Usefulness of CT Scan in Diagnosing Acute Appendicitis in Patients with Low Alvarado Scores

Waheed, Khawaja Bilal; Shah, Waseem Jan; Alshehri, Ali Salman; Altaf, Bilal; Amjad, Muhammad; Amin, Muhammad Sohail; Said, Emad Fouad Mahmoud; Bukhamsin, Noor Riyadh

doi:10.14260/jemds/2019/653

Cited by 3 publications

(2 citation statements)

References 26 publications

(36 reference statements)

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“…The classification of AS was different in every study, which made statistical modeling more difficult. Some of the studies 51 – 46 , 53 have calculated AS retrospectively, which underestimates the true performance of AS (raises the possibility of performance bias). Variables collected in each study were different from one another, and there was a lot of missing data when we combined the data, leading to statistical heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis

Gupta

Kolli

Costa

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: The Alvarado score (AS) has not been widely used for diagnosing acute appendicitis although it has shown to be a good predictor for diagnosing appendicitis. The aim was to perform a systematic review of the available literature and synthesize the evidence. Methods: A systematic review was performed as per the PRISMA guidelines using search engines like Ovid, PubMed, and Google Scholar with predefined, strict inclusion and exclusion criteria. The quality assessment of included studies was performed using the QUADAS 2 tool. Summary statistics were performed for all variables. A linear regression model was performed between dependent and independent variables using STATA software. Heterogeneity testing showed significant heterogeneity within the included studies; hence, a forest plot with pooled estimates could not be constructed, and therefore a meta-regression was performed. Results: Seventeen full-text articles met inclusion and exclusion criteria. Ten of which were identified as low-risk studies. Five studies were included in final data pooling with total patients being 2239 and mean age of 31.9 years. (1) Linear regression demonstrated an association between ‘histological appendicitis’ and ‘AS 7–0’ with patients receiving intervention, with a significant P value of less than 0.005. (2) Meta-regression demonstrated a positive coefficient (0.298), a positive Z score of 2.20 with a significant P value of 0.028 for patients with ‘high AS’ who received interventions that were significantly proven to be ‘histologically appendicitis’, indicating a cause-and-effect relationship. Conclusion: High AS (7 and above) is a significant predictor of acute appendicitis. The authors recommend further prospective randomized clinical trials to establish a cause-and-effect relationship.

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Section: Discussionmentioning

confidence: 99%

A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis

Gupta

Kolli

Costa

et al. 2023

Annals of Medicine &Amp; Surgery

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“…5,6 There have been fewer cases of negative appendectomies as a result of recent developments in the imaging diagnosis and the early application of computed tomography (CT). 7,8 On other hand reported that, since more than twenty years ago, magnetic resonance imaging (MRI) has been utilized for the assessment of acute appendicitis. 9,10 However, because of its high cost and restricted availability, its use has been severely limited, especially in low-income source developing nations.…”

Section: Introductionmentioning

confidence: 99%

Comparative Study Between Karaman Score and Modified Alvarado Score for Predictability in Avoiding Negative Appendectomy in the Suspected Cases of Acute Appendicitis

