scholarly journals Outcome of Alvarado scoring system in the diagnosis of acute appendicitis at a tertiary care teaching hospital

2021 ◽  
Vol 15 (10) ◽  
pp. 2649-2651
Author(s):  
Afza Saleem ◽  
Zahra Ali ◽  
Wasif Majeed Chaudhry ◽  
Aruj Alam ◽  
Muhammad Shoaib ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Teaching Hospital ◽  
Clinical Judgment ◽  
Scoring System ◽  
Iliac Fossa ◽  
Tertiary Care ◽  
Accurate Diagnosis ◽  
Care Hospital ◽  
Alvarado Score ◽  
Surgical Residents

Background: Diagnosis of acute appendicitis is usually made on the basis of clinical judgment and experience of the surgeon. It may sometimes become a challenge due to variability in presentation. It is not unusual for surgical residents & consultants to miss the diagnosis. Aim: To evaluate the effectiveness of Alvarado score in making an accurate diagnosis of acute appendicitis and assessing its sensitivity at a tertiary care hospital, in Lahore, Pakistan. Methods: A Prospective observational study was conducted at the department of Surgery, Ghurki Trust Teaching Hospital (GTTH). The data was collected from 117 patients on a self-designed proforma over a one-year period i.e., from 1st January 2018 to 31st December 2018 with the suspected diagnosis of acute appendicitis and who underwent surgery. The variables were evaluated with Alvarado scoring system to assess its effectiveness and sensitivity. The data was analyzed using SPSS vr 23. Results: Demographic results showed 73(62.4%) males and 44(37.6%) female. The mean age was 23 years and most of the patient were in age group 11-20years 55(47%). Abdominal pain was the commonest feature found in all the patients followed by Nausea in 72% and migration of pain to Right Iliac fossa 60%. Complicated appendicitis was found as gangrenous (7.5%) and perforated (6%). 53% of the cases were performed by on-call team consisted of SRs and surgical residents. Conclusion: Alvarado score is an effective scoring system in making an accurate diagnosis of acute appendicitis. It can be very useful in the prompt management of patients with equivocal features and in extreme of ages. Keywords: Acute appendicitis, Clinical scoring, Alvarado score

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

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. 

scholarly journals Comparison of acute inflammatory score and Alvarado score in diagnosis of acute appendicitis at a tertiary care hospital

2017 ◽  
Vol 4 (12) ◽  
pp. 4034
Author(s):  
Padmaja Rani Gopalam ◽  
M. V. Saila Suman Konidala
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Financial Burden ◽  
Tertiary Care ◽  
Area Under The Curve ◽  
High Specificity ◽  
Lower Sensitivity ◽  
Negative Appendectomy ◽  
Care Hospital ◽  
Alvarado Score

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. The most common and widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. A recently introduced appendicitis inflammatory response score (AIR) was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. The objective the present study was to evaluate the AIR score on cases of suspicious appendicitis and to compare it with Alvarado scorings system.Methods: A prospective study for a period of two years from March 2015 to February 2017 was conducted on consecutive patients who presented to emergency department and scoring was performed based on the necessary variables.Results: The present study was conducted on 300 cases suspicious of appendicitis. The results analysed showed the area under the ROC curve of the AIR score was 0.94 and better than the area under the curve of Alvarado score of 0.82. The AIR score also did well in difficult cases of women, children when compared to Alvarado score in diagnosis of appendicitis. In our study, in cases with >8 points, a lower sensitivity was observed in AIR scoring than Alvarado scoring (0.26 vs. 0.12), but was associated with higher specificity (1.00 vs. 0.95). In these cases, PPV turned out to be 1.00 for AIR scoring and 0.77 for Alvarado scoring.Conclusions: To conclude, AIR scoring performed well almost equally with Alvarado system with high specificity and high negative predictive value preventing unnecessary negative appendectomies. Follow up of these cases will help in deciding surgical intervention in unnecessary cases. This scoring system also prevents unnecessary and costly radiological investigations thereby reducing the financial burden to the patients.

scholarly journals Validity of RIPASA scoring system as a diagnostic tool of acute appendicitis in comparison with Alvarado scoring system in the Arab population

2018 ◽  
Vol 5 (6) ◽  
pp. 2011
Author(s):  
Tamer M. Abdelrhman ◽  
Mohammed S. Al Saeed ◽  
Samir A. Badr ◽  
Mohamed A. Shaban ◽  
Aseel Abuduruk ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Clinical Judgment ◽  
Predictive Value ◽  
Scoring System ◽  
Iliac Fossa ◽  
Asian Population ◽  
Roc Curve Analysis ◽  
Arab Population ◽  
Alvarado Score

