The Alvarado score versus computed tomography in the diagnosis of acute appendicitis: A prospective study

Al-Faouri, Ashraf F.; Ajarma, Khaled Y.; M.Al-Abbadi, Abdulhamid; Al-Omari, Abdullah; AL-Munaizel, Tariq; Alzu’bi, Alaa A.; Al-Jarrah, Ra’ed Y.; Abo-Zaiton, Omar Y.

doi:10.1016/j.mjafi.2016.06.007

Cited by 9 publications

(4 citation statements)

References 16 publications

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“…Details such as age, sex and ethnic origin of all the patients were recorded. Appendicitis inflammatory response score (AIR) [17,18], as well as the Alvarado score [20], were also calculated based on presenting symptoms and laboratory investigations simultaneously. The clinical risk of acute appendicitis was estimated and classified as necessary.…”

Section: Study Populationmentioning

confidence: 99%

Analysis of CT characteristics in the diagnosis of Schistosoma japonicum associated appendicitis with clinical and pathological correlation: a diagnostic accuracy study

et al. 2019

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Purpose To clarify unique non-contrast CT (NCCT) characteristics for early recognition of Schistosomal associated appendicitis (SAA) differentiating from Non-schistosomal associated appendicitis (NSA). Material and methods Clinical and pathological data of 50 cases with SAA and 60 cases with NSA who underwent emergency appendectomy were retrospectively compared to pre-surgical NCCT features such as direct and indirect signs of acute appendicitis as well as appendicoliths, colon calcifications as diagnostic criteria. Statistical methods such as Chi-square (χ 2), t-tests, Principal component analysis (PCA), Binary Logistic regression (LR) and Factor Analysis (FA) were utilized to observe differences and isolate recognizable CT features of SAA. Pre and post hoc diagnostic performance of all criteria was calculated as sensitivity, specificity, and the Odds Ratio (OR). Results Age > 50 years, diameter > 13 mm, pneumatosis, peri appendiceal abscess, focal wall defect, perforation; Orbital, linear and point types of appendicular wall calcifications; sigmoid colon and cecal curvilinear calcifications were observed as unique characteristics with a sensitivity of 84-95% and specificity of 91-98% in predicting SAA by OR of 6.2 times. Pre and post hoc hypothetical analysis did not show any significance for all other factors. Conclusion Factors such as elderly age, CT features such as larger appendicular diameter, appendicular wall calcifications along with sigmoid colon, and cecal calcifications, signs of perforation or abscess are characteristic for early recognition of SAA. Keywords Schistosoma japonicum • Intestinal Schistosomiasis • Multislice computed tomography • curvilinear calcifications • Peri appendiceal abscess Abbreviations AIR score Appendicitis inflammatory response score SAA Schistosomal associated acute appendicitis Bimbadhar Valluru, Zhou Zhou contributed equally to this work.

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Section: Study Populationmentioning

confidence: 99%

Analysis of CT characteristics in the diagnosis of Schistosoma japonicum associated appendicitis with clinical and pathological correlation: a diagnostic accuracy study

et al. 2019

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“…Many of the studies have documented utilization AS, and compared its scoring with CT and surgical outcomes. [23][24][25] Better clinical assessment and higher scores may help to avoid unnecessary CT examinations. 25 However, this may not be true in difficult cases and further imaging may be warranted to establish a diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of CT Scan in Diagnosing Acute Appendicitis in Patients with Low Alvarado Scores

Waheed¹,

Shah²,

Alshehri³

et al. 2019

jemds

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BACKGROUND Alvarado score has been routinely used in clinical practice for assessing the probability of acute appendicitis in patients presenting with right lower quadrant abdominal pain. Computed tomography can be used for equivocal or difficult cases. We wanted to evaluate role of computed tomography (CT) in patients with low or equivocal Alvarado scores. METHODS This is a retrospective, observational study conducted in the Department of Radiology at our Hospital in Dhahran from October 2017 to October 2018. 138 patients with equivocal Alvarado scores (AS, 4-6) and negative (non-conclusive or limited) ultrasounds, were retrospectively reviewed. Pregnant, postoperative (bowel surgery) cases and chronic appendicitis cases were excluded. Diagnosis of acute appendicitis on CT was based on a thickened or fluid dilated appendix (diameter > 6mm, wall enhancement) with at least one of the associated findings (like appendicolith, peri-appendiceal fat stranding, free fluid, extra-luminal air foci, caecal base thickening and mesenteric lymph nodes). Imaging findings were reviewed by two radiologists and consensus reporting was made. Findings on CT were categorized as AA (Acute Appendicitis), OD (Other Diagnosis) and NOR (Normal). Surgical candidates were confirmed on histopathology, while nonsurgical cases were followed up on either imaging or clinical grounds. Chi-square test was used to determine association. The main outcome measure was diagnosis on CT and histopathology. RESULTS 29.7% (41 patients) were found to have acute appendicitis on CT imaging. Majority of patients with AS of 5 were having OD, while most of AA cases were having AS of 6. All patients with AS of 4 were having normal CT scans. CONCLUSIONS Computed tomography helps to diagnose acute appendicitis or establish an alternate diagnosis in patients with equivocal Alvarado scores.

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“…10 At present, on the other hand, several reports have suggested a reduced clinical value in the use of advanced radiological methods. 11 Although its predictive power and use have been lowered recently, it is a widely known fact that the scores of 7 or greater are a strong predictor of AA. This study demonstrated that a high Alvarado score showed that abdominal pain may be secondary to AA with a sensitivity of 85% in patients with suspected AA and coexisting ovarian cysts.…”

Section: Discussionmentioning

confidence: 99%

Differences in Abdominal Pain Etiology: Is it from Appendicitis or Ovarian Cyst?

Aydin¹,

Soy²,

Tezcaner³

et al. 2019

JCOG

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n childbearing age, abdominal pain presents a unique diagnostic dilemma. The causes of abdominal pain are gastrointestinal, gynecological, urological, or pulmonary diseases. These patients are often evaluated by a general surgeon and gynecologist to determine pain etiology. Thorough knowledge of history and physical examination are key to differentiate the diagnosis. Acute appendicitis (AA) is the most common abdominal surgical emergency with a rate of 27%. 1 In addition, it is the most common cause of nongynecological pelvic pain. 2 It is known to occur simultaneously with various gynecological diseases. 3 Ovarian cysts are frequently seen in women in reproductive age and can also cause abdominal or pelvic pain. 4 In these patients with abdominal or pelvic pain, the differential diagnosis of AA and ovarian cysts is challenging. The aim of this study was to compare the preoperative parameters in patients with ovarian cysts, evaluate the negative appendectomy factors in patients undergoing appendectomy with AA diagnosis, and predict negative appendectomy.

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The Alvarado score versus computed tomography in the diagnosis of acute appendicitis: A prospective study

Cited by 9 publications

References 16 publications

Analysis of CT characteristics in the diagnosis of Schistosoma japonicum associated appendicitis with clinical and pathological correlation: a diagnostic accuracy study

Analysis of CT characteristics in the diagnosis of Schistosoma japonicum associated appendicitis with clinical and pathological correlation: a diagnostic accuracy study

Usefulness of CT Scan in Diagnosing Acute Appendicitis in Patients with Low Alvarado Scores

Differences in Abdominal Pain Etiology: Is it from Appendicitis or Ovarian Cyst?

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