Diagnosing Acute Appendicitis in Children Using Alvarado Score

Arif, Abdus Salam; Amin, Shahidul; Quamruzzaman, SM; Rahman, Mizanur

doi:10.3329/akmmcj.v2i2.8165

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Scoring systems have been designed to aid clinical assessment of acute appendicitis; the Alvarado score being the most well known,4 However, the Alvarado score may overpredict diagnosis of acute appendicitis in the pediatric population, contributing to increased negative appendectomy rates and leading to unnecessary morbidity and even mortality 5. The Appendicitis Inflammatory Response (AIR) score6 has been found to outperform the Alvarado score in retrospective studies in the adult population 7…”

Section: Introductionmentioning

confidence: 99%

Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population

Musbahi

Rudd

Dordea

et al. 2019

World Jnl Ped Surgery

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BackgroundAcute appendicitis is one of the most common causes of acute abdominal pain with an incidence of 1.17 per 1000 and lifetime risk of approximately 7%. It remains the most common indication for emergency abdominal surgery in childhood. Diagnosis of acute appendicitis is particularly difficult in young women and the pediatric population. In the USA, CT imaging is used to avert diagnostic dilemma, however the procedure is associated with radiation risk in this vulnerable population. Additionally, the procedure has high cost and variable availability.MethodsA retrospective study involving all suspected pediatric cases of appendicitis between the ages of 5 and 17 who were operated on between 2012 and 2015 was carried out. Data were collated from clinical notes on age, sex, ultrasound findings; postoperative complications, white cell count, neutrophils, C-reactive protein, histology result, and number of days to theater. All patients in the time period were retrospectively scored on the Alvarado and Appendicitis Inflammatory Response (AIR) scores.ResultsA total of 239 patients between 11 and 17 (mean 13.6±SE) years of age were included in the study. Of these, 79 had preoperative ultrasound, of which 52 were negative, and only one patient had CT scan. 213 of the patients had an appendicectomy and 26 had diagnostic laparoscopy with no appendicectomy. Of the 213 appendixes removed, 71 were histopathologically normal, giving a negative appendectomy rate of 33.3%. 28 appendixes were perforated. The average number of days from admission to theater was 1.0 SE in males and 1.424 in females (p=0.0498). The average number of days from admission to theater in those who had ultrasound was 2.03 days compared with 0.75 in those who did not have ultrasound (p<0.0001). AIR scoring that was high and medium risk showed slightly lower negative appendicectomy rates but not significantly different.ConclusionsOur study has found no significant difference between the AIR scores and Alvarado. There is a role for scoring systems to be used to aid in the decision to undergo imaging and as an adjunct to clinical diagnosis.

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Section: Introductionmentioning

confidence: 99%

Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population

Musbahi

Rudd

Dordea

et al. 2019

World Jnl Ped Surgery

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“…Acute appendicitis is the most common cause of abdominal pain requiring emergency surgical intervention in children and adolescents [ 1 ]. It is generally uncommon in toddlers and rare during infancy [ 1 - 3 ]. This condition once thought to be rare in Nigeria, is now believed to be on the increase in many urban centers due to changes in life style and diet [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…The high morbidity and occasional mortality associated with acute appendicitis are related to delay in presentation by patients or delay in diagnosis by the clinician. These delays may result in complications like gangrene, perforation, appendiceal mass and peritonitis [ 2 , 3 , 5 ], all of which would prolong hospital stay and increase the cost of treatment [ 5 ]. The aim of this study is to determine the pattern of presentation of children with acute appendicitis, to correlate the effect of late presentation on surgical outcome and to determine rate of negative appendicectomy amongst children in Ile-Ife, Nigeria.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological review of 156 appendicectomies for acute appendicitis in children in Ile-Ife, Nigeria: a retrospective analysis

et al. 2015

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BackgroundAcute appendicitis is one of the most common causes of acute abdomen in children. Late surgical intervention is often associated with increase morbidity and sometimes fatal outcome. We sought to determine the pattern of presentation of acute appendicitis, and the effect of late presentation on surgical outcome in children.MethodsThis is a retrospective descriptive study done at the paediatric surgical unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. The hospital records of all 180 patients (15 years and below) treated for acute appendicitis, between January 1995 and December 2012, were reviewed; only 156 patients had adequate records out of which 139 cases confirmed histologically as having appendicitis were analyzed.ResultsThere were 80 (57.6%) females and 59 (42.4%) males. The age range was 5-15years with mean (SD) age of 11.2 (±2.9) years. Most patients (64.7%) were more than 10 years old. Sixty-four (46%) patients had simple appendicitis while 75 (54%) patients had complicated appendicitis. More children with complicated appendicitis (63, 84.0%) presented after 24 hours of abdominal pain; and they had more vomiting (59, 78.7%), spent longer days on admission (57, 76.0%) and had more post- operative complications (34, 45.3%) compared with uncomplicated appendicitis (25, 39.1%; 29, 45.3%; 7, 10.9%; 1, 1.6% respectively), and this was statistically significant (p < 0.05). No mortality was recorded among these children.ConclusionLate presentation was common and was associated with longer duration of hospital stay and high morbidity. No mortality was recorded from the disease.

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Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

Fakhry

Shawky

2017

J Pediatr Dis

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Appendicitis is the most common cause of emergency abdominal surgeries in children. Ultrasound (US) has been proven to be a helpful imaging modality in patient evaluation, especially in children suspected of appendicitis. The Alvarado score is a 10-point scoring system for the diagnosis of appendicitis based on clinical data and differential leukocyte count. The aim of the present study was to evaluate a combination of clinical scoring (Alvarado score) and US findings for accurate diagnosis of appendicitis in children. The study was done in Menoufia University Hospitals from March 2011 to January 2013. 322 children with abdominal pain clinically suspected of having appendicitis were included in the study and clinically assessed to calculate the Alvarado score. Patients were referred to the radiology department for abdominal US. Among the 153 of the 322 patients who were operated on, 149 patients were diagnosed pre-operatively with acute appendicitis and 4 girls were diagnosed with complex ovarian cysts. Of the 149 patients diagnosed with appendicitis, the percentage of appendicitis was 93% (139/149) and 10 (7%) patients had normal appendix. The prevalence of appendicitis among the patients of the study was 43% (139/322). In conclusion, a combination of Alvarado scores and abdominal US is a good approach for the diagnosis of appendicitis in children to reduce the number of laparotomies for normal appendix. In the case of normal appendix or nonvisualization of the appendix via abdominal US without a high Alvarado score, appendicitis can be safely ruled out. If it is proven as an inflamed appendix on US or a high Alvarado score, patient should be subjected for appendectomy without delay. Keywords

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Diagnosing Acute Appendicitis in Children Using Alvarado Score

Cited by 3 publications

References 9 publications

Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population

Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population

Clinicopathological review of 156 appendicectomies for acute appendicitis in children in Ile-Ife, Nigeria: a retrospective analysis

Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

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