Background: RIPASA scoring has been developed to replace the disappointingly low accuracy Alvarado score in Asian population for diagnosis of acute appendicitis. Objective of present study was to compare the RIPASA and Alvarado score in Arab population and determine their accuracy when applied to our patients in Egypt and Kingdom of Saudi Arabia (KSA).Methods: By applying the RIPASA and Alvarado scores to 100 patients from KSA, 100 patients from Egypt who presented to emergency with right iliac fossa pain. The decisions for appendicectomy were based on clinical judgment only. Histopathology as gold standard was correlated with both scores. ROC curve analysis, sensitivity, specificity, positive predictive value and negative predictive value, diagnostic accuracy for RIPASA and Alvarado system were calculated using SPSS version 20.Results: On comparing both the scoring system in patients of both hospital groups, we found that sensitivity of RIPASA scoring is greater than Alvarado scoring system 95.51% and 73.03% respectively in BTH group, and 97.56% and 79.27% respectively in KASH group, while the specificity of RIPASA scoring system is less than Alvarado scoring system 72.73% and 81.82% respectively in BTH group and 66.67% and 83.33% respectively in KASH group.Conclusions: In our Arab population the RIPASA score could be applied in diagnosis of acute appendicitis with higher sensitivity, NPV and diagnostic accuracy compared to the Alvarado score.

scholarly journals Diagnostic Accuracy Of RIPASA Scoring System In Presumptive Accurate Diagnosis Of Acute Appendicitis : A case control study

2021 ◽  
Author(s):  
Mehwish Mooghal ◽  
Wajiha Khan ◽  
Shahid Mehmood ◽  
Lal Bux ◽  
Asrar Ahmad ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Accurate Diagnosis ◽  
Negative Appendectomy ◽  
Care Hospital ◽  
Cross Sectional ◽  
Ripasa Score

Introduction: The RIPASA scoring system was established specifically for Asians. Chong CF in his study consisting of 312 patients who had an emergency appendectomy concluded that optimal cut-off threshold score for negative appendectomy was 7.5. Objective: To determine the diagnostic accuracy of RIPASA scoring system in presumptive accurate diagnosis of acute appendicitis by taking histopathology as the gold standard. Materials and methods: This Cross Sectional Study was carried out at Surgery department at a tertiary care hospital, Karachi over a period of 6 months, from 15th December 2019 to 15th June 2020. A total of 141 patients of both gender of suspected cases of acute appendicitis presenting with sign and symptoms were included in the study. Patients underwent detailed history, general and physical examination and scoring of patients according to RIPASA scoring scale and then decision of appendectomy was taken on the basis of RIPASA score. Removed appendix samples were sent for histopathology. Results: Age range in this study was from 15 to 50 years with mean age of 30.191±6.09 years and mean RIPASA score was 5.375±1.77. Majority of patients were males (58.9%). RIPASA score diagnosed 28(19.9%) and histopathology diagnosed 27(19.1%) patients with acute appendicitis. RIPASA score showed sensitivity of 85.2%, specificity 95.6%, diagnostic accuracy 94%, PPV 82.1% and NPV was 96.4%. Conclusion: We conclude that RIPASA scoring system is the scoring system of choice in diagnosis of the acute appendicitis with good sensitivity albeit a hit high and specificity albeit a bit low profile.

scholarly journals Application of Modified Alvarado scoring system in the diagnosis of acute appendicitis: a study in a tertiary care hospital

2018 ◽  
Vol 6 (10) ◽  
pp. 3192
Author(s):  
Anup Kumar Saha ◽  
Ankit Sandhu ◽  
Kumar Vikram
Keyword(s):  
Acute Appendicitis ◽  
Scoring System ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Scoring Systems ◽  
Care Hospital ◽  
Alvarado Score ◽  
Cross Sectional ◽  
Group I ◽  
Negative Appendicectomy

Background: Acute Appendicitis is one of the common surgical diseases which require early intervention; however, it may lead to higher negative appendicectomy rates, in uncertain Diagnosis. Negative appendicectomy rate is 20-40%. There are various scoring systems to assist in diagnosis. The aim of this study is to assess the effectiveness of Modified Alvarado Scoring System (MASS) in patients with acute appendicitis in AGMC and GBP Hospital.Methods: This was a cross sectional study to evaluate the effectiveness of MASS in patients presenting with acute appendicitis. The Principal Investigator scored all the patients according to the variables of MASS and divided them into three groups. Group I included patients with MASS of four and below, Group II were patients with MASS of 5-6 and Group III included patients with MASS of seven and above. The diagnosis of acute appendicitis was confirmed by histopathological examination. Data was collected using a coded, pre-tested questionnaire and analyzed using SPSS statistical software version 11.5.Results: In this study, 36 cases out of 42 cases had acute appendicitis. The sensitivity of Modified Alvarado Score of >7 was 85.7% (proportion of true positive). The sensitivity was highest among males i.e., 92% while in females, it was 76.4%. Negative appendicectomy rates were highest among females (23.6%), whereas in case of males it was 8%.Conclusions: The present study has shown that MASS provides high degree of sensitivity, specificity, PPV, NPV and accuracy in the diagnosis of acute appendicitis and has found to be more helpful in and high positive predictive value for male patients as compared to females.

scholarly journals A prospective study of accuracy of modified Alvarado score in patients with acute appendicitis in tertiary care hospital

2018 ◽  
Vol 5 (3) ◽  
pp. 937
Author(s):  
Suman Parihar ◽  
M. S. Parihar ◽  
J. L. Kumawat ◽  
C. P. Joshi
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Tertiary Care ◽  
Care Hospital ◽  
Alvarado Score ◽  
Medical College ◽  
Modified Alvarado Score ◽  
A Prospective Study

