International Journal of Surgery Research and Practice (original) (raw)
Related papers
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
Role of Modified Alvarado Score in the Diagnosis of Acute Appendicitis
Acute appendicitis has remained the most common diagnosis of emergency hospital admissions requiring laparotomy.[1,2] Approximately 6% of the population suffers from acute appendicitis during their lifetime. The mortality rate is less than 0.1% for non-complicated appendicitis, 0.6% in gangrenous appendicitis, and 5% for perforated cases. Therefore much effort has been directed towards early diagnosis and intervention.[3] The diagnosis of appendicitis can be difficult, occasionally taxing the diagnostic skills of even the most experienced surgeons .The classical signs and symptoms of acute appendicitis were first reported by Fitz in 1886.[4] As the incidence of perforation is usually proportional to the duration of the disease process, traditional teaching has encouraged surgeons to operate even if the diagnosis is probable rather than wait until it is certain. The morbidity and mortality rates associated with appendicectomy are greatly increased when perforation ensues.[5] There is three time increase in wound infection rate, fifteen fold increases in intra – abdominal abscess and mortality may be 50 times greater.[3] Appendiceal perforation can also cause tubal infertility.[6] Hence aim of the surgeon must be to operate before perforation occurs, in spite of high rate of negative appendicectomy. The removal of normal appendix carries a price, the usual spectrum of immediate post–operative complications like hemorrhage, wound infection, intra–abdominal abscess in up to 15% of patients.[3] and late complications such as intestinal obstruction, incisional hernia[7] , right sided inguinal hernia[8] and sterility due to fimbrial adhesions.[9] Hence 20-44% negative apendicectomy rate which surgeons hence hitherto accepted, can no longer be justified.[10] Despite extraordinary advances in modern imaging and other diagnostic investigations, the accurate pre-operative diagnosis of acute appendicitis remains an enigmatic challenge. Scoring systems appear to be ideal, convenient accurate, non-invasive and require no special equipment. Modified Alvarado’s score is the most simple to use, easy to apply and is also dynamic since it relies only on history, clinical examination and basic laboratory investigations.[11] The present study aims to evaluate the usefulness of the modified Alvarado Scoring system in the preoperative diagnosis of acute appendicitis to reduce the false positive appendicectomy rate.
Acute appendicitis: accuracy of Alvarado Score in the diagnosis
North American Academic Research, 2022
Acute appendicitis causes acute abdomen in surgical patients. The Alvarado score (AS) is used to diagnose acute appendicitis. This study comprised 180 patients with acute appendicitis. Alvarado scores were determined for patients 12 years and older of both sexes. AS 1-4, 5-6, and 7-10 were the patient groups. AA and non-AA rates were compared using different parameters. We analyzed each patient's signs, symptoms, lab results, surgical procedures, and pathology reports. Histopathology confirmed diagnosis. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were calculated. Data analysis utilized SPSS 16. 180 cases were studied, 72 men (40%) and 108 women (60 %). 129 patients (76.6%) were under 30 years of age. 20 percent of patients with Alvarado score 1-4 had acute appendicitis, 35.29 percent with 5-6, and 96% with 7-10. AS increased negative appendicectomy rate. AS was 90% accurate in diagnosing acute appendicitis. This study demonstrated no variation in AS reliability by gender, age, or BMI. Alvarado scoring system helps diagnose acute appendicitis before surgery, especially in resource-limited settings.
Bangladesh Journal of Medical Science, 2016
Aim: To evaluate the usefulness and feasibility of the Alvarado scoring system in acute surgery in reducing the percentage of negative appendicectomy in our institute.Materials and Methods: A prospective study was conducted, comprising 100 patients, admitted to department of Surgery in Maharishi Markendeshwar Institute of Medical sciences & Research (M.M.I.M.S.R), Mullana, Ambala, India during the period October 2012 to July 2014 with a preliminary diagnosis of acute appendicitis. Patients of both sexes and all age groups were included in the study and their Alvarado scores calculated, on the basis of which patients were divided into three groups: group1 (alv. Score >7) , group 2 (alv. score 5-6), group 3 (alv. Score <4). 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 of scoring sy...
Alvarado scoring system in prediction of acute appendicitis. J Coll Physicians Surg Pak. 2011 Dec;21(12):753-5. doi: 12.2011/JCPSP.753755. [PubMed] PMID:22166697, 2011
Objective: To evaluate the diagnostic accuracy of Alvarado score for the prediction of acute appendicitis.Study Design: Analytical study.Place and Duration of Study: This study was carried out in the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, during the period from January 15, 2009 to July 15, 2010.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).Conclusion: The presence of a high Alvarado score in adult males is highly predictive of acute appendicitis, however, in women of child bearing age other causes of similar clinical presentation lead to a low diagnostic accuracy of the score.