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Koroth A, Basheer S, Abdul Rasheed MF, Ali Usman A, Sadanandan A. Association Between Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Scoring and Pathological Severity of Acute Appendicitis: A Cross-Sectional Study. Cureus 2024; 16:e56166. [PMID: 38618466 PMCID: PMC11015883 DOI: 10.7759/cureus.56166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
Background and objectives Appendicitis is a frequent cause of abdominal pain. Because of the limited availability of imaging services in many medical centers and an urge to reduce the substantial number of unnecessary appendectomies, several clinical diagnostic tools have been constructed. A novel diagnostic tool, referred to as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, has been created to assist in identifying acute appendicitis (AA) in Asian nations. The study aimed to assess the correlation between RIPASA scores and the severity of appendicitis as determined by pathological examination. Materials and methods The study was a prospective observational investigation undertaken in the Department of General Surgery at Muslim education society (MES) Medical College Perinthalmanna over 12 months. The study included all patients who had been diagnosed with AA and underwent appendectomy, provided they satisfied both the inclusion and exclusion criteria. An analysis was conducted on a convenience sample of 225 individuals using a prestructured proforma. The RIPASA scores were estimated before their surgery, taking into account their age, gender, symptoms, physical examination findings, and laboratory findings. These scores were subsequently contrasted with the histopathological results obtained after the appendectomy. The individuals were categorized into three groups according to their RIPASA scores. The lower-score category, scores between 4 and 7. The intermediate-score category consists of scores ranging from 7.5 to 11.5, while the higher-score category includes scores of 12 and above. These scores are correlated with the histopathology report (HPR) to determine the presence of appendicitis, perforated appendix, appendicular abscess, or the absence of pathology observed. Results The study population comprised of 137 (60.9%) males and 88 (39.1%) females. Among these, 177 individuals (78.7%) were younger than 40 years, while 48 individuals (21.3%) were older than 40 years. Out of 225 cases, 146 cases were AA (64.9%), 27 (12%) appendicular abscess cases, and 41 (18.2%) appendicular perforation cases. The normal appendix was noted in 11 out of 225 cases in the low-score group. The association between the histopathological report and RIPASA score was found to be statistically highly significant (p=0.000). In the low-score group, there were 14 cases of appendicitis (53.8%), one case of appendicular abscess (3.8%), a total of 11 cases without pathology observed (42.3%), and no reported instances of appendicular perforation. In the intermediate-score category, there were 121 cases of appendicitis (89.6%), 12 cases of appendicular abscess (8.9%), 2 cases of appendicular perforation (1.5%), and no reported cases in the non-pathology category. Among the high-score category, there were 11 cases of appendicitis (17.2%), 14 cases of appendicular abscess (21.9%), 39 cases of appendicular perforation (60.9%), and no reported instances of negative appendectomy. Conclusion The study has shown that the RIPASA scoring system had a high diagnostic efficacy in identifying AA. This scoring system is an effective, dependable, cost-effective, noninvasive, reproducible, and safe diagnostic technique that does not require additional expenses or concerns.
