A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis

Gupta, Sapna; Kolli, Venkata S.; Costa, Kimberly Da; JAVED, S.O.; Ammar, Ahmed; Rasheed, Ashraf

doi:10.1097/ms9.0000000000000238

Cited by 5 publications

(8 citation statements)

References 57 publications

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“…It encompasses eight different clinical findings, totaling 10 points: migration of pain - 1 point, anorexia - 1 point, nausea - 1 point, tenderness in the right lower quadrant - 2 points, rebound pain - 1 point, elevated temperature - 1 point, leukocytosis - 2 points, and shift of white blood cell count to the left - 1 point. [ 10 ] In this study, the Alvarado score was determined for all patients diagnosed with AA, and it was found to be higher in CAA patients (p<0.001). The Alvarado score was used as the baseline in the newly designed scoring system.…”

Section: Discussionmentioning

confidence: 75%

Identification of complicated and non-complicated appendicitis: a new alvarado-based scoring system

Polat Düzgün

2024

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: In the presence of non-complicated appendicitis, treatment typically involves a simple appendectomy and can even be managed medically. However, in cases of complicated appendicitis, surgery becomes more difficult, and the morbidity and mortality rates increase. This study aims to develop a method for recognizing complicated acute appendicitis operatively. METHODS: This retrospective study developed a scoring system based on the Alvarado score. Several variables were scored in this new scoring system, including the Alvarado score, female gender, elevated direct bilirubin, increased appendicitis thickness, and the presence of complications as evidenced by imaging or appendicoliths. RESULTS: The study included a total of 404 patients with a mean age of 38.50±12.94 years, all operated on for acute appendicitis. Of these, 45.8% were female. Complicated acute appendicitis was present in 25% of the patients. The presence of complicated acute appendicitis was identified with a sensitivity of 86.1% and a specificity of 90.4% in patients who scored 10.5 or above. CONCLUSION: It is critical to identify perioperative and postoperative complications, provide appropriate patient counseling, and consider medical treatment when appropriate to diagnose acute complex appendicitis effectively. The new scoring system is an effective method for recognizing acute complicated appendicitis.

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Section: Discussionmentioning

confidence: 75%

Identification of complicated and non-complicated appendicitis: a new alvarado-based scoring system

Polat Düzgün

2024

Ulus Travma Acil Cerrahi Derg

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Section: Introductionmentioning

confidence: 99%

“…Acute appendicitis is one of the most common causes of abdominal pain in the emergency department and is clinically characterised by a rapid onset, rapid change in condition and metastatic abdominal pain. 1 , 2 Acute appendicitis is an inflammatory condition of the appendix with earthy malformation, located in the right lower abdominal quadrant, and the pain often worsens with inflammation and shifts proportionately. 3 However, the diagnosis of acute appendicitis is not easy, and with the advent of ultrasound and computed tomography, the diagnosis of acute appendicitis can be made in 85%–90% of cases, but in fact these diagnostic modalities are time‐consuming, expensive and may not always be available, especially in young children who are unable to accurately describe their pain.…”

Section: Introductionmentioning

confidence: 99%

Effects of clinical nursing pathway on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta‐analysis

Zhang,

et al. 2023

International Wound Journal

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This study aimed to explore the impact of clinical nursing pathway applied to acute appendicitis surgery on patients' postoperative wound infections and complications. A computerised search of PubMed, Cochrane Library, Web of Science, EMBASE, Wanfang, Chinese Biomedical Literature Database and China National Knowledge Infrastructure was conducted and supplemented by a manual search, from database inception to October 2023, to collect randomised controlled trials (RCTs) on the application of clinical nursing pathways to acute appendicitis surgery. Literature screening, data extraction and quality assessment of the included literature were carried out independently by two researchers. RevMan 5.4 software was applied for data analysis. Twenty‐one RCTs with a total of 2408 patients were finally included. The analysis revealed the implementation of clinical nursing pathway could effectively reduce the incidence of wound infection (OR = 0.26, 95% CI: 0.15–0.46, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15–0.27, p < 0.001), as well as shorten the hospital length of stay (MD = −3.26, 95% CI: −3.74 to −2.79, p < 0.001) and accelerated the time to first ventilations (MD = −14.85, 95% CI: −21.56 to −8.13, p < 0.001), as well as significantly improved patient satisfaction (OR = 5.52, 95% CI: 3.52–8.65, p < 0.001) in patients undergoing surgery for acute appendicitis. The application of clinical nursing pathway in acute appendicitis surgery can significantly reduce postoperative wound infection and complications, and at the same time can shorten the hospital length of stay as well as improve the satisfaction of patients.

