Alvarado score: can it reduce unnecessary CT scans for evaluation of acute appendicitis?

Apisarnthanarak, Piyaporn; Suvannarerg, Voraparee; Pattaranutaporn, Poompis; Charoensak, Aphinya; Raman, Steven S.; Apisarnthanarak, Anucha

doi:10.1016/j.ajem.2014.11.056

Cited by 36 publications

(32 citation statements)

References 30 publications

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“…The RRLs for these examinations are designated as "varies." not improved the outright diagnostic accuracy of the clinical examination [3], and demonstrate mixed results as an adjunct to help guide CT use [4,5]. Imaging remains the diagnostic mainstay in the workup of suspected appendicitis and RLQ abdominal pain.…”

Section: Summary Of Literature Review Introduction/backgroundmentioning

confidence: 99%

ACR Appropriateness Criteria® Right Lower Quadrant Pain-Suspected Appendicitis

García

Camacho

Karolyi

et al. 2018

Journal of the American College of Radiology

108

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Appendicitis remains the most common surgical pathology responsible for right lower quadrant (RLQ) abdominal pain presenting to emergency departments in the United States, where the incidence continues to increase. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of experts.

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Section: Summary Of Literature Review Introduction/backgroundmentioning

confidence: 99%

ACR Appropriateness Criteria® Right Lower Quadrant Pain-Suspected Appendicitis

García

Camacho

Karolyi

et al. 2018

Journal of the American College of Radiology

108

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“…Specifi city and sensitivity of BT is high in diagnosis of acute appendicitis (25). Appendix diameter, which is over 7 mm in BT images, supports the diagnosis of acute appendicitis (26,27).…”

Section: Discussionmentioning

confidence: 86%

Laboratory in complicated appendicitis prediction and predictive value of monitoring

Aydın¹,

Soylu²,

Dandin³

et al. 2017

BLL

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OBJECTIVES: The purpose of the study was that monitoring, which is used in diagnosis of acute appendicitis, and laboratory values, were evaluated for verifying diagnosis of complicated appendicitis and these parameters revealed cut-off values in complicated acute/non-complicated appendicitis. METHODS: 195 patients, who had had an operation for acute appendicitis between January 2012 and March 2015 and who were proved to have acute complicated/non-complicated appendicitis from the results of histopathology consideration, were included in this study. Patients' age, preoperative serum, WBC, CRP, NLR and BT with USG results were evaluated. RESULTS: Among the groups, there were no meaningful differences in the sense of age. CONCLUSION: It is important that treatment options are evaluated to be able to discriminate complicated appendicitis fast and with a high accuracy. In the case that serum WBC is higher than 13800. CRP is higher than 5.98, NLR is higher than 4.87 and appendicitis diameter is longer than 11mm, infl ammation of appendicitis is complex with gangrene, perforation and abscess and it emphasizes the suggestion of surgical treatment option to patients (Tab. 4, Fig. 1, Ref. 28). Text in PDF www.elis.sk.

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“…Although it has been shown in the radiology literature that the use of US and computed tomography (CT) has improved the diagnostic performance of physicians, these study modalities are time-consuming, delay the diagnosis and fi nal disposition, and in the case of CT, the patient is exposed to ionising radiation. [14][15][16][17][18][19][20] Appendicitis is diagnosed using US by demonstrating the lack of compressibility of a non-peristalsing tubular structure found in the lower-right quadrant that measures more than 6 mm in diameter (Figure 1). Depending on the patient's body habitus, it may be necessary to use constant pressure in the lower-right quadrant with a transducer to compress subcutaneous fat and displace loops of the bowel.…”

Section: Discussionmentioning

confidence: 99%

Application of scoring systems with point-of-care ultrasonography for bedside diagnosis of appendicitis

Ünlüer

Urnal

Eser

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND: Appendicitis is a common disease requiring surgery. Bedside ultrasound (BUS) is a core technique for emergency medicine (EM). The Alvarado score is a well-studied diagnostic tool for appendicitis. This study aimed to investigate the relationship between patients' symptoms, Alvarado score and ultrasound (US) findings, as performed by emergency physicians (EPs) and radiologists, of patients with suspected appendicitis. METHODS:Three EM specialists underwent the BUS course and core course for appendicitis assessment. Patients suspected of having appendicitis were selected and their Alvarado and modifi ed (m) Alvarado scores calculated. The specialists performed the BUS. Then, patients were given a formal US and surgery consultation if necessary. Preliminary diagnoses, admission or discharge from the emergency department (ED) and fi nal diagnosis were documented. The patients were also followed up after discharge from the hospital. RESULTS:The determined cut-off value was 2 for Alvarado and 3 for mAlvarado scores. The sensitivities of the two scores were 100%. Each score was used to rule out appendicitis. The results of EP-performed BUS were as follows: accuracy 70%, sensitivity 0.733, specifi city 0.673, + LR 2.24, and -LR 0.40 (95%CI). Radiologists were better than EPs at diagnosing appendicitis and radiologists and EPs were equally strong at ruling out appendicitis by US. When US was combined with Alvarado and mAlvarado scores, EP US+Alvarado/mAlvarado scores ≤3 and radiology US+Alvarado/ mAlvarado scores ≤4 perfectly ruled out appendicitis.CONCLUSION: BUS performed by EPs is moderately useful in detecting appendicitis. Combined with scoring systems, BUS may be a perfect tool for ruling out decisions in EDs.

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Alvarado score: can it reduce unnecessary CT scans for evaluation of acute appendicitis?

Cited by 36 publications

References 30 publications

ACR Appropriateness Criteria® Right Lower Quadrant Pain-Suspected Appendicitis

ACR Appropriateness Criteria® Right Lower Quadrant Pain-Suspected Appendicitis

Laboratory in complicated appendicitis prediction and predictive value of monitoring

Application of scoring systems with point-of-care ultrasonography for bedside diagnosis of appendicitis

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