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Affiliation(s)
- Arshad Koroth
- Department of General Surgery, Kasturba Medical College, Manipal, Manipal, IND
| | - Shiraz Basheer
- Department of General Surgery, Muslim Educational Society (MES) Academy of Medical Sciences, Perinthalmanna, IND
| | - Muhamed Fawas Abdul Rasheed
- Department of General Surgery, Muslim Educational Society (MES) Academy of Medical Sciences, Perinthalmanna, IND
| | - Azif Ali Usman
- Department of General Surgery, Muslim Educational Society (MES) Academy of Medical Sciences, Perinthalmanna, IND
| | - Arjun Sadanandan
- Department of General Surgery, Muslim Educational Society (MES) Academy of Medical Sciences, Perinthalmanna, IND
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Adir A, Braester A, Natalia P, Najib D, Akria L, Suriu C, Masad B, Igor W. The role of blood inflammatory markers in the preoperative diagnosis of acute appendicitis. Int J Lab Hematol 2024; 46:58-62. [PMID: 37644670 DOI: 10.1111/ijlh.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Acute appendicitis (AA) requires a prompt diagnosis. According to postoperative pathological results, a significant number of appendectomies are performed on a normal appendix (NA). The aim of this study is to evaluate the role of preoperative inflammatory markers in supporting and improving the clinical diagnosis of AA, extracting more information from CBC parameters. METHODS The study is a retrospective one. The histopathological results of operated appendix from 102 patients, who underwent appendectomy for clinically suspected AA, were extracted from the Galilee Medical Center systems. Two patient groups (NA and true AA) were compared for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and mean platelet volume (MPV). The obtained data were statistically analyzed, using the independent sample t test and Mann-Whitney test. Category data have been compared among groups with the chi-squared test. The primary endpoint of our research was to assess the predictive power of blood biomarkers. RESULTS Patients with suspected AA, based on clinical picture and contrast enhanced computed tomography (CECT), and with MLR-value ≥0.3357 were 5.25 times more likely than normal to have AA. Patients with NLR-value ≥3.2223 were 7 times more likely than normal to have AA. The differences in PLR and MPV values were not statistically significant. CONCLUSIONS The NLR and MLR biomarkers can assist in diagnosis of AA. This can be particularly helpful in cases where CECT is contraindicated, as in pregnant women or children.
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Affiliation(s)
- Alper Adir
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | | | - Dally Najib
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
- Hematology Institute, Ziv Medical Center, Safed, Israel
| | - Luiza Akria
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | - Celia Suriu
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | - Barhoum Masad
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
| | - Waksman Igor
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Hematology Institute, Galilee Medical Center, Nahariya, Israel
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Shahmoradi L, Safdari R, Mirhosseini MM, Rezayi S, Javaherzadeh M. Development and evaluation of a clinical decision support system for early diagnosis of acute appendicitis. Sci Rep 2023; 13:19703. [PMID: 37951984 PMCID: PMC10640605 DOI: 10.1038/s41598-023-46721-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023] Open
Abstract
The most frequent reason for individuals experiencing abdominal discomfort to be referred to emergency departments of hospitals is acute appendicitis, and the most frequent emergency surgery performed is an appendectomy. The purpose of this study was to design and develop an intelligent clinical decision support system for the timely and accurate diagnosis of acute appendicitis. The number of participants which is equal to 181 was chosen as the sample size for developing and evaluating neural networks. The information was gathered from the medical files of patients who underwent appendicectomies at Shahid Modarres Hospital as well as from the findings of their appendix samples' pathological tests. The diagnostic outcomes were then ascertained by the development and comparison of a Multilayer Perceptron network (MLP) and a Support Vector Machine (SVM) system in the MATLAB environment. The SVM algorithm functioned as the central processing unit in the Clinical Decision Support System (CDSS) that was built. The intelligent appendicitis diagnostic system was subsequently developed utilizing the Java programming language. Technical evaluation and system usability testing were both done as part of the software evaluation process. Comparing the output of the optimized artificial neural network of the SVM with the pathology result showed that the network's sensitivity, specificity, and accuracy were 91.7%, 96.2%, and 95%, respectively, in diagnosing acute appendicitis. Based on the existing standards and the opinions of general surgeons, and also comparing the results with the diagnostic accuracy of general surgeons, findings indicated the proper functioning of the network for the diagnosis of acute appendicitis. The use of this system in medical centers is useful for purposes such as timely diagnosis and prevention of negative appendectomy, reducing patient hospital stays and treatment costs, and improving the patient referral system.