Ghumro¹,

Parveen²,

Ahmed³

et al. 2022

PJMHS

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Objective: To compare the diagnostic accuracy between the Karaman score and the Modified Alvarado score for predictability in avoiding a negative appendectomy in suspected cases of acute appendicitis. Material and methods: This comparative study was done at the general surgery department of JPMC Karachi, from February 2022 to August 2022. All the patients diagnosed as the cases of acute appendicitis undergoing surgical treatment, aged more than 14 years and of either gender, were included. Both the Karaman and the Alvarado scoring systems were implemented in order to assign points to each of the study subjects. The Alvarado score is comprised of eight different parameters, while the Karama score only makes use of six different parameters. After evaluating the patient on both scores, the decision to perform surgery was primarily based on the surgeon's clinical judgement after considering all clinical, laboratory, and radiological findings. Postoperative histopathology reports were collected, and the scores of both Alvarado and Karaman score were compared. Patients were operated and monitored throughout the stay in hospital up to discharge. Afterwards, for each score, sensitivity, specificity, and positive and negative predictive values were determined. All the data was collected via a study proforma, and SPSS version 26 was used for the data analysis. Results: In this study, 180 cases of appendicitis undergoing surgical treatment were studied, their mean age was 27.03 ± 10.12 years, and their mean BMI was 19.88 ± 3.43 kg/m2. Males accounted for 80.0% of all study participants. As per histological findings, acute appendicitis was found in 78.9% of the cases, 14.4% of the patients had gangrenous appendicitis, while 6.5% of the cases had a normal appendix. Histopathological evaluation was statistically significant according to the appendicitis identification by Karaman scoring system and Alvarado scoring system (p-0.001). Although both scoring systems showed almost similar diagnostic accuracy, the Karaman scoring system showed sensitivity (98%), specificity (75%), PPV (98%), NPV (75%), and accuracy (96%), while the Alvarado scoring system showed sensitivity (97%), specificity (58%), PPV (97%), NPV (63%), and accuracy (95%). Conclusion: In the study conclusion, the Karaman score and Alvarado scoring systems both were observed to be the good predictive to distinguishing acute appendicitis in avoiding the negative appendectomy. Both showed almost similar and high sensitivity and accuracy by taking histopathology is gold standard. Keywords: Appendicitis, Karaman score, Alvarado score, Accuracy

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Abnormal CT findings among patients with abdominal pain in the radiology department of a tertiary care center

Almushayti

Alsalhi²,

Alsagri³

et al. 2022

F1000Res

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Background: Abdominal pain is a common symptom in people of different ages due to various benign and life-threatening causes. Imaging studies, including computerized tomography (CT) scans, explore the clinical reasons behind this pain to prevent delayed diagnosis. Owing to abnormal findings, timely identification of the exact cause of abdominal pain is important in most diseases so treatment can be started earlier, but it has not yet been studied, making this research novel. This study was conducted to identify the prevalence of abnormal CT scan findings among referred patients with abdominal pain and to confirm or determine other diagnoses compared to other imaging modalities in the Emergency Department (ED). Methods: This observational retrospective study was conducted at the King Fahad Hospital, a tertiary hospital in Qassim. We included 2,144 patients who visited the ED and underwent abdominal CT scans between January 2021 and January 2022. Data on age, sex, CT findings, and results from other imaging modalities were collected from the Radiology Department. Results: We found that 2,144 patients referred from the ED to the Radiology Department complained of acute abdominal pain in 2021 for CT diagnosis. Approximately 28.2% of these patients had normal CT diagnoses. The average age at normal CT diagnosis was 38.6 years old. While 52% of CT diagnoses were abnormal, including obstructive ureteric stone (435, 20.3%), appendicitis (205, 9.6%), bowel obstruction (51, 2.4%), renal cancer (27, 1.3%), ovarian cancer (25, 1.2%), and obstructive bladder stone (25, 1.2%), with an average age of 40.4 years old, and 19% with accidental findings. Conclusions: Most of the cases with abdominal pain showed abnormal results in the CT scan. These results demonstrate the sole inefficiency of CT scan for the diagnosis of abdominal pain. So, clinical evaluations should be used together with abdominal ultrasonography to perform a timely and exact diagnosis.

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Usefulness of CT Scan in Diagnosing Acute Appendicitis in Patients with Low Alvarado Scores

Cited by 3 publications

References 26 publications

A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis

A systematic review and meta-regression for validation of the Alvarado score as a tool for predicting acute appendicitis

Comparative Study Between Karaman Score and Modified Alvarado Score for Predictability in Avoiding Negative Appendectomy in the Suspected Cases of Acute Appendicitis

Abnormal CT findings among patients with abdominal pain in the radiology department of a tertiary care center

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