Acute appendicitis: accuracy of Alvarado Score in the diagnosis (original) (raw)
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Alvarado Scoring System in Prediction of Acute Appendicitis
2011
Objective: To evaluate the diagnostic accuracy of Alvarado score for the prediction of acute appendicitis. Methodology: The study included all adult patients of either gender who presented with clinical findings suggestive of acute appendicitis, who were assigned Alvarado score of < 4 pre-operatively and subsequently underwent emergency appendicectomy with histological examination of the resected specimens. Based on the Alvarado score, the patients were stratified into two groups. i.e. Group I (with a score of > 7) and Group II (with a score of 5-7). Alvarado score was compared with the histopathology. The data was subjected to statistical analysis to measure the objective. Results: The overall sensitivity, specificity, positive predictive value and negative predictive value of Alvarado score for acute appendicitis were 66%, 81%, 96%, 29% respectively. The sensitivity was higher though not significant, for males with a score over 7 than females with similar scores (97% vs. 92%). However, for scores less than 7, sensitivity among males was significantly higher than females with similar scores (79% vs. 61%; p < 0.05).
Surgical Endoscopy, 2014
Background The Alvarado score is a clinical scoring system used in the diagnosis of acute appendicitis. This study aimed to compare the reliability of the Alvarado score and clinical judgment and to refine the score to make it easier to use. Methods In this prospective, randomized study, patients presenting at the authors' outpatient department with suspected appendicitis during a 1-year period were assigned in weekly alternation to either group A or group B. The group A patients were treated on the basis of their Alvarado score, and the group B patients underwent treatment based on clinical judgment. The correctness of the methods was assessed by evaluation of the final histology. Statistical comparison of the data was performed using SPSS 20. Results The study investigated 269 patients (131 in group A and 138 in group B). The groups were homogeneous in terms of mean age, gender, body mass index, and American Society of Anesthesiologists score. The number of negative appendectomies was 12 (9.16 %) in group A versus 5 (3.6 %) in group B (p = 0.063). The clinical judgment had better specificity and sensitivity than the Alvarado score. For that reason, the specificity of the Alvarado score was refined using statistical methods, with weighting of certain clinical data and inclusion of new ones (e.g., ultrasound investigation). Consequently, the area under the curve by receiver operating characteristic analysis gradually increased, and the Alvarado score became more accurate. Conclusion The study findings showed clinical judgment to be more reliable in the diagnosis of acute appendicitis than the Alvarado score, but the score is a useful diagnostic aid, especially for young colleagues. The use of the new scoring system has become easier. It includes fewer criteria as well as an important and sensitive predictor: the ultrasound investigation. Keywords Appendix Á Statistical Á Technical Á Abdominal Á Ultrasonography Acute appendicitis is the most common urgent surgical condition, with 9 % of the population affected [1]. Its differential diagnosis is extremely difficult, especially for the elderly, children, and fertile-age women, in whom it can mimic numerous gynecologic and urogenital conditions [2]. The lethality of the condition is about 0.7 %, which means that it causes the death of almost 100 patients in Hungary each year [3]. Furthermore, the number of negative appendectomies remains in the approximate range of 5-10 %, although the negative appendectomy rate (NAR) has decreased in recent decades due to better diagnostic techniques (i.e., ultrasound and preoperative computed tomography [CT]) [4]. The diagnosis of acute appendicitis is based on the medical history, the physical examination, and the laboratory analysis, but imaging techniques (ultrasound and CT scan) also may be helpful. The ultrasound scan is easy to perform and inexpensive, but its result is examiner-and patientdependent. With its help, however, the number of negative appendectomies can be decreased by 10 % [5]. The CT scan
Role of alvarado score in diagnosis of acute appendicitis
Journal of Surgical Sciences