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Affiliation(s)
- Leila Shahmoradi
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Mikail Mirhosseini
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sorayya Rezayi
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mojtaba Javaherzadeh
- General Surgery and Thoracic Surgery, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mehbub H, Baig AA, Khalid R, Mehmood MS, Ur Rehman O, Ghani U, Ahmad A. A Comparison of the Modified Alvarado Score and the Raja Isteri Pengiran Anak Saleha Appendicitis (Ripasa) Score in a Southeast Asian Population With Histopathology as the Gold Standard. Cureus 2023; 15:e46715. [PMID: 38021985 PMCID: PMC10630786 DOI: 10.7759/cureus.46715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background The diagnosis of acute appendicitis has remained difficult despite it being one of the most common surgical emergencies in the world. One of the most frequently used scoring systems is the Modified Alvarado Score (MAS). However, the MAS has been known to be less efficient in Asian populations. To overcome this issue, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score has been specifically developed to improve the diagnosis of acute appendicitis in Asian populations. This study aimed to evaluate the accuracy of the RIPASA score compared to the MAS for the diagnosis of acute appendicitis in a Southeast Asian population keeping histopathology as the gold standard. Methodology The study group comprised 150 patients. Data were collected from each patient using a simple proforma to ascertain both the MAS and the RIPASA score for each patient at the time of presentation. The patients then underwent open appendectomy and histopathology was used as the gold standard to determine the presence or absence of acute appendicitis in the excised specimens. Results The RIPASA score had a sensitivity and specificity of 89.83% and 59.38%, respectively, compared to 64.41% and 53.12%, respectively, for the MAS. Diagnostic accuracy was similarly higher for the RIPASA score at 83.33% versus 62.00% for the MAS. Conclusions The RIPASA score is superior to the MAS for the diagnosis of acute appendicitis. Using the RIPASA score instead of the MAS in Southeast Asian populations can lead to a more accurate and timely clinical diagnosis of patients with suspected acute appendicitis and help improve patient outcomes.
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Affiliation(s)
- Hummaz Mehbub
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Aftab A Baig
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Rizwan Khalid
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | | | | | - Usman Ghani
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Ashfaq Ahmad
- General Surgery, Akhtar Saeed Medical and Dental College, Lahore, PAK
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McNulty E, Greene A, Boehmer SJ, Tsai A, Olympia RP. Referrals for Pediatric Appendicitis to a Tertiary Care Children's Hospital. Pediatr Emerg Care 2023; 39:612-616. [PMID: 37404059 DOI: 10.1097/pec.0000000000003000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
OBJECTIVES This study aimed to analyze pediatric referrals for definite or possible appendicitis, to compare clinical predictors and laboratory values between patients with and without a final diagnosis of appendicitis, and to determine the accuracy of prereferral diagnostic interpretations of computed tomography scans, ultrasound, and magnetic resonance imaging modalities. METHODS We conducted a retrospective analysis of pediatric patients referred from 2015 to 2019 to a tertiary care children's emergency department with definitive or possible appendicitis. Data abstracted included patient demographics, clinical symptoms, physical examination findings, laboratory results, and diagnostic imaging findings (by the referring center and the pediatric radiologist at the accepting center). An Alvarado and Appendicitis Inflammatory Response (AIR) score was calculated for each patient. RESULTS Analysis was performed on 381 patients; 226 (59%) had a final diagnosis of appendicitis. Patients with appendicitis were more likely to have symptoms of nausea ( P < 0.0001) and vomiting ( P < 0.0001), have a higher mean temperature ( P = 0.025), right lower quadrant abdominal pain to palpation ( P = <0.0001), rebound tenderness ( P < 0.0001), a higher mean Alvarado score [5.35 vs 3.45 ( P < 0.0001)], and a higher mean AIR score [4.02 vs 2.17 ( P < 0.0001)]. Of the 97 diagnostic images initially interpreted as appendicitis by the referring center, 10 (10.3%) were read as no evidence of appendicitis. Of the 62 diagnostic images initially interpreted as "possible appendicitis" by the referring center, 34 (54.8%) were read as no evidence of appendicitis. Of those diagnostic images initially interpreted as "appendicitis" or "possible appendicitis" by the referring center, 24/89 (27.0%) of computed tomography scans, 17/62 (27.4%) of ultrasounds, and 3/8 (37.5%) of magnetic resonance imaging results were read as no evidence of appendicitis. CONCLUSIONS Usage of established scoring algorithms, such as Alvarado and AIR, may decrease the unnecessary cost of diagnostic imaging and transfer to tertiary care. Virtual radiology consultations may be 1 potential solution to improve the referral process for pediatric appendicitis if initial interpretation is uncertain.
