Validation of the Modified Alvarado Score in Patients Attending A&E Unit With Suspected Appendicitis – Prospective Clinical Study

BackgroundThe aim of our prospective study was to confirm the validity, diagnostic accuracy of the modified Alvarado score developed in the Department of Surgery, University of Szeged.Methods138 patients were enrolled in our study between 01 January 2019 and 01 January 2020. The patient’s modified Alvarado score was calculated in the Emergency Department before surgical consultation and decision of further therapy. The score was validated based on the final histology finding of the removed appendix. Additionally, potential correlation was examined between the frequency of drain usage, hospital stay, antibiotic use and the severity of the inflammation. ResultsComparing the scores with the histological findings, specificity of the modified Alvarado score was 84.78%, its sensitivity was 97.83% (with cutoff value of 5.5). Spearman's rank correlation (0.796) and ROC analysis (area under the curve 0.968) confirmed that the modified Alvarado score has an excellent predictive value in the diagnosis of acute appendicitis. Based on the result of the Fisher's exact test, cross tabulation and Spearman’s rank correlation correlation was found between the severity of the inflammation determined by the histology finding, the selected antibiotic and the duration of the antibiotic therapy, the average duration of hospitalization and drain insertion. ConclusionsBased on the results of our study, predictive value of the new, modified score system is excellent, using this score system is safe in the differential diagnosis of acute appendicitis as an aid for non-surgical consultants in emergency care. This new score system may decrease the number of unnecessary surgical consultations, decrease waiting time of the patients and some unnecessary examinations can be avoided. Trial RegistrationValidation of the modified Alvarado score in patients presenting in the Emergency Department with right lower abdominal complaints, ethical license number: 248/2018/SZTE, date of registration: 2018.11.04., name of ethics committee: SZTE SZAKK Regionális és Intézményi Humán Orvosbiológiai Kutatásetikai Bizottság- Clinical Research Coordination Office of the University of Szeged

Comparison of the Modified Alvarado Score and Ultrasonography for Diagnosing Acute Appendicitis

Background: Acute appendicitis can be diagnosed much accurately by using Modified Alvarado score and Ultrasound together in the clinical setting. Objectives: Comparison of the diagnostic accuracy of Modified Alvarado score and Ultrasonographic findings in acute appendicitis. Materials and Methods: A total of 200 patients of age group ranging from 4-65 years, both male and female, who visited the tertiary health care center with clinical features suggestive of acute appendicitis were randomly selected. Data from the patients regarding their Modified Alvarado score, ultrasonographic findings and histopathological reports were collected for the study. Statistical analysis was performed for the results of both Modified Alvarado score and Ultrasonographic findings in contrast to the pathology reports. Results: The study included 200 patients, with maximum incidence of acute appendicitis seen in males (70.5%) and among 21-30 age groups (40.5%). The sensitivity, specificity of Modified Alvarado Score was 89.47% and 73.33%, with Positive Predictive Value, Negative Predictive Value and diagnostic accuracy being 40%, 73.33% and 45% respectively. Ultrasonography revealed 89.58% sensitivity, 15.62 % specificity, Positive predictive value and NPV were 75.88% and 50%, and diagnostic accuracy was 72%. The negative appendectomies rates accounted to 15%. Conclusion: It is advised that both Modified Alvarado score and Ultrasound can be used to together to diagnose acute appendicitis. This can be useful in decreasing the negative appendectomies and hence reduce the morbidity and mortality.