Background: Appendicitis may be associated with morbidity and occasionally mortality. If failed to diagnose early, the situation may become more complicated. Objective: To validate the role of Alvarado score in diagnosis of acute appendicitis. Methods: A total of 282 patients with clinically diagnosed acute appendicitis were included in this study. Patients were examined thoroughly, investigated and managed accordingly. The relevant data collected and analyzed. Results: Out of 282 patients, surgical procedures were performed in 59.57% of the patients. The overall negative Appendectomy rate was 9.52%, and the percentage of Positive Predictive Value (PPV) for Alvarado score was 92.26%. Conclusion: Our study validates the Alvarado score as fast, simple and reliable diagnostic tool for acute appendicitis. Journal of Surgical Sciences (2017) Vol. 21 (2): 94-98
Evaluation of Alvarado Score in Diagnosing Acute Appendicitis
Journal of Universal Surgery
Background: Using a reliable scoring system to diagnose acute appendicitis can help reduce the rate of unnecessary surgery and, henceforth, its complications. This cohort study aimed to evaluate Alvarado scoring system for diagnosing acute appendicitis in our health facility. Methods: 100 patients of different age groups with clinical suspicion of acute appendicitis admitted in the General Surgical Ward, Karak Teaching Hospital in Karak, Jordan, from April, 2013 to December, 2014 were included in the study. All patients underwent surgery and were grouped according to the variables of Alvarado scoring system and then divided into two groups. Group I patients (score 7 or more), group II patients (scores 3-5, and 5-6). Diagnosis was confirmed by histopathologic examination. Reliability of scoring system was assessed by calculating negative appendectomy rate and positive predictive value. Results: Out of total 100 patients, appendicitis was confirmed 80 patients, thus giving negative appendectomy rate of 20% (male 6%, female 16%). Perforation rate was 4%, positive predictive value was 90%, negative predictive value of 29%, sensitivity of 54%, specificity 75%, and diagnostic accuracy value of 58%. Conclusion: Alvarado score is not sensitive tool for aiding diagnosis of acute appendicitis.
Acute appendicitis: Diagnostic accuracy of Alvarado scoring system
Asian Journal of Surgery, 2013
To evaluate the usefulness of the Alvarado scoring system in reducing the percentage of negative appendectomy in our unit. Materials and methods: A cross-sectional study was conducted, comprising 110 patients, admitted to Surgical Unit I, Civil Hospital, Karachi, in 2011 with a preliminary diagnosis of acute appendicitis. Patients of both sexes and all age groups except younger than 10 years were included in the study and their Alvarado scores calculated, on the basis of which patients were divided into two groups: Group A (Alvarado score <6) and Group B (Alvarado score 6). The signs, symptoms, laboratory values, surgical interventions, and pathology reports of each patient were evaluated. Diagnosis was confirmed by histopathological examination. Sensitivity, specificity, and positive and negative predictive values were calculated. Results: Out of 110 cases (79 males, 31 females), 31 belonged to Group A (28.2%) and 79 belonged to Group B (71.8%). Surgical procedures were performed in 98.2% of cases, along with conservative treatment. Final diagnosis by histopathology was confirmed in 77 cases (71.3%). The overall negative appendectomy rate was 28.7% (males: 28.2%, females: 30%). Sensitivity and specificity of the Alvarado scoring system were found to be 93.5% and 80.6% respectively. Positive and negative predictive values were 92.3% and 83.3%, respectively, and accuracy was 89.8%. Conclusion: Alvarado score can be used effectively in our setup to reduce the incidence of negative appendectomies. However, its role in females was not satisfactory and needs to be supplemented by other means.
Evaluation of the Alvarado score in the diagnosis of acute appendicitis
Acta Chirurgica Iugoslavica, 2008
We performed this study on 57 patients with diagnosis suspected for acute appendicitis (ages 16-70). Parameters that make the Alvarado score are the following: migration of pain, anorexia, nausea or vomiting, right lower abdominal quadrant tenderness, rebound tenderness in right iliac fossa, elevated temperature, leukocytosis, shift to the left of neutrophils. The aim of the work is to evaluate the Alvarado scoring system in diagnosis of the acute appendicitis. With all the patients Alvarado score has been determinate preoperatively, and diagnosis was confirmed by intraoperative finding and histopatological examination of the removed appendix. All the patients with score 7 or more were surgically managed. Specificity (positive predictive value) was 92,59 % in males and 76,67 % in females. The negative appendectomy rate was 7,41 % with the males and 23,33 % with the females. The values of the Alvarado score are significantly higher in the patients with acute appendicitis, compared with the patients of the other diseases. With the application of the Alvarado scoring system we can decrease postoperative morbidity and mortality.
