Manifestations of Acute Appendicitis: A Prospective Study on Acute Abdominal Pain

Laurell, Helena; Hansson, Lars‐Erik; Gunnarsson, Ulf

doi:10.1159/000350043

Cited by 15 publications

(7 citation statements)

References 35 publications

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“…There is great variation in the presentation, severity of disease, radiological workup, and surgical management of patients having acute appendicitis. 27 The results of the present study confirm the clinical value of Alvarado scoring in all cases, and imaging techniques (USG, CT scan) in doubtful cases. Conservative management of doubtful cases of acute appendicitis (Alvarado score 1-4 and radiologically not suggested cases of score of 5-6), with close monitoring.…”

Section: Discussionsupporting

confidence: 84%

Management of Acute Abdomen: Acute Appendicitis

Neupane¹,

Paudel²,

Shrestha³

et al. 2019

J. Gandaki Med. Coll. Nepal

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Background: Traditionally, appendectomy has been the treatment of choice for acute appendicitis but many times diagnosis can be difficult. Clinicians are looking through different ways to come to the correct diagnosis to decrease negative appendectomy. The aim of this study was to determine relation between clinical pattern, laboratory and ultrasonography findings with histopathological report of appendectomy specimen and to evaluate the Alvarado scoring regarding its usefulness in the early diagnosis in our set up. Methods: Prospective cross-sectional study was carried out in Gandaki Medical College Teaching Hospital and Fewa City Hospital from Jan 1, 2016 to Dec 31, 2018 on consecutively admitted patients with clinical diagnosis of acute appendicitis with study variables as demography, Alvarado score, radiological/laboratory investigations, surgical management, histopathology, and clinical outcome. Results: Among 1021 patients (48.8% men, 51.2% women), patients with Alvarado score offive and more (967, 88.8%) had abdominal USG and some (134) with score of 5-6 (13.12%) had CT scan. On the basis which 818patients (151 patients with score 5-6 and 667 with score 7 to 10) underwent emergency appendectomy; 705 (86.19%) by open and 113 (13.81%) by laparoscopic technique. Appendicitis was suggestive per-operatively in 76.2% of patients with Alvarado score of 5-6 and 97.4% of patients with the score of 7-10. Histo-pathologically diagnosis was correct in 752 (91.9%), 91.2% in open appendectomy and 96.5% in laparoscopic appendectomy cases. Only two patients had infective complication and no mortality. Conclusion: Alvarado scoring in patients presenting with acute abdominal pain is reliable predicting tool for acute appendicitis.

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Section: Discussionsupporting

confidence: 84%

Management of Acute Abdomen: Acute Appendicitis

Neupane¹,

Paudel²,

Shrestha³

et al. 2019

J. Gandaki Med. Coll. Nepal

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“…Furthermore, the presence of nausea and vomiting is also not used in the Karaman score due to low sensitivity (75.8%) and specificity (24.2%), which has also previously been demonstrated in other studies (sensitivity: 40-72% and specificity: 45-69%). [15][16][17] In the present study, the cutoff threshold of the Karaman score in distinguishing acute appendicitis from negative appendectomy was ≥9, with an 84.3% sensitivity, 64.7% specificity, a 92.1% PPV, and a 45.8% NPV. A higher sensitivity (96.2%) and sensitivity (90.5%) were found in a study performed by Nanjundaiah et al [18] with a Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score of >7.5.…”

Section: Discussionmentioning

confidence: 46%

The XXXX score: A new diagnostic score for acute appendicitis

Karaman

Ercan²,

Demir³

et al. 2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: The Karaman score is a novel diagnostic scoring system consisting of 6 parameters. The aim of the present study was to assess the diagnostic performance of the Karaman score in comparison with the Alvarado score. METHODS: A total of 200 patients who underwent an appendectomy were enrolled in the study (research registry number: 2290). RESULTS: The cutoff threshold of the Karaman score in distinguishing acute appendicitis from negative appendectomy was ≥9 with 84.3% sensitivity, 64.7% specificity, 92.1% positive predictive value (PPV), and 45.8% negative predictive value (NPV). The cutoff threshold of the Alvarado score in distinguishing acute appendicitis from negative appendectomy was ≥8 with 72.9% sensitivity, 70.6% specificity, 92.4% PPV, and 34.8% NPV. In multivariate logistic regression analysis, an Alvarado ≥8 score (Odds ratio [OR]:6.644, 95% confidence interval [CI]: 2.854-15.466; p<0.001) and a Karaman ≥9 score (OR:10.374, 95% CI: 4.383-24.558; p<0.001) were each individually predictive in distinguishing acute appendicitis from negative appendectomy when correction was made according to age and gender. However, when both scores were evaluated together, the Alvarado score ≥8 lost its efficacy (OR:1.838, 95% CI: 0.517-6.530; p=0.347), whereas the Karaman score ≥9 retained its predictive power (OR:6.586, 95% CI: 1.893-22.917; p=0.003). CONCLUSION: The Karaman score was more predictive than the Alvarado score in distinguishing acute appendicitis from a negative appendectomy.

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“…We decided to exclude retrospective studies from our review. All of these studies had issues related to reliability of their retrospectively abstracted data.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

Benabbas

Hanna

Shah

et al. 2017

Academic Emergency Medicine

167

101

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Presence of AA is more likely in patients with undifferentiated abdominal pain migrating to the RLQ or when cough/hop pain is present in the physical examination. Once AA is suspected, no single history, physical examination, laboratory finding, or score attained on PAS can eliminate the need for imaging studies. Operating characteristics of ED-POCUS are similar to those reported for RUS in literature for diagnosis of AA. In ED patients suspected of AA, a positive ED-POCUS is diagnostic and obviates the need for CT or MRI while negative ED-POCUS is not enough to rule out AA.

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Manifestations of Acute Appendicitis: A Prospective Study on Acute Abdominal Pain

Cited by 15 publications

References 35 publications

Management of Acute Abdomen: Acute Appendicitis

Management of Acute Abdomen: Acute Appendicitis

The XXXX score: A new diagnostic score for acute appendicitis

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

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