Combined Use of Modified Alvarado Score and USG in Decreasing Negative Appendicectomy Rate: Critical Appraisal of Data

Garg, Pankaj Kumar; Jain, Bhupendra Kumar

doi:10.1007/s12262-013-0878-4

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“…[ 1 ] The accuracy of a clinical diagnosis ranges somewhere between 70% and 85%. [ 2 ] Although ultrasonography (USG) is often helpful in ruling out other diagnoses, it has its own drawbacks and histopathology still remains the gold standard for confirming AA. [ 3 ] The clinical course can progress over a period of 48–72 h from a simple, nonperforated, or uncomplicated AA (UC-AA) to complicated conditions (C-AA), such as perforation and intraabdominal abscess or, in extreme cases, fecal peritonitis.…”

Section: Introductionmentioning

confidence: 99%

Role of Ultrasonography and Inflammatory Markers in Predicting Complicated Appendicitis

Banerjee

Ratan

Neogi

et al. 2022

Journal of Indian Association of Pediatric Surgeons

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Aim: The aim is to compare the diagnostic accuracy of laboratory investigations and ultrasonography (USG) in distinguishing complicated appendicitis (C-AA) from uncomplicated appendicitis (UC-AA). Materials and Methods: Forty-six children who underwent appendicectomy at our center between November 2018 and July 2020 were included. Based on intraoperative findings, they were divided into two groups – complicated (perforated, gangrenous, or associated with fecal peritonitis; n = 18) and UC-AA (n = 28). USG findings and inflammatory markers were compared in both groups at admission. Results: At admission, the mean values for total leukocyte count (TLC) (16090.56 vs. 11739.29 per mm3), high sensitivity C-reactive protein (hsCRP) (35.8 vs. 31.62 mg/L), and procalcitonin (PCT) (3.83 vs. 1.41 ng/mL) were significantly higher in C-AA. Visualization of a blind tubular aperistaltic structure was the only sonographic sign showing statistical significance – significantly lower in C-AA (50% vs. 90%). Independent predictors of C-AA were – duration of symptoms >48 h (odds ratio [OR] 6.3), free fluid/loculated collection in right iliac fossa (OR 3.75), TLC >11000/mm3 (OR 3.6), hsCRP >35 mg/L (OR 6.0), PCT >0.6 ng/mL (OR 4.02), and nonvisualization of appendix on USG (OR 8.33). Biochemical factors were sensitive (89%) and specific (55%) in differentiating C-AA from UC-AA but the addition of sonological parameters significantly improved the specificity of predicting complicated AA to 61% (P = 0.0036). Conclusion: Combining laboratory data with sonological findings significantly improves the predictive value for differentiating C-AA from UC-AA and can help decide operative approach and prognosticating.

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Section: Introductionmentioning

confidence: 99%