Evaluation of Alvarado score in the Early Diagnosis of Acute Appendicitis: A Prospective Study
Journal of Medical Science And clinical Research
Acute appendicitis is a common surgical emergency condition with difficulty in accurate diagnosis. Alvarado scoring system is useful tool for early diagnosis. Aim of this study: This study is to evaluation of Alvarado score system in the early diagnosis of acute appendicitis: a prospective study. Materials and Methods: All consecutive patients with diagnosis of acute appendicitis admitted and evaluated by scoring system described by Alvarado. Patient who had undergone surgery, the diagnosis of appendicitis was confirmed by histo-pathological examination and compared with previous clinical diagnosis on the basis of Alvarado score. Results: Accuracy of diagnosis in male patients was more sensitive then female patient in child bearing age.
The professional medical journal, 2015
The objective of this study was to compare the efficacy of Clinical Evaluation and modified Alvarado scoring system in diagnosing acute appendicitis. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at Surgical Unit III of Civil Hospital Karachi from May 2010 to October 2010. Methodology: This study consisted of eighty patients. Patients were divided in two groups. Group A for complete clinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring system comprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea, vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively and undergoing emergency appendectomy during this period, age >12 years and both gender. Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant female patients and those who did not give written consent. Results: A total of 80 patients were included in the study, placed alternatively into two groups of 40 patients each with majority being male (n = 61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients of Group A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basis of Gender for the two groups, the positive predictive value for male patients of Group A and B was 90.09% and 89.28% respectively, but for females the positive predictive value of Group A and B was 100% and 50% respectively. Conclusion: We conclude that modified Alvarado score can be used safely and effectively in diagnosing acute appendicitis in adult males especially as the score increases from seven to nine.
Modified Alvarado Score in Diagnosis of Acute Appendicitis
2006
Background: Acute appendicitis is one of the commonest surgical emergencies in all ages. Diagnosis is mainly clinical, delay in diagnosis definitely increases the morbidity, mortality and cost of treatment, more aggressive surgical approach has resulted in increased white appendectomies. Methods: A total 100 cases hospitalized with abdominal pain, suggestive of acute appendicitis on the basis of modified Alvarado scoring system and were subsequently operated, were included in the present study in our institute for period of 20 Months. Results: Males belonging to young age group of 21-30 were most commonly affected. Abdominal pain was seen in 100% of patients. Fever seen in 87% of patients and vomiting in78%. Modified Alvarado score of 9 had positive predictive value of 100% while negative predictive value 8.9%, while score between 7-8 had positive predictive value of 98.9% and negative predictive value 27.8%. The sensitivity was 86.1% and specificity was 83.3%. The ultrasonography showed a sensitivity of 94.68%. In present study rate of total white appendectomy was 6%. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy. Conclusions: Young males are most commonly affected almost always presents with abdominal pain. The Modified Alvarado scoring system is a reliable and practicable diagnostic modality to increase the accuracy in diagnosis of acute appendicitis and thus to minimise unnecessary appendectomy.
Evaluation of validity of Alvarado scoring system for diagnosis of acute appendicitis
Pak J Med Sci April-June, 2009
Objective: Appendicitis is part of the differential of an acute abdomen and can be difficult diagnosis to make. A number of clinical scores have been developed attempting to decrease the false-positive rates of appendectomies. In this study we evaluated validity of Alvarado score in patients with suspected appendicitis and compared its performance between men and women. Methodology: From May 2006 to December 2007, 152 adults who were operated for acute abdominal pain and diagnosis of acute appendicitis were evaluated. In each patient, signs, Symptoms, laboratory values and pathology reports were collected and evaluated. The sensitivity, specificity, positive and negative predictive values and receiver operator characteristic curves of each indicator were calculated in men and women. Results: In this study, we evaluated 152 patients (85 men, 67 women). In men, 71 patients had acute appendicitis. In women, 49 patients had acute appendicitis. In men the mean of total score was 7.3±1.18 in patients with acute appendicitis and 5.40.75 in non-appendicitis patients (p=0.001). In women, the mean of total score was 7.21.19 in patients with appendicitis and 6.31.37 in non-appendicitis patients (p=NS). The area under the curve was 0.91 for men and 0.71 for women Conclusion: Our study showed that Alvarado score is not accurate for determination of acute appendicitis in women. It also showed that in all patients with abdominal pain and right lower quadrant tenderness, operation should be performed without using the Alvarado score. Sanei B, Mahmoodieh M, HosseinpourM. Evaluation of validity of Alvarado scoring system for diagnosis of acute appendicitis. Pak J Med Sci 2009;25(2):298-301.