A one year prospective study to compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in acute appendicitis, in adults

Karamercan

et al. 2016

UCD

Objective: Acute appendicitis (AA) is one of the most common surgical emergencies. Despite extraordinary advances in modern investigations, the accurate diagnosis of AA remains an enigmatic challenge. The aim of this study was to compare and evaluate the diagnostic accuracy of inflammatory parameters [C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], ultrasound (US) and Alvarado score (AS) in reducing the rate of negative appendectomies. Material and Methods:Two hundred seventy-eight patients were included in this study. Patients were separated into two main groups as the surgery group (n=184) and non-operative group (n=94). Complete blood count, ESR and PCT levels were assessed, abdominal US was performed and AS was calculated for all patients. Results:In the surgery group, clinical predictive factors for histopathologic results such as AS ≥7, AA signs on US, neutrophilia and leukocytosis were significant. Neutrophilia and leukocytosis had the highest accuracy rate among these factors. Inflammatory parameters were not predictive for histopathologic results, although higher CRP and PCT levels were significant in perforated and necrotizing appendicitis. Multifactorial regression analyses showed that AS was not of significant predictive value in the non-operative group. Conclusion:There was no superiority of AS and/or US in the diagnosis of AA. Recent findings have shown the most reliable parameters in the diagnosis of AA to be primarily 'neutrophilia' and secondarily 'leukocytosis'. Other results of this study indicated that inflammatory parameters (CRP, PCT, ESR) were not superior to other parameters but CRP and PCT levels were significantly high in complicated cases.

Section: Introductionmentioning

confidence: 99%

The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis

Karamercan

et al. 2016

UCD

“…Appendiceal perforation can be diagnosed when the appendix demonstrates irregular contour or when peri appendiceal fluid collection are identified. 1,2,7 Doppler ultrasound examination usually reveals increased vascularity in and around the acutely inflamed appendix this examination is useful as an adjunct sign of appendicitis when appendiceal measurement is equivocal, in which it is uncertain as to whether the imaged appendix is normal or inflamed.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The condition is difficult to diagnose during the early stages when the classical signs and symptoms are usually subtle. 1,4 Different disease process mimic the diagnosis of acute appendicitis as there are number of causes leading to pain in the right iliac fossa particularly in female patients.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 It has been observed that many patients undergoing appendectomy prove to be negative on histopathology of the surgically removed appendix, which is the gold standard for diagnosis of appendicitis. 2 Removing a normal appendix is a burden both on patients and health resources. 1 However, early recognition of the condition and prompt operation have been the most important factors in reducing morbidity and possible mortality length of stay and the cost of treatment.…”

Section: Introductionmentioning

confidence: 99%

“…The accuracy offered by sonography should keep negative laparotomy ratio at approximately 10%, which is improvement over the rate achieved by instinct alone. 2 CT scan is complimentary to sonography. However, CT scan is associated with greater cost, exposure to ionizing radiation and exposure to contrast agents.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A three year prospective study-suspected acute appendicitis: diagnostic accuracy of modified Alvarado score versus ultrasonography in adults

Gaikwad¹,

Auti²,

Magare³

2017

Int Surg J

Background: To evaluate and compare diagnostic accuracy of modified Alvarado score and ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis.Methods: A prospective study of the patients who underwent appendectomy for suspected acute appendicitis at IIMS and R Medical College and Noor Hospital Warudi, Badnapur, Dist. Jalna (Maharashtra). The clinical (radiological) and ultrasonography data of 760 patients with suspected appendicitis was collected between March 2014 to Feb. 2017. These patients were evaluated by modified Alvarado score and ultrasonographically, which was corrected with histopathological finding.Results: Out of 760 patients 69.34% had acute appendicitis 63.81% had modified Alvarado score≥7 and 58.28% patients were ultrasonographically positive. In present study modified Alvarado score has sensitivity of 89.37% specificity 93.99% positive predictive value 97.11%, negative predictive value 79.64%, diagnostic accuracy of 81.32%.Conclusions: Modified Alvarado score can be used effectively in clinical decision making. When compare with ultrasonography neither one is advantageous. However, additional information provided by ultrasonography improves diagnostic accuracy.

Diagnostic Accuracy of Abdominal Ultrasound for Diagnosis of Acute Appendicitis: Systematic Review and Meta‐analysis

et al. 2016