Diagnosis of Acute Appendicitis using Modified Alvarado Score and Abdominal Ultrasound

Mishra, Aabhas; Kumar, Sukumar Santosh; Sinha, Anamika

doi:10.7860/jcdr/2018/34611.11417

Cited by 3 publications

(2 citation statements)

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“…In a study by Kanaskar et al, sensitivity was 74.19% [ 13 ]. Another study by Mishra et al reported a sensitivity of 71.26 % [ 14 ]. Because USG is operator dependent, the results are prone to variability.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Diagnostic Reliability of Modified Alvarado Scores and Abdominal Ultrasonography in Acute Appendicitis

Bhardwaj¹,

Behura²,

Mohapatra³

et al. 2023

Cureus

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Introduction Acute appendicitis is a common surgical emergency. Clinical assessment plays a major role; however, subtle clinical features in early stages and atypical presentation makes diagnosis challenging. Ultrasonography (USG) of the abdomen is a usual investigation that aids in diagnosis, however, it is operator dependent. A contrast-enhanced computed tomography (CECT) of the abdomen is more accurate; however, it exposes the patient to hazardous radiation. The study aimed to combine clinical assessment and USG abdomen in the reliable diagnosis of acute appendicitis. Objectives The objective of this study was to assess the diagnostic reliability of the Modified Alvarado Score and ultrasonography of the abdomen in acute appendicitis. Material and methods All patients with right iliac fossa pain, clinically suspected of having acute appendicitis, admitted to the department of general surgery, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, between January 2019 and July 2020, who gave consent were included. Clinically, Modified Alvarado Score (MAS) was calculated, after which patients were subjected to USG abdomen, where findings were noted and a sonologic score was calculated. The study group was the patients who needed appendicectomy (n=138). Operative findings were noted. Histopathological diagnosis of acute appendicitis was deemed as confirmatory in these cases and was correlated with MAS and USG scores to determine diagnostic accuracy. Results A combined clinicoradiological (MAS + USG) score of seven showed a sensitivity of 81.8% and a specificity of 100%. The specificity of score seven or above was 100%; however, the sensitivity at 81.8%. The diagnostic accuracy of the clinicoradiological was 87.5%. The negative appendicectomy rate was 4.34%, with a diagnosis of acute appendicitis being confirmed for 95.7% of patients upon histopathological examination. Conclusion The MAS and USG of the abdomen, which is an affordable and non-invasive tool, showed increased diagnostic reliability, and hence it can help reduce the use of CECT abdomen, as CECT abdomen is considered as a gold standard for confirmation or exclusion of diagnosis of acute appendicitis. Use of the combined scoring system of MAS and USG abdomen can be used as a cost-effective alternative.

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Section: Discussionmentioning

confidence: 99%

Assessment of the Diagnostic Reliability of Modified Alvarado Scores and Abdominal Ultrasonography in Acute Appendicitis

Bhardwaj¹,

Behura²,

Mohapatra³

et al. 2023

Cureus

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“…Various studies have suggested the use of ultrasound as an adjunct in cases where clinical scoring is not definite 11 . A study by Agrawal et al .…”

Section: Introductionmentioning

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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A Study to Evaluate the Combined Use of Alvarado Score and Imaging for Diagnosis of Acute Appendicitis

Mukhopadhyay¹,

Majhi²,

Bhattachariya³

et al. 2021

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Thyroid pathology is very common in general population, even when on inspection no abnormality is detected, nodules are seen on ultrasound sonography (USG). We are describing importance of peripheral halo sign in the diagnosis of benign nodules. Among all the endocrine gland lesions noted in India, thyroid lesion is the most common. In about 19 - 60 % of the adult population thyroid nodules are seen; however, less than 1 % of the thyroid nodules are malignant. Halo seen on ultrasound near the thyroid is considered as reliable and specific sign of benignity. 1 The morphological characteristics that suggest that the thyroid nodule is benign are echogenicity of thyroid gland in that being the identical echo signal or being moderately hyperechogenic corresponding to surrounding normal thyroid tissue. The solid nodule may be accompanied by a hypoechoic halo, which represents compressed thyroid tissue, fibrous connective tissue and vessels. The cystic nodule lesion contains colloid, and this appears as a hyper-echogenic spot with “comet-tail shadowing or ring-down sign”.2 The spongiform appearance on ultrasound has specificity of 99.7 % for benign disease it has 98.5 % negative predictive value for malignancy. 3,4 At the peripheries of the nodule, complete eggshell calcification is noted.5 A thyroid nodule with the above-mentioned characteristics is considered to be benign nodule and it does not require fine-needle aspiration cytology (FNAC) and in such patients there is neither a risk of malignancy nor a follow up USG is recommended.2 In benign thyroid lesion, there is rapid and controlled growth of thyroid cells compressing the surrounding thyroid parenchyma appearing as the echogenic rim called as sonolucent halo, on the contrary, malignant lesion has spontaneous but uncontrolled growth of the cells which lack cellular cohesion causing incomplete halo.6

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Diagnosis of Acute Appendicitis using Modified Alvarado Score and Abdominal Ultrasound

Cited by 3 publications

References 0 publications

Assessment of the Diagnostic Reliability of Modified Alvarado Scores and Abdominal Ultrasonography in Acute Appendicitis

Assessment of the Diagnostic Reliability of Modified Alvarado Scores and Abdominal Ultrasonography in Acute Appendicitis

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

A Study to Evaluate the Combined Use of Alvarado Score and Imaging for Diagnosis of Acute Appendicitis

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