Background: Acute appendicitis is the most common acute emergency of the abdomen. Clinical diagnosis of acute appendicitis is challenging in most of situation. The present study was designed to evaluate the role of modified Alvarado scoring system in diagnosis of acute appendicitis.Methods: One hundred consecutive patients presenting in the department of surgery Geetanjali Medical College and Hospital from January 2014 to 2016 were included. Demographic characteristics, symptoms and signs, laboratory results were recorded. Data was collected using a pre-tested questionnaire and analyzed using statistical calculation.Results: In the present study 100 patients were studied in a period of two years. Maximum percentage of patients were in age group 20-30 years and males dominated the series. The sensitivity and specificity of modified Alvarado score was 91.57% and 76.47% respectively with positive predictive value 95% and negative predictive value 65% and diagnostic accuracy of 89%.Conclusions: This study shows that use of modified Alvarado scoring system in patients with acute appendicitis provides a high degree of diagnostic accuracy.

scholarly journals Diagnostic Accuracy of the Alvarado Scoring System in Patients Undergoing Appendicectomy at the University Teaching Hospital in Lusaka

2020 ◽  
Vol 4 (2) ◽  
pp. 21-28
Author(s):  
Songiso Mutumba ◽  
◽  
J Mulundika ◽  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Teaching Hospital ◽  
Roc Curve ◽  
Scoring System ◽  
Area Under The Curve ◽  
University Teaching ◽  
Alvarado Score ◽  
Negative Case ◽  
The University

Background: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis has been associated with a reduction of negative appendicectomies. This study aimed to assess the diagnostic accuracy of the Alvarado scoring system at predicting acute appendicitis in patients undergoing appendicectomy at the University Teaching Hospital (UTH). Methods: A prospective study was done to evaluate the diagnostic value of the Alvarado score in patients undergoing appendicectomy at the UTH. Data was collected from the participants diagnosed with acute appendicitis and undergoing appendicectomy. The Alvarado scores for all the participants enrolled into the study were tabulated and correlated with the histopathology results. The sensitivity and the specificity of the Alvarado score was determined and used to construct the ROC curve using the SPSS version 20. The area under the curve was used to determine the diagnostic accuracy of the Alvarado score in this study. Setting: The University Teaching Hospital in Lusaka, Zambia. Results: To determine the diagnostic accuracy of the Alvarado score the ROC curve test was run in SPSS version 20. The results showed that the area under the curve was C=0.842 with SE=0.047 and 95% CI from 0.750 to 0.934. The area under the curve represents the probability that the Alvarado score result for a randomly chosen positive case will exceed the result for a randomly chosen negative case. It shows from the ROC that the Alvarado score is a good indicator to anticipate acute appendicitis. In other words, these results have confirmed that the Alvarado scoring system has very high predictive ability to discriminate acute appendicitis from normal appendix subjects. Conclusion: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis at UTH will reduce the rate of negative appendicectomies. This will lead to a reduction in unnecessary operations, which are a burden on the health care system.

scholarly journals A study of correlation between clinical, radiological and pathological diagnosis of appendicitis: a retrospective analytic study

2018 ◽  
Vol 5 (9) ◽  
pp. 3011
Author(s):  
Prabhu R. ◽  
Vijayakumar C. ◽  
Balagurunathan K. ◽  
Senthil Velan M. ◽  
Kalaiarasi R. ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Scoring System ◽  
Acute Abdominal Pain ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Radiological Finding ◽  
Clinical Signs ◽  
Emergency Setting ◽  
Alvarado Score

Background: Acute appendicitis is the most common cause of acute abdominal pain in young adults requiring emergency surgery. Appendicectomy is the most frequently performed surgery. The diagnosis is often challenging and the decision to operate in an emergency setting is always debatable. A combination of clinical signs and symptoms with laboratory findings in many scoring systems are suggesting the probability of appendicitis and the possible subsequent management pathway. The aim was to evaluate accuracy of the clinical Alvarado scoring system, radiological finding and histopathological examination for the diagnosis of acute appendicitis.Methods: A retrospective study was conducted in the department of general surgery in a tertiary care centre in South India. Total of 237 patients with acute abdominal pain were included and evaluated with the clinical Alvarado scoring system, radiological finding with (USG/CT abdomen) and histopathological examination for the diagnosis of acute appendicitis. The data was collected and analyzed retrospectively.Results: Of the 237 patients, 164 patients were male (69.1%) and rest is female. The correlation of the Alvaroda score with histopathological findings in groups with score > 7 and ≤7 the correlation of Alvarado score and the ultrasound findings were comparable between the study groups. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score >7 was 72.99%. The sensitivity of ultrasound in diagnosing acute appendicitis in patients with Alvarado score ≤7 was decreased to 27%.Conclusions: The diagnostic accuracy of clinical features is far better than radiological investigations in the diagnosis of acute appendicitis. Therefore, it is concluded that it is better to use radiological investigations only to confirm the diagnosis of acute appendicitis rather to diagnose it.

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