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Affiliation(s)
- Ellie McNulty
- From the Penn State College of Medicine, Hershey, PA
| | - Alicia Greene
- Department of General Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Susan J Boehmer
- Department of Public Health Services, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Anthony Tsai
- Department of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA
| | - Robert P Olympia
- Department of Emergency Medicine and Pediatrics, Penn State Milton S. Hershey Medical Center and Penn State Children's Hospital, Hershey, PA
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Borruel Nacenta S, Ibáñez Sanz L, Sanz Lucas R, Depetris M, Martínez Chamorro E. Update on acute appendicitis: Typical and untypical findings. RADIOLOGÍA (ENGLISH EDITION) 2023; 65 Suppl 1:S81-S91. [PMID: 37024234 DOI: 10.1016/j.rxeng.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 04/08/2023]
Abstract
Acute appendicitis is the most common indication for emergency abdominal surgery throughout the world and a common reason for consultation in emergency departments. In recent decades, diagnostic imaging has played a fundamental role in identifying acute appendicitis, helping to reduce the rate of blind laparotomies and hospital costs. Given the results of clinical trials supporting the use of antibiotic therapy over surgical treatment, radiologists need to know the diagnostic criteria for complicated acute appendicitis to be able to recommend the best treatment option. This review aims not only to define the diagnostic criteria for appendicitis in different imaging modalities (ultrasonography, computed tomography, and magnetic resonance imaging), but also to explain the diagnostic protocols, atypical presentations, and other conditions that can mimic appendicitis.
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Zeb M, Khattak SK, Samad M, Shah SS, Shah SQA, Haseeb A. Comparison of Alvarado score, appendicitis inflammatory response score (AIR) and Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score in predicting acute appendicitis. Heliyon 2023; 9:e13013. [PMID: 36711320 PMCID: PMC9876948 DOI: 10.1016/j.heliyon.2023.e13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Introduction Acute Appendicitis is the most common surgical emergency encountered in emergency departments. To prevent the rate of negative appendectomies, different systems i.e. Alvarado score and Appendicitis Inflammatory Response Score (AIR) scores were used, but their diagnostic accuracy in Asian population is questionable. Raja Isteri Pengiran Anak Saleha (RIPASA) score has showed promising results in the recent literature. The purpose of this study is to compare the efficacy of Alvarado, AIR and RIPASA scores in the diagnosis of acute appendicitis. Methods Alvarado, AIR and RIPASA scores were prospectively applied to 132 included patients that were admitted with provisional diagnosis of acute appendicitis and then their surgery was performed in General Surgery Unit, Hayatabad Medical Complex Peshawar, Pakistan from 1st January 2022 to 31st July 2022. Final diagnosis was confirmed by histopathology report and scores were correlated with final report. Cut off value of score >7, >5 and >7.5 were set for Alvarado, AIR and RIPASA score, respectively according to previous literature. Statistics analysis was done for all 3 scoring systems on SPSS version 23. Results Of 132 patients, there were n = 79(59.8%) males and n = 53(40.2%) females. Mean age was 24 years (SD ± 11.6) with youngest patient of 9 years and oldest one was 70 years old. Negative Appendectomy rate was 8.3%(n = 11). RIPASA score was superior to AIR and Alvarado score in Sensitivity, NLR, Accuracy and Area under the Curve. AIR score performed better in specificity, NPV, PLR compared to RIPASA and Alvarado score. Conclusion RIPASA score is an overall better scoring system in diagnosing acute appendicitis in compared to Alvarado and AIR score.
