Alvarado Score in the Diagnosis of Acute Appendicitis: Correlation with the Tomographic and Intra-Operative Findings

Spina, Christian; Iamarino, Ana Paula Marconi; Rosa, Otto Mauro dos Santos; Ribeiro, Marcelo Augusto Fontenelle

doi:10.15406/ijrrt.2018.05.00135

Cited by 4 publications

(2 citation statements)

References 20 publications

(41 reference statements)

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“…The radiological assessment of AA with ultrasound (US) or computed tomography (CT) scan was left for cases with a borderline Alvarado score or a patient with confusing clinical presentation according to gender and clinical suspicion [16,17]. Many centers all over the world consider CT scans as their main diagnostic tool to avoid false-positive cases and decrease the rate of negative appendectomies to less than 5% of operated cases but with the risk of radiation hazards and its remote lifelong complication and risks, as well as with its impact of delay of management and its potential cost [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population

Al‐Tarakji¹,

Zarour²,

Singh³

et al. 2022

Cureus

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Background/objectiveAcute appendicitis (AA) is one of the most common surgical emergencies that require a proper diagnosis to avoid a negative outcome in the case of missed or delayed diagnosis. Our study aims to assess the diagnostic power of the Alvarado score and the prediction of the severity of acute appendicitis in correlation to intraoperative findings and the final histopathology (HP) result. MethodsThis retrospective study was applied to 1,303 patients with clinically proven acute appendicitis (AA) and available HP results. We correlated Alvarado score to the gold standard HP and intraoperative findings. We selected the cutoff point of Alvarado at 5 and 7 as they were the most frequent cutoff value mentioned in the literature and based on the ROC curve in this study to assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). ResultsThe mean age of the study cohort is 33.3 ± 9.5 years, with a male predominance (75.8%). The negative appendectomy (NA) rate was 4%. The operative complication rate was 1.2%, and we recorded one mortality case (0.1%). The diagnostic evidence of AA was in 95.9% of cases. Alvarado score ≥ 7 presented sensitivity and specificity of 66.4% and 69.8%, respectively, with PPV of 98.1% and NPV of 8.1%, with an accuracy of 66.5%. For Alvarado score ≥ 5, the sensitivity was 91.2%, specificity was 22.6%, PPV was 96.5%, NPV was 9.8%, and accuracy was 88.4%. In addition, we demonstrated statistical significance between Alvarado risk stratification with HP and intraoperative grades (p = 0.001 each). ConclusionThe Alvarado scoring system alone is not enough to diagnose AA with unsatisfactory sensitivity and specificity. However, it is a good indicator of the severity of AA that we can depend on to prioritize those patients waiting for surgery.

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Section: Introductionmentioning

confidence: 99%

The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population

Al‐Tarakji¹,

Zarour²,

Singh³

et al. 2022

Cureus

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“…They are affordable, noninvasive, simple to use and duplicate [5][6][7]. Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring is a novel system of diagnostic scoring created for the detection of appendicular inflammation in Asian people [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of RIPASA and Lintula Scores in Diagnosing Acute Appendicitis Using Surgical Findings as the Gold Standard

Naeem¹,

Sadiq²,

Awais³

et al. 2022

Cureus

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Background: Appendicitis is an inflammation of the vermiform appendix's inner lining that spreads to its other sections. Appendectomy is still the standard way to cure appendicitis. The diagnosis of acute appendicitis is still clinical and supported by a raised neutrophilic count and imaging studies; moreover, scoring systems, such as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Lintula scores, help the clinicians in the diagnosis. The main objective of this study was to establish the diagnostic accuracy of RIPASA and Lintula scores for acute appendicitis using surgical findings as the gold standard, in an Asian population.

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Clinical scores (Alvarado and AIR scores) versus imaging (ultrasound and CT scan) in the diagnosis of equivocal cases of acute appendicitis: a randomized controlled study

Noori

Jabbar

Noori

2023

Annals of Medicine &Amp; Surgery

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Introduction About 50% of acute appendicitis cases are atypical in their presentation. The objectives of this study was to assess and compare the feasibility of clinical scores [Alvarado and Appendicitis Inflammatory Response (AIR)] and imaging [ultrasound and abdominopelvic computed tomography (CT) scan] in the evaluation of equivocal cases of acute appendicitis in a clinical trial to identify that subset of patients who really need and will benefit from imaging, mainly CT scan. Methods: A total of 286 consecutive adult patients with suspected acute appendicitis were included. The clinical scores, including Alvarado and AIR scores and ultrasound, were done for all patients. Abdominal and pelvic CT scans were done for 192 patients to resolve the diagnosis of acute appendicitis. The sensitivity, specificity, positive and negative predictive values, and accuracy rate of both clinical scores and imaging (ultrasound and CT scan) were compared. The final histopathology was used as the gold standard for which the diagnostic feasibility of the clinical score and imaging were compared. Results: Out of 286 total patients who presented with right lower quadrant abdominal pain, a presumptive diagnosis of acute appendicitis was made in 211 patients (123 males and 88 females) after thorough clinical evaluation, clinical scores, and imaging, and they were submitted to appendicectomy. The overall prevalence of acute appendicitis proved by histopathology as a gold standard was 89.1% (188 patients) with a negative appendectomy rate of 10.9%. Simple acute appendicitis was reported in 165 (78.2%) patients and perforated appendicitis in 23 (10.9%) patients. For patients with equivocal clinical scores (≥4 to ≤6), the sensitivity, specificity, predictive values, and accuracy rate of CT scan were significantly higher than those of Alvarado and AIR scores. Patients with low clinical scores (≤4) and high clinical scores (≥7), the sensitivity, specificity, predictive values, and accuracy rate of clinical scores and imaging were comparable. The diagnostic feasibility of AIR scores was significantly higher than the Alvarado score, and the clinical scores were associated with significantly higher diagnostic accuracy than ultrasound. CT scan is unlikely to be needed and will add little to the diagnosis of acute appendicitis for patients with high clinical scores (≥7). The sensitivity of the CT scan for perforated appendicitis was lower than that for nonperforated appendicitis. The use of CT scans for query cases did not change the negative appendectomy rate. Conclusion: CT scan evaluation is beneficial only for patients with equivocal clinical scores. For patients with high clinical scores, surgery is recommended. AIR score was superior to the Alvarado score in terms of sensitivity, specificity, and predictive values. A CT scan is usually not required for patients with low scores since acute appendicitis is unlikely; in such cases, ultrasound co...

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Alvarado Score in the Diagnosis of Acute Appendicitis: Correlation with the Tomographic and Intra-Operative Findings

Cited by 4 publications

References 20 publications

The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population

The Role of Alvarado Score in Predicting Acute Appendicitis and Its Severity in Correlation to Histopathology: A Retrospective Study in a Qatar Population

Accuracy of RIPASA and Lintula Scores in Diagnosing Acute Appendicitis Using Surgical Findings as the Gold Standard

Clinical scores (Alvarado and AIR scores) versus imaging (ultrasound and CT scan) in the diagnosis of equivocal cases of acute appendicitis: a randomized controlled study

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