To evaluate the diagnostic accuracy of alvarado score, C-reactive protein, ultrasonography and computed tomography in acute appendicitis and to correlate them with operative and histological findings

Pipal, Dharmendra Kumar; Kothari, Saurabh; Shrivastava, Harshit; Soni, Amit; Pipal, Vibha Rani

doi:10.18203/2349-2902.isj20164470

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…Various studies, such as Pipal et al . 22 , show that the addition of imaging modalities to the clinical scoring system increases the diagnostic accuracy of the test and Kurane et al . 20 which was also shown by our combined score test.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of modified Alvarado score combined with ultrasound in the diagnosis of acute appendicitis: A prospective analytical study

Sirpaili,

Rajthala,

Banmala

et al. 2024

Annals of Medicine &Amp; Surgery

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Background: Appendicitis is the most common surgical emergency encountered in the emergency department and diagnosis is difficult at times. Imaging and various clinical scoring are present to aid in the diagnosis. Ultrasound is an easily accessible modality and can accomplish more than a computed tomography (CT) scan at times. Modified Alvarado score (MAS) includes parameters that do not pose an extra financial burden to the patient. Combining both the imaging and clinical scoring systems, we decided to evaluate the Combined MAS for the diagnosis of acute appendicitis. Methods: This is a prospective analytical study conducted in a tertiary hospital for one and a half years. Fifty-five patients with right lower quadrant pain were enrolled, and evaluated along with an ultrasound. Modified Alvarado score and Combined MAS were obtained and the results were compared with the histopathological examination results. Results: Out of 55 clinically diagnosed cases who underwent emergency appendectomy, 27 were males and 28 were females. Of these, 50 cases had acute appendicitis as per histopathological examination. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the MAS was 42%, 100%, 100%, 20.8%, 47.27% respectively. The sensitivity, specificity, PPV, NPV and accuracy of the USG were 84%, 40%, 93.3%, 20%, and 80% respectively. Combining both the scores, the Combined MAS had the sensitivity, specificity, PPV, NPV, and accuracy of 98.18%, 0%, 90.7%, 0%, and 89.09% respectively. Conclusion: As the combination of USG has raised the sensitivity and diagnostic accuracy of the MAS, it can be an alternative to CT/MRI imaging for the diagnosis of acute appendicitis in resource-limited settings. This score requires further studies to validate with a larger sample size.

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Section: Discussionmentioning

confidence: 99%

Efficacy of modified Alvarado score combined with ultrasound in the diagnosis of acute appendicitis: A prospective analytical study

Sirpaili,

Rajthala,

Banmala

et al. 2024

Annals of Medicine &Amp; Surgery

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“…The Alvarado score was chosen because it includes the patient's symptoms, findings and laboratory evaluation and has reported accuracy rates between 78% and 82% for acute appendicitis. 9 According to this scoring system, surgery is recommended in patients that have 7 or more points; patients with fewer than 7 points should be monitored. 10 As well as descriptive statistical methods…”

Section: Methodsmentioning

confidence: 99%

Reliability of ultrasonography and the Alvarado scoring system in acute appendicitis

et al. 2018

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Yazar AS, Erdoğan S, Şahin C, Güven Ş. Reliability of ultrasonography and the Alvarado scoring system in acute appendicitis. Turk J Pediatr 2018; 60: 173-179.In this study, we aimed to evaluate the diagnostic performance of ultrasonography, the Alvarado score, mean platelet volume and C-reactive protein in the diagnosis of acute appendicitis.Patients admitted to the pediatric emergency department with abdominal pain who were operated on with a preliminary diagnosis of acute appendicitis were evaluated. The patients who had acute appendicitis diagnosis in the histopathological assessment were considered as the Appendicitis (App) Group, while patients who did not have acute appendicitis according to histopathology were considered as the Non-app Group.Of 200 patients assessed in the study, 137 (68.5%) were male and 63 (31.5%) were female. Of the patients operated on; 170 (85%) had acute appendicitis, while the pathological results of 30 (15%) were not consistent with acute appendicitis. The Alvarado score of the patients in App Group was significantly higher than those in Non-app Group (p=0.001). The sensitivity and specificity of the Alvarado score and ultrasonography were 60%, 81.18% and respectively, for the diagnosis of appendicitis. There were no significant differences (p> 0.05) in terms of average white blood cell, absolute neutrophil count, platelet count, mean platelet volume and C-reactive protein between the two groups.According to our study the use of Alvarado Scoring System with ultrasonography is more effective and accurative than ultrasonography performing alone. We recommend performing ultrasonography on patients with right lower quadrant pain and suspected appendicitis admitted to the emergency department and to operate on patients with a ultrasonography-supported appendicitis diagnosis and an Alvarado score of 7 and above. Patients with an appendicitis diagnosis not supported by ultrasonography and an Alvarado score lower than 7 should be closely monitored.

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Acute Appendicitis - Study of Role of Ultrasound and CT Scan in Decision Making for Surgery in a Tertiary Care Government Hospital in Eastern India

Kumar¹,

Komal²

2021

jebmh

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BACKGROUND Acute appendicitis (AA) is one of the commonest causes of acute abdominal emergencies. Accurate diagnosis and earlier surgery is imperative in such cases. Ultrasonography (US), and computed tomography (CT), are main stays accurate diagnosis of this disease. This study was conducted to compare the accuracy of US and CT in the diagnosis of AA and reduce number of negative appendectomies. METHODS This prospective study was done after approval from institutional ethical committee and obtaining written consent. 164 patients with clinical features suggestive of AA, were selected from emergency department of Patna Medical College, Patna India during the period from January 2019 to December 2020. 98 were males and 66 females, mean age being 18.08 years. 142 patents (86.58 %) underwent surgery, and 22 patients (13.41 %) were kept on clinical observation in hospital after imaging. After detailed clinical workup and laboratory investigations, all patients were subjected to both US and CT examination. Each patient was reevaluated clinically, and a clinical correlation was done between both sets of results. Based on these, final decision was made. Accuracy was decided based on intra-operative findings in appendectomy group and were correlated with imaging findings later with histopathologic findings. RESULTS Males outnumbered females, abdominal pain was present in 100%. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of US in diagnosis of AA in our study were 92.6 %, 76.4 %, 95.3%, 71.0% and 88.9 % respectively. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of CT in diagnosis of AA were 99.1 %, 90.5 %, 98.6%, 87.8% and 97.8 % respectively. CONCLUSIONS US should be the first-line imaging modality as it is free from radiation. CT is recommended as additional imaging tool to raise accuracy in diagnosis except in pregnancy and selected pediatric patients. KEYWORDS Acute Appendicitis, Computed Tomography, Ultrasound

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To evaluate the diagnostic accuracy of alvarado score, C-reactive protein, ultrasonography and computed tomography in acute appendicitis and to correlate them with operative and histological findings

Cited by 3 publications

References 6 publications

Efficacy of modified Alvarado score combined with ultrasound in the diagnosis of acute appendicitis: A prospective analytical study

Efficacy of modified Alvarado score combined with ultrasound in the diagnosis of acute appendicitis: A prospective analytical study

Reliability of ultrasonography and the Alvarado scoring system in acute appendicitis

Acute Appendicitis - Study of Role of Ultrasound and CT Scan in Decision Making for Surgery in a Tertiary Care Government Hospital in Eastern India

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