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Affiliation(s)
- Muhammad Zeb
- Surgical Resident, General Surgery Ward, Hayatabad Medical Complex, Peshawar, KPK, Pakistan
| | - Sabir Khan Khattak
- Surgical Resident, Orthopedic Ward, Hayatabad Medical Complex, Peshawar, KPK, Pakistan
- Corresponding author.
| | - Maryam Samad
- Surgical Resident, General Surgery Ward, Hayatabad Medical Complex, Peshawar, KPK, Pakistan
| | - Syed Shayan Shah
- Surgical Resident, General Surgery Ward, Hayatabad Medical Complex, Peshawar, KPK, Pakistan
| | - Syed Qasim Ali Shah
- Surgical Resident, General Surgery Ward, Hayatabad Medical Complex, Peshawar, KPK, Pakistan
| | - Abdul Haseeb
- Surgical Resident, General Surgery Ward, Hayatabad Medical Complex, Peshawar, KPK, Pakistan
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Heiranizadeh N, Mousavi Beyuki SMH, Kargar S, Abadiyan A, Mohammadi HR. Alvarado or RIPASA? Which one do you use to diagnose acute appendicitis?: A cross-sectional study. Health Sci Rep 2023; 6:e1078. [PMID: 36698708 PMCID: PMC9851161 DOI: 10.1002/hsr2.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/10/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Background and Aims Acute appendicitis is one of the most common causes of lower abdominal pain, which is considered a general surgical emergency worldwide. The present study aimed to compare the diagnostic value of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado score systems in diagnosing acute appendicitis. Methods A prospective cross-sectional study was conducted at Shahid Sadoughi and Shahid Rahnemoon Hospitals in Yazd between September 2020 and February 2020. The statistical population consisted of all of the patients referred to the Accident and Emergency department with right iliac fossa (RIF) pain. All patients were scored using Alvarado and RIPASA scoring system. sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed by using SPSS statistical software. An receiver operating characteristic curve were plotted. Results In present study, one hundred suspected patients with appendicitis who underwent appendectomy were evaluated. The mean age of our study population was 25.2 ± 12.1 years, and the gender distribution was 57% males and 43% females. The sensitivity, specificity, PPV and NPV of RIPASA were 86.6%, 66.7%, 92.2%, and 52.2%, respectively. The sensitivity, specificity, PPV and NPV of Alvarado score were 67.1%, 72.2%, 91.7%, 32.5%, respectively. The diagnostic accuracy was 68% for Alvarado score and 83% for RIPASA. The area under the curve for RIPASA (0.87) was more than that for Alvarado score (0.77). Conclusion The RIPASA score system had higher sensitivity, PPV, NPV, and accuracy than the Alvarado one. It is recommended for the physician and surgeon to evaluate patients with RIF pain using the RIPASA score.
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Affiliation(s)
| | | | - Saeed Kargar
- Department of Surgery Shahid Sadoughi University of Medical Sciences Yazd Iran
| | - Aryana Abadiyan
- Department of Surgery Shahid Sadoughi University of Medical Sciences Yazd Iran
| | - Hamid Reza Mohammadi
- Student Research Committee, Department of Surgery Shahid Sadoughi University of Medical Sciences Yazd Iran
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Diagnostic Accuracy Rates of Appendicitis Scoring Systems for the Stratified Age Groups. Emerg Med Int 2022; 2022:2505977. [PMID: 36353722 PMCID: PMC9640239 DOI: 10.1155/2022/2505977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/28/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Many scoring systems have been developed for acute appendicitis, which is the most common emergent disorder in surgical practice. Considering the physiological changes and chronic diseases occurring with advancing age, an applied scoring system may not produce the same score in similar patients in all age groups. OBJECTIVES We aimed to compare the predictive values of scoring systems in different age groups. METHODS In this prospective study, the patients operated on in our clinic with a prediagnosis of acute appendicitis between March 2020 and March 2021 were included. We divided them into three age groups as 18-45 years (group 1), 46-65 years (group 2), and >65 years (group 3). We compared the scores of the nine acute appendicitis scoring systems most commonly used in the literature for these age groups. RESULTS A total of 203 patients were included in our study. The Alvarado scoring system yielded the most accurate results for group 1, whereas the Fenyo-Linberg scoring system was the most accurate system for group 2 and the Eskelinen scoring system for group 3. CONCLUSION Age should be considered as a major parameter during the selection of the scoring system to be applied for patients with prediagnosis of acute appendicitis. Our study revealed the Alvarado and the Fenyo-Lindberg scoring systems as the most accurate systems for the differential diagnosis of appendicitis in the 18-45 and 46-65 years age groups, respectively. Although we found the Eskelinen scoring system as the most accurate one in the >65 years age group, the confidence intervals indicated that it may not be appropriate for use alone in this group.