Effectiveness of Modified Alvarado Scoring System for Diagnosis of Acute Appendicitis

BACKGROUND Acute appendicitis is very commonly diagnosed when a patient presents with acute abdomen. This is more commonly seen in the young and middle-aged individuals. The clinical signs and symptoms determine the diagnosis and management. Scoring systems are in plenty to diagnose acute appendicitis and mainly include the presenting signs and symptoms, but are not acceptable for all populations with different age groups. Modified Alvarado scoring system is a timed tested scoring system used in different populations and age groups with good efficacy and to provide a bedside clinical diagnosis of acute appendicitis. The purpose of this study was to assess effectiveness of modified Alvarado score in the early diagnosis of acute appendicitis. METHODS A prospective observational study was done which incorporated 50 patients presenting with the signs and symptoms pointing out to acute appendicitis, clinically. The patients were evaluated by Modified Alvarado score during admission and based on the treating surgeon’s decision, were operated. Finally, the score was compared with the diagnosis achieved with a histopathological examination of the operated specimen. RESULTS The sensitivity of raja isteri penigran anak saleha appendicitis (RIPASA) score was 70.58 %, specificity was 68.75 %, positive predictive value (PPV) was 82.75 %, negative predictive value (NPV) of RIPASA score was 52.38 % and the diagnostic accuracy of RIPASA score was 70 %. CONCLUSIONS Modified Alvarado scoring system is simple scoring system which can be used in a bedside manner but uses specific and limited features for the diagnosis of acute appendicitis which limits the effectiveness of this scoring system. KEY WORDS Acute Abdomen, Clinical Scoring System, Modified Alvarado Scoring System

Comparative study between clinical diagnosis using modified Alvarado score and ultrasound imaging in decreasing negative appendectomy rate

Background: Acute appendicitis is the acute inflammation of appendix which is the most common cause of acute surgical emergencies. Appendicitis can mimic other pathologies. Removing normal appendix is an economical burden both on patients and health resources. Misdiagnosis and delay in surgery can lead to complications like perforation and finally peritonitis.Methods: This was prospective comparative study carried out in 200 patients over the period of 2 years. Patients with clinical features of acute appendicitis and fitting in inclusion and exclusion criteria were selected. Detailed history was noted and clinical examination was done. Necessary investigations were done, modified Alvarado score was calculated and all were subjected to ultrasonography of abdomen and pelvis. Intra operative findings were noted about nature of appendix and histopathology findings were noted.Results: The sensitivity of ultrasound is 78.19% and specificity is 50%. The sensitivity of modified Alvarado scoring system is 78.7% and specificity is 25%. Negative appendicectomy rate in the study was 6%.Conclusions: Modified Alvarado score has slightly higher sensitivity and ultrasound imaging has higher specificity of in the diagnosis of acute appendicitis and in decreasing negative appendicectomy rates. Ultrasound imaging provides good supportive diagnosis in cases of low or equivocal modified Alvarado scores.

A clinical study on conservative management of acute appendicitis in a tertiary care centre

Background: Acute appendicitis is the most common clinical entity which is treated surgically by appendectomy. In recent years acute uncomplicated appendicitis can also be managed non surgically with antibiotic therapy. Aim and Objective was to assess the outcome of conservative treatment in the management of acute appendicitis.Methods: All patients who were diagnosed as acute appendicitis radiologically were enrolled into the study considering inclusion and exclusion criteria. Modified Alvarado score (MAS) was calculated based on clinical symptoms, signs and laboratory investigations. Injection ceftriaxone and injection metronidazole was given for 48-72 hours. Patients who responded for i.v. antibiotics were switched to tablet ciprofloxacin and tablet metronidazole for 7 days and followed for 6 months. Patients who didn’t respond to conservative treatment or had recurrence were classified as treatment failure/recurrence.Results: Totally 100 patients were enrolled in the study, 43 males and 57 females with a ratio of 1:1.32. Majority were in age group of 21-30. Ultrasound was performed in 91 patients, CT scan in 9 patients. 28 patients had MAS between 4-6 and 72 had between 7-9. 82 patients were successfully managed conservatively. 12 patients had failure of conservative treatment and 6 patients had recurrence.Conclusions: Success rate of conservative treatment in patients with MAS 4-6 was more than those with MAS 7-9 in this study. Complicated acute appendicitis should be managed surgically and uncomplicated acute appendicitis can be managed by conservative treatment provided they are strictly followed every month for 6 months to detect recurrences.

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

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.

EVALUATION OF THE PERTINENCE OF MODIFIED ALVARADO SCORE IN THE DIAGNOSIS OF 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.

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

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.