Randomized control trial comparing an Alvarado Score-based management algorithm and current best practice in the evaluation of suspected appendicitis

Tan, Winson Jianhong; Acharyya, Sanchalika; Foo, Fung Joon; Chan, Weng Hoong; Wong, Wai Keong; Ooi, London Lucien Peng Jin; Ng, Justin H. J.; Ong, Hock Soo

doi:10.1186/s13017-020-00309-0

Cited by 8 publications

(3 citation statements)

References 24 publications

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“…CT is highly sensitive and specific for AA [7], resulting in reduced negative appendectomy rates [8]. Its use is increasing globally but remains variable [9].…”

Section: Discussionmentioning

confidence: 99%

Assessing Clinical Acumen in Predicting Acute Appendicitis in Emergency Surgery: A Prospective Study

et al. 2022

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Background Clinical acumen and experience are critical in the diagnosis of the commonest surgical emergency, acute appendicitis. However, there is an increasing focus on haematological and radiological parameters in reaching the diagnosis of appendicitis, which can negate the importance of clinical findings. The aim was to assess the accuracy of each grade of the surgical team in diagnosing acute appendicitis using clinical acuity alone and compare them to each other as well as validated predictive scores. Methods A prospective single‐centre study was performed over a six‐month period (Dec 2020–May 2021). All patients presenting to the emergency department with right iliac fossa pain were included. Results A total of 180 patients were included of whom 35% were male. Mean age was 36.2 years (range 16–91). 51.1% had a final diagnosis of appendicitis, of which 91.3% were managed surgically and 8.7% were treated conservatively with antibiotics. Consultants were correct in their prediction of appendicitis in 84.6% of cases (females—83.4%, males—86.6%). Registrars accurately predicted appendicitis in 82.2% of patients (females—80.3%, males—85.7%), whilst house officers (SHOs) and interns were right in 73.8% (females—69.2%, males—82.5%) and 72.7% (females—66.6%, males—83.9%) of cases, respectively. In patients with a histological or radiological diagnosis of appendicitis, the mean Acute Inflammatory Response Score and Acute Appendicitis Score were 7.0 (high risk ≥ 9) and 12.5 (high risk ≥ 16), respectively. Clinicians had superior diagnostic accuracy when compared with both the clinical scores used. Conclusion Seniority was associated with improved diagnostic accuracy in clinically predicting acute appendicitis. This study showed that the clinical judgement of experienced surgeons is more reliable than clinical scores in the diagnosis of appendicitis.

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“…CT is highly sensitive and specific for AA [7], resulting in reduced negative appendectomy rates [8]. Its use is increasing globally but remains variable [9].…”

Section: Discussionmentioning

confidence: 99%

Assessing Clinical Acumen in Predicting Acute Appendicitis in Emergency Surgery: A Prospective Study

et al. 2022

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“…In such a case, the physician has to make a decision based on the physical examination findings and laboratory results. The Alvarado scoring system, which is frequently used today, is a diagnostic method with high predictive value developed according to the clinical and laboratory results of the patient (10). It consists of eight parameters: right localization of pain (migration), right lower quadrant pain, fever, leukocytosis, nausea-vomiting, left shift in acute phase response, rebound sign, and loss of appetite.…”

Section: Introductionmentioning

confidence: 99%

“…It consists of eight parameters: right localization of pain (migration), right lower quadrant pain, fever, leukocytosis, nausea-vomiting, left shift in acute phase response, rebound sign, and loss of appetite. Right lower quadrant pain 2 points, leukocytosis 2 points, other parameters 1 point, a total of 10 points are evaluated (10).…”

Section: Introductionmentioning

confidence: 99%

Akut apandisit tanısında doğruluk: Fizik muayene ile görüntüleme yöntemlerinin karşılaştırılması

Benek

AÇAR

2023

HTD

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Abstract Background Acute appendicitis is one of the most common causes of acute abdomen. In case of delay in the diagnosis process, perforation develops, and the patient's morbidity and mortality increase. In our study, we evaluated the effectiveness of laboratory, radiological, and physical examination findings in diagnosing acute appendicitis. Methods A total of 488 patients hospitalized with a prediagnosis of acute appendicitis were included in the study. 162 patients constituted the unoperated and 326 patients constituted the operated group (Groups 1 and 2). The two groups were compared in terms of age, gender, and ultrasonographic findings, as well as Alvarado score parameters. Results In logistic regression analysis, which included only Alvarado parameters, anorexia was the most valuable parameter in predicting surgery (p=0.000). The Alvarado score was found to be the most useful parameter in making the surgery decision (p

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Clinical Decision Rules in the Evaluation and Management of Adult Gastrointestinal Emergencies

Cullison

Franck

2021

Emergency Medicine Clinics of North America

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Randomized control trial comparing an Alvarado Score-based management algorithm and current best practice in the evaluation of suspected appendicitis

Cited by 8 publications

References 24 publications

Assessing Clinical Acumen in Predicting Acute Appendicitis in Emergency Surgery: A Prospective Study

Assessing Clinical Acumen in Predicting Acute Appendicitis in Emergency Surgery: A Prospective Study

Akut apandisit tanısında doğruluk: Fizik muayene ile görüntüleme yöntemlerinin karşılaştırılması

Clinical Decision Rules in the Evaluation and Management of Adult Gastrointestinal Emergencies

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