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Actualización de la apendicitis aguda: hallazgos típicos y atípicos. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Favara G, Maugeri A, Barchitta M, Ventura A, Basile G, Agodi A. Comparison of RIPASA and ALVARADO scores for risk assessment of acute appendicitis: A systematic review and meta-analysis. PLoS One 2022; 17:e0275427. [PMID: 36178953 PMCID: PMC9524677 DOI: 10.1371/journal.pone.0275427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background In the last decades, several clinical scores have been developed and currently used to improve the diagnosis and risk management of patients with suspected acute appendicitis (AA). However, some of them exhibited different values of sensitivity and specificity. We conducted a systematic review and metanalysis of epidemiological studies, which compared RIPASA and Alvarado scores for the diagnosis of AA. Methods This systematic review was conducted using PubMed and Web of Science databases. Selected studies had to compare RIPASA and Alvarado scores on patients with suspected AA and reported diagnostic parameters. Summary estimates of sensitivity and specificity were calculated by the Hierarchical Summary Receiver Operating Curve (HSROC) using STATA 17 (STATA Corp, College Station, TX) and MetaDiSc (version 1.4) software. Results We included a total of 33 articles, reporting data from 35 studies. For the Alvarado score, the Hierarchical Summary Receiver Operating Curve (HSROC) model produced a summary sensitivity of 0.72 (95%CI = 0.66–0.77), and a summary specificity of 0.77 (95%CI = 0.70–0.82). For the RIPASA score, the HSROC model produced a summary sensitivity of 0.95 (95%CI = 0.92–0.97), and a summary specificity of 0.71 (95%CI = 0.60–0.80). Conclusion RIPASA score has higher sensitivity, but low specificity compared to Alvarado score. Since these scoring systems showed different sensitivity and specificity parameters, it is still necessary to develop novel scores for the risk assessment of patients with suspected AA.
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Affiliation(s)
- Giuliana Favara
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Andrea Ventura
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
- * E-mail:
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Bouali M, El Berni Y, Moufakkir A, El Bakouri A, El Hattabi K, Bensardi F, Fadil A. Value of Alvarado scoring system in diagnosis of acute appendicitis. Ann Med Surg (Lond) 2022; 77:103642. [PMID: 35637993 PMCID: PMC9142662 DOI: 10.1016/j.amsu.2022.103642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction Methods Results Conclusion Acute appendicitis is one of the most common causes of acute abdomen in surgical patients. Various scoring systems are used for decision making in appendicitis. Alvarado score remains the most popular scoring system.
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Abstract
Abdominal pain is the most common chief complaint in the Emergency Department. Abdominal pain is caused by a variety of gastrointestinal and nongastrointestinal disorders. Some frequently missed conditions include biliary pathology, appendicitis, diverticulitis, and urogenital pathology. The Emergency Medicine clinician must consider all aspects of the patient's presentation including history, physical examination, laboratory testing, and imaging. If no diagnosis is identified, close reassessment of pain, vital signs, and physical examination are necessary to ensure safe discharge. Strict verbal and written return precautions should be provided to the patient.
