Prospective Validation of Two Systems of Classification for the Diagnosis of Acute Appendicitis

Escribá, Alexandre; Gamell, Anna; Fernández, Yolanda; Quintilla, José M.; Luaces, Carles

doi:10.1097/pec.0b013e31820d6460

Cited by 81 publications

(91 citation statements)

References 20 publications

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“…[7][8][9][10][11][12] The sensitivity, specificity, and diagnostic accuracy of the Alvarado score were reported to be between 84.2-92%, 66.7-91.2%, and 87-92%, respectively. [30][31][32][33] The sensitivity, specificity, and diagnostic accuracy of the Lintula score in adults are reported to be 87%, 98%, and 91%, respectively. [14] All three articles found through a PubMed-based literature research on the Lintula scoring system are written by Lintula et al [7,14,34] According to the results of the present study, the diagnostic accuracy of the Alvarado and Lintula scoring systems in our patients was consistent with the existing literature.…”

Section: Discussionmentioning

confidence: 99%

The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain

Kırkıl¹,

Karabulut²,

Aygen³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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Section: Discussionmentioning

confidence: 99%

The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain

Kırkıl¹,

Karabulut²,

Aygen³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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“…Recently, Kulik et al 16 examined the performance of six unique clinical decision rules in 4,200 children with suspected appendicitis. The authors concluded that although the PAS and the Alvarado scores were the best validated, 16,[18][19][20][21] neither score met the current performance benchmarks. With respect to the key diagnostic strategies, Ramarajan et al 11 conducted a retrospective review of an appendicitis pathway where children with equivocal initial US underwent clinical examinations and those with persistent abdominal pain had CT scans.…”

Section: Discussionmentioning

confidence: 99%

“…The PAS quantifies the probability of appendicitis by using clinical data (anorexia, vomiting, migration of pain, right lower quadrant tenderness, pain with hopping/coughing, and fever) and laboratory data (white blood cell count > 10 9 10 9 cells/ L, neutrophil count >7.5 9 10 9 /L). 13 This instrument was created specifically for children, 13 has previously been demonstrated to have good interobserver reliability when using consistent measurements, 20 has been prospectively validated in multiple settings, [18][19][20][21] and thus represents the best validated appendicitis-related instrument. 16 However, since a high-quality, consistently high-performing clinical prediction rule for appendicitis has not been identified to date, 16 we have limited the use of the PAS as an entry criterion, and all management decisions were made without its use.…”

Section: Study Setting and Populationmentioning

confidence: 99%

“…[9][10][11][12] Several scoring systems, including the pediatric appendicitis score (PAS), 13 also do not perform well in isolation at diagnosing appendicitis. [14][15][16][17][18][19][20][21] An intravenous contrast-enhanced computed tomography (CT) scan is currently recommended in children with equivocal screening US results. 22 However, due to rising awareness of a potential CT-related risk of radiation-induced malignancies in children, [23][24][25] there has been a decrease in the CT rate over the past decade.…”

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confidence: 99%

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Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Schuh

Langer

Kulik

et al. 2015

Academic Emergency Medicine

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Objectives: The primary objective was to determine the diagnostic accuracy of a serial ultrasound (US) clinical diagnostic pathway to detect appendicitis in children presenting to the emergency department (ED). The secondary objective was to examine the diagnostic performance of the initial and interval US and to compare the accuracy of the pathway to that of the initial US.Methods: This was a prospective cohort study of 294 previously healthy children 4 to 17 years old with suspected appendicitis and baseline pediatric appendicitis scores of ≥2, who were managed with the serial US clinical diagnostic pathway. This pathway consisted of an initial US followed by a clinical reassessment in each patient and an interval US and surgical consultation in patients with equivocal initial US and persistent concern about appendicitis. The USs were interpreted by published criteria as positive, negative, or equivocal for appendicitis. Children in whom this pathway did not rule in or rule out appendicitis underwent computed tomography (CT). Cases with missed appendicitis, negative operations, and CTs after the pathway were considered inaccurate. The primary outcome was the diagnostic accuracy of the serial US clinical diagnostic pathway. The secondary outcomes included the test performance of the initial and interval US imaging studies.Results: Of the 294 study children, 111 (38%) had appendicitis. Using the serial US clinical diagnostic pathway, 274 of 294 children (93%, 95% confidence interval [CI] = 90% to 96%) had diagnostically accurate results: 108 of the 111 (97%) appendicitis cases were successfully identified by the pathway without CT scans (two missed and one CT), and 166 of the 183 (91%) negative cases were ruled out without CT scans (14 negative operations and three CTs). The sensitivity of this pathway was 108 of 111 (97%, 95% CI = 94% to 100%), specificity 166 of 183 (91%, 95% CI = 87% to 95%), positive predictive value 108 of 125 (86%; 95% CI = 79% to 92%), and negative predictive value 166 of 169 (98%, 95% CI = 96% to 100%). The diagnostic accuracy of the pathway was higher than that of the initial US alone (274 of 294 vs. 160 of 294; p < 0.0001). Of 123 patients with equivocal initial US, concern about appendicitis subsided on clinical reassessment in 73 (no surgery and no missed appendicitis). Of 50 children with persistent symptoms, 40 underwent interval US and 10 had surgical consultation alone. The interval US confirmed or ruled out appendicitis in 22 of 40 children (55.0%) with equivocal initial US, with one false-positive interval US. Conclusions:The serial US clinical diagnostic pathway in suspected appendicitis has an acceptable diagnostic accuracy that is significantly higher than that of the initial US and results in few CT scans.

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“…Alfred Bond [6], Escriba [7], Dado [8] consider the performance of the score as being very good, while others like Macklin [9], Hsiao [10[, Schneider [11] consider the results as being modest.…”

Section: Discussionmentioning

confidence: 99%

Alvarado score: can it reduce unnecessary interventions for acute appendicitis in children?

Chisalau¹,

Tica

Chirila

et al. 2017

ARS Medica Tomitana

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The purpose of the study is to compare the outcomes of surgical interventions for acute appendicitis with the values of the Alvarado score. We conducted the study on 572 patients that underwent surgical interventions for acute appendicitis. Retrospectively, based on the medical records, we calculated the MANTRELS score and compared the outcomes of the intervention with the values of the applied score. Almost one third of the patients with a MANTRELS score lower than 6 had negative appendectomies. These patients represent 60% of the total cases of negative appendectomies, while in the case of patients with a high score around 2% had negative appendectomies. We concluded that using this scoring system to assess the need of immediate surgical intervention is important and can increase the rate of positive diagnosis mainly by limiting the number of unnecessary interventions.

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Prospective Validation of Two Systems of Classification for the Diagnosis of Acute Appendicitis

Abstract: Both scores are a useful tool in the evaluation of children with possible AA. For extreme values of scores, the results really ensure their use in the emergency department. The AUS can help on decision making for intermediate values.

Cited by 81 publications

References 20 publications

The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain

The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Alvarado score: can it reduce unnecessary interventions for acute appendicitis in children?

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