity of RIPASA score were 91.04% and 71.42% respectively. Accuracy of the Alvarado scoring system is 82.44% and for RIPASA scoring system is 89.18%. The results show that the RIPASA scoring system is a better diagnostic tool for the diagnosis of Acute Appendicitis.Conclusions: RIPASA scoring system is simple, accurate, convenient, and more specific scoring system than the modified Alvarado scoring system for the Indian population.

scholarly journals Incidence of negative appendicectomy, our experience of 100 patients at Sir Ganga Ram Hospital Lahore

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Muhammad Aslam ◽  
Ayesha Shaukat ◽  
Farid Zafar ◽  
Amir Riaz Bhutta ◽  
Aftab A Choudhri ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Clinical Examination ◽  
Scoring System ◽  
Iliac Fossa ◽  
Age Groups ◽  
International Studies ◽  
Alvarado Score ◽  
History Of ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score

Background: Despite recent advances in diagnostic medicine, the diagnosis of Acute Appendicitis is still doubtful in a number of cases. Majority of the Clinicians rely on their clinical examination, strengthened by the laboratory tests. This study was done to see the incidence of negative appendicectomy in Patients, who presented in surgical emergency with pain in Rt. Iliac fossa. These patients were assessed and evaluated by clinical examination as well as with the help of Modified Alvarado Scoring system and surgery was decided accordingly. Aims and Objective: To see the incidence of Negative appendicectomies at Sir Ganga Ram Hospital, Lahore and comparing the rate with the rate of other international Studies. Study Design: It was a prospective clinical and Pathological study, consisting of 100 patients, presenting in the Sir Ganga Ram Hospital Lahore, with history of right iliac fossa pain. Material and Method: One hundred patients were included in the study, and diagnosis of acute appendicitis was bas ed on Clinical Examination and Modified Alvarado Score. The patients selected for this study were of all age groups and both sexes. Out of hundred, 56 patients were operated after being assessed by clinical Examination and Modified Alvarado Scoring System. Results: The incidence of negative appendicitis was about 7% in male, 20% in female and about-10% in children. Conclusion: Over all the rate of negative appendicectomies was 15%, which is with in lower limit of the other international studies.

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

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.

scholarly journals VALIDITY OF ALVARADO SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS

1969 ◽  
Vol 5 (2) ◽  
pp. 663-666
Author(s):  
ASGHAR ALI ◽  
ABDUR RAHMAN ◽  
FAZAL RAHIM
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Iliac Fossa ◽  
Cross Sectional Study ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Female Ratio ◽  
Suspected Appendicitis ◽  
Surgical Ward ◽  
Male To Female

BACKGROUND: The first appendectomy was performed by Claudius Amyand in 1736 when he wasoperating on a boy for hernia and found appendix lying in hernial sac. Reginald Fitz introduced the wordappendicitis in 1886 and before that it was called typhlitis or perityphlitis.Frederick Treves performedthe lstappendicle surgery in England for the new disease ‘appendicitis’ in 1887.OBJECTIVE: To study the accuracy of modified Alvarado scorning system in diagnosis of acuteappendicitis.MATERIAL & METHODS: This descriptive cross sectional study was conducted at DHQ HospitalTimergara Dir lower from January 2015 to July 2015 to find out the accuracy of Alvarado Scoringsystem in the diagnoses of acute appendicitis. A total of 50 patients admitted in surgical ward from OPDand Casualty with suspected appendicitis were included in the study. Patients less than 7 years andpatients with mass right iliac fossa were excluded. Every patient was evaluated with modified Alvaradoscoring system on a standard Proforma. Patients with Alvarado score of > 6 underwent appendectomy.The removed appendices were sent for histopathology to confirm or otherwise the provisional diagnosisof acute appendicitis and hence the accuracy of Alvarado scoring system.RESULTS: Out of 50 patients, 20 were male &30 were female with a male to female ratio of 1:1.5. Themean age of the patients was 19.7 ± 9.6years. The mean Alvarado score was 7.92 ± 1.383. TheHistopathology reports of the specimens of 37 patients were confirmative of acute appendicitis whereasthe rest of the (13 patients) removed appendices were reported normal by histopathalogist. So thesensitivity is 74%.CONCLUSION: Our study shows that Alvarado scoring system is a simple and quick tool in theevaluation and management of suspected cases of acute appendicitis. Its accuracy increases if used inpatients above 14 years of age.KEYWORD: Alvarado scoring system, Appendicitis, Accuracy.

scholarly journals Augmentation of modified Alvarado score with abdominal ultrasound in diagnosis of acute appendicitis

2020 ◽  
Vol 8 (1) ◽  
pp. 111
Author(s):  
Shipra Sharma ◽  
Ankit Soni ◽  
Sanjay Kumar ◽  
Manoj Poptani
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Abdominal Ultrasound ◽  
Laboratory Findings ◽  
Alvarado Score ◽  
Surgical Emergencies ◽  
Increased Sensitivity ◽  
Negative Appendicectomy ◽  
Modified Alvarado Score ◽  
Sensitivity Specificity

Background: Acute appendicitis is one of the commonest surgical emergencies. But confirming the diagnosis of acute appendicitis is still a subjective issue for clinicians. Modified Alvarado score is based on clinical and laboratory findings which is scored upto 9. Management of 5 to 7 modified Alvarado score came under equivocal. Either may be conservative or operative.Methods: We augmented the modified Alvarado score with abdominal ultrasound in diagnosis of acute appendicitis.Results: Outcomes were evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and negative appendicectomy rate, results of our study are sensitivity 95.7%, specificity is 76.92%, PPV 93.75% and NPV 33.34%.Conclusions: Overall increased sensitivity, specificity, NPV and PPV of the augmented approach is useful for diagnosis of acute appendicitis which scored under 5-7 of modified Alvarado scoring system.

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