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Affiliation(s)
- Maglin Halsey-Nichols
- University of North Carolina at Chapel Hill, Houpt Building (Physician Office Building) Suite 1116, 170 Manning Drive- CB-7594, Chapel Hill, NC 27599-7594, USA.
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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Jose T, Rajesh PS. Appendicitis Inflammatory Response Score in Comparison to Alvarado Score in Acute Appendicitis. Surg J (N Y) 2021; 7:e127-e131. [PMID: 34295969 PMCID: PMC8289675 DOI: 10.1055/s-0041-1731446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Appendicitis is a common differential diagnosis of right lower quadrant pain. Clinical evaluation alone results in high negative appendicectomy rates. Alvarado scoring is the most commonly used clinical prediction rule. The study aimed to compare the recently developed appendicitis inflammatory response (AIR) score with the Alvarado score. This cross-sectional observational study included patients who underwent appendicectomy for clinical suspicion of appendicitis. The clinical and laboratory parameters required for obtaining Alvarado score and AIRS were gathered. Area under ROC curve was calculated for both Alvarado score and AIRS. The study included 130 patients (77 males and 53 females). The negative appendicectomy rate was 10.7%. The perforation rate was 10.3%. The area under ROC for Alvarado score was 0.821 and for AIR score was 0.901. The Alvarado score had a sensitivity of 72% and a specificity of 79% at score ≥6. The appendicitis inflammatory response score had a sensitivity of 98% for scores ≥5 and a specificity of 97% for score ≥6. The C-reactive protein (CRP) value was the best performing individual parameter with an area under ROC of 0.789, followed by WBC count with an area under ROC of 0.762. Appendicitis inflammatory response score is a recently developed score that outperforms the Alvarado score. AIR score has a higher specificity. The sound construction, gradation of parameters, the inclusion of CRP, and avoidance of subjective parameters make the AIR score an attractive clinical prediction rule which can decrease the rate of negative appendicectomy.
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Affiliation(s)
- Toney Jose
- Department of Surgical Gastroenterology, Bangalore Medical College and Research Institute, Bangalore, India
| | - P S Rajesh
- Department of General Surgery, Government Medical College, Kottayam, Kerala, India
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Validity of Appendicitis Inflammatory Response Score in Distinguishing Perforated from Non-Perforated Appendicitis in Children. CHILDREN-BASEL 2021; 8:children8040309. [PMID: 33921577 PMCID: PMC8073718 DOI: 10.3390/children8040309] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022]
Abstract
Background: This prospective observational study aimed to evaluate the validity of appendicitis inflammatory response (AIR) score in differentiating advanced (perforated) from simple (non-perforated) appendicitis in pediatric patients. Methods: A single-center prospective cross-sectional study was conducted between 1 January 2019 until 1 May 2020 including 184 pediatric patients who underwent appendectomy. Based on the intraoperative finding of advanced (n = 38) or simple (n = 146) appendicitis the patients were divided into two groups. Recipient-operator curve (ROC), with calculation of sensitivity and specificity of best cutoff and the area under the curve (AUC), were used to measure the diagnostic value and the potential for risk stratification of the AIR score, among the patients with simple or advanced acute appendicitis. Results: The median value of the AIR score in the perforated and non-perforated groups was 10 (interquartile range, IQR 9, 11), and was 7 (IQR 6, 9), respectively (p < 0.001). Based on the calculated value of AIR score, the patients were classified with a high precision into low, indeterminate and high risk groups for acute appendicitis (p < 0.001). A cutoff value of ≥9 was demonstrated to serve as a reliable indicator of perforated appendicitis with a sensitivity and a specificity of 89.5% and 71.9%, respectively (AUC = 0.80; 95% CI: 0.719–0.871; p < 0.001). Conclusions: Acute appendicitis can be detected with a high level of sensitivity and specificity using the AIR score. Also, the AIR score may differentiate perforated from non-perforated appendicitis in pediatric patients with a high level of accuracy.
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