Evaluation of the modified Alvarado score incorporating the C-reactive protein in the patients with suspected acute appendicitis

Objective. Main objective was whether the combination of C-Reactive Protein (CRP) and Alvarado Score (AS) increase the diagnosis accuracy of AS among 2-to-20-year-old patients with suspected acute appendicitis presenting to Emergency Departments. Materials and methods. This is a secondary analysis of prospective cohort study consecutively including all patients from 2 to 20 years of age attended for suspected acute appendicitis in 4 Spanish Emergency Departments during 6-month period. We collected demographic, clinical, analytic and radiographic, and surgical data. AS categories were retrospectively calculated as low (0-4 points), intermediate (5-6 points) or high (7-10 points). The cut-off levels were >0.5 mg/dl for CRP. The outcome was diagnosis of acute appendicitis within 14 days of the index visit. Results. A total of 331 patients with suspected of acute appendicitis (mean age 11.8 (SD 3.8) years; 52.9% males) were recruited. According to AS, 108 (32.6%) were at low risk, 76 at (23.0%) intermediate risk and 147 (44.4%) at high risk of acute appendicitis. One hundred and sixteen (35.0%) cases had confirmed histopathological diagnosis of acute appendicitis. The AUCs of ROC were 0.76 (0.70-0.81) for AS and 0.79 (95% CI 0.75-0.84) for CRP-AS being the difference statistically significant (p=0.003). The CRP for diagnosis acute appendicitis in low risk AS group had negative predictive value of 95.8% (95%CI 87.3-98.9) and likelihood ratio negative of 0.4 (95%CI 0.2-1.0). Conclusions. CRP-AS has shown to increase the diagnostic accuracy of AS for acute appendicitis. This approach may be useful to rule out the diagnosis of acute appendicitis in paediatric patients attended for abdominal pain suggestive of acute appendicitis.

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Accuracy in Diagnosis of Acute Appendicitis by Comparing Serum C - reactive protein Measurements and Modified Alvarado Score

IOSR Journal of Dental and Medical Sciences ◽

10.9790/0853-1509062731 ◽

2016 ◽

Vol 15 (09) ◽

pp. 27-31 ◽

Cited By ~ 1

Author(s):

Dr Joel Mathew John ◽

Dr K.N. Rajan Babu

Keyword(s):

Acute Appendicitis ◽

C Reactive Protein ◽

Alvarado Score ◽

Reactive Protein ◽

Modified Alvarado Score

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Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis

BMC Emergency Medicine ◽

10.1186/s12873-018-0166-5 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Mohamed Amine Msolli ◽

Kaouther Beltaief ◽

Wahid Bouida ◽

Nahla Jerbi ◽

Mohamed Habib Grissa ◽

...

Keyword(s):

Acute Appendicitis ◽

C Reactive Protein ◽

Alvarado Score ◽

Early Change ◽

Reactive Protein ◽

Modified Alvarado Score

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Predictive values of Alvarado score, serum C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis: a prospective study

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00074-y ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Ademola Olusegun Talabi ◽

Tewogbade Adeoye Adedeji ◽

Oludayo Adedapo Sowande ◽

Olusanya Adejuyigbe

Keyword(s):

Acute Appendicitis ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

C Reactive Protein ◽

Blood Cell Count ◽

Alvarado Score ◽

Reactive Protein ◽

Wbc Count

Abstract Background The diagnosis of acute appendicitis in children is quite challenging as the rate of negative appendectomy varies between 15 and 57%. Increased utilization of imaging diagnostic facilities in advanced countries seems to have reduced the incidence of operating on normal appendix to a single digit. In low- and middle-income countries, the incidence remains unacceptably high (double digits). Inflammatory markers and scoring systems may be a suitable adjunct to increase diagnostic yield in most third world countries. Thus, the aim of this study was to evaluate the diagnostic value of Alvarado score, white blood cell count, and serum C-reactive protein in children with acute appendicitis. Results The ages of patients ranged between 4 and 15 years with a mean of 11.2 ± 2.8 years. The male to female ratio was 1.4 to 1.0. Nineteen percent of patients had negative appendiceal findings on histological examination. The sensitivity and specificity of Alvarado score, C-reactive protein estimation, total white blood cell count in diagnosing acute appendicitis were 86.4% and 63.2%, 98.8% and 36.8%, and 51.9% and 89.5% respectively. Alvarado score has the highest area under ROC curve analysis 0.824, 95% CI of 0.724 to 0.924 compared with CRP, 0.769. 95% CI of = 0.647 to 0.891 and WBC count, 0.765, 95% CI of 0.643 to 0.887. Both CRP and WBC count showed higher discriminatory values between complicated and uncomplicated appendicitis, p < 0.001. Conclusion Alvarado score outperformed other tests in setting the diagnosis of acute appendicitis. However, none of the tests can be relied on wholly for operative decision. Clinical judgement remains the bedrock for diagnosis and operative management.

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

10.21203/rs.2.18784/v1 ◽

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.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20175145 ◽

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.

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

10.36106/ijsr/3722725 ◽

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.

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