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“…According to the summary of the results of studies validating the most common score systems by Kularatna et al, AIR has the greatest diagnostic accuracy, its sensitivity and specificity being 92% and 63%, respectively [ 7 ], but according to a prospective study in 2020 made by Elsherbiny et al, Alvarado score is specific in the diagnosis of acute appendicitis and could identify all patients with normal appendix [8]. Furthermore a systematic review by Gupta et al suggests that high Alvarado score (7 and above) is a significant predictor for acute appendicitis [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Validation of the modified Alvarado score on patients attending A&E units with suspected appendicitis

Mán,

Szilágyi,

Simonka

et al. 2023

BMC Emerg Med

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Introduction The aim of our prospective study was to confirm validity and diagnostic accuracy of the modified Alvarado score, which was developed at the Department of Surgery, University of Szeged, on patients presenting with symptoms suggestive of acute appendicitis (right lower quadrant complaints) at the A&E department. Patient population, methods 138 patients were included in our study between 01.01.2019 and 01.01.2020. For patients attending A&E, the first medic calculated and recorded the modified Alvarado score before surgical consultation. The consulting surgeon decided on further treatment without knowing the score. Validation of the score was based on the pathology report of the removed appendix (whether the operation was warranted, and if the score also supported indication for surgery), if there was readmission or surgery due to worsening symptoms after discharge from A&E. We also examined if there was any connection between the value of the Alvarado score and the severity of inflammation. Our aim was to prove that using modified Alvarado score at the A&E Units helps to reduce patient’s waiting time and avoid unnecessary surgical consultations. Furthermore our study included measuring the diagnostic accuracy of the ultrasound examination (specificity, sensitivity). Results Based on the results, patients presenting at A&E had a mean modified Alvarado score of 6.5. Comparing the score to histological results showed that the specificity of the modified Alvarado score was 100%, and its sensitivity was 80.7%. Based on Spearman’s rank correlation (0.796) and ROC analysis (AUC 0.968), the modified Alvarado score has an excellent predictive value in diagnosing acute appendicitis. When comparing the patients’ waiting times with the use of modified Alvarado score and without it we found that there was a significant difference in group also in group under 4 points and in group over 7 points when using modified Alvarado score, so the diagnostic and therapeutic algorithm should be much quicker with the help of the score. We found a correlation between the severity of inflammation based on the Fisher’s exact test. Rank correlation of the same question also showed a significant connection. All patients had an US examination during their diagnostic course, its sensitivity was 82.6%, specificity was 87%. Based on this, we can conclude that the predictive value of the imaging method is good. Conclusions We can conclude according to our results that the predictive value of the modified score is excellent, and it can be safely applied by non-surgeons in urgent care in the differential diagnosis of acute appendicitis. The new score incorporates the results of an easily obtainable, ionising radiation free imaging method, the ultrasound, which was not included in previous scores. With the help of the new score, the number of unnecessary surgical referrals and waiting times for patients are reduced, excess examinations will become avoidable.

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A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis

Cited by 5 publications

References 57 publications

Identification of complicated and non-complicated appendicitis: a new alvarado-based scoring system

Identification of complicated and non-complicated appendicitis: a new alvarado-based scoring system

Effects of clinical nursing pathway on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta‐analysis

Validation of the modified Alvarado score on patients attending A&E units with suspected appendicitis

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