CRITERIOS DE ALVARADO PARA APENDICITIS AGUDA PDFJuly 6, 2020
Objective: To compare the sensitivity and specificity of the Alvarado score for the de Alvarado como recurso clínico para el diagnóstico de la apendicitis aguda. de escalas diagnósticas de apendicitis aguda: Alvarado, RIPASA y AIR and has better accuracy for the diagnosis of acute appendicitis. Introducción: la apendicitis aguda constituye la primera causa de Los mejores valores diagnósticos de la enfermedad para la escala fueron aquellos con.
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In order to avoid delay in the diagnosis of acute appendicitis and reduce the margin of error, the use of scales has been used. The aim of this study was to compare the effectiveness of the Alvarado and RIPASA scores in the clinical diagnosis of acute appendicitis and to correlate with the histopathological results.
Prospective, longitudinal, analytical, comparative and observational study. Patients with abdominal pain syndrome suggestive of acute appendicitis and submitted to surgical intervention were included; the Alvarado and RIPASA scores were simultaneously applied.
The pathology report was agusa and the efficacy of aguva scores for the diagnosis of acute appendicitis was compared. One hundred patients were included.
Se incluyeron pacientes. One billion dollars are spent each year on negative appendectomies, 4,5 so high rates of negative appendectomies are no longer acceptable. In order to avoid delayed diagnosis, to reduce the margin of error and to identify patients requiring emergency surgery or patients without AA, the application of a scoring scale would be very useful.
The Alvarado score suggests, with a higher score, the probability that the patient has AA symptoms.
The purpose of this study was to apply both scales in the emergency department in cases of patients with presumptive diagnosis of AA and to compare these with paara pathology reports after appendectomy, thereby comparing the efficacy, sensitivity and specificity of the Alvarado and RIPASA scores in the diagnosis of AA at a tertiary hospital serving the population of eastern Mexico. An analytical, observational study was conducted between June 1 and December 31, in patients of both sexes cditerios were 18 years of age or older and came to the emergency department of the Hospital de Alta Especialidad of Veracruz with suspected diagnosis of AA and underwent appendectomy.
Included for study were all cases treated with urgent appendectomy that had pathology results. The study was approved by the hospital’s Ethics Committee.
The 2 different classifications, the Alvarado and the RIPASA scores, were applied to each of the patients lara a resident doctor in surgery, without influencing the surgeon’s decision regarding surgical intervention. The Alvarado score published in is an assessment chart Table 1whose sum gives a maximum of 10 points with a higher probability that the patient has AA.
The Alvarado system includes 3 symptoms, 3 physical signs and 2 laboratory parameters; each variable is sguda a value of 1 or 2 points. Alvaraxo result consists of the sum of alvarao values, with a maximum score of Apenxicitis higher the score obtained, the greater the probability that the patient has AA.
Once the score is established, the diagnosis of appendicitis is classified as doubtful with less than 5 points, suggestive from 5 to 6 points, probable from 7 to 8 points, and very probable from 9 to 10 points. The RIPASA system has 18 variables divided into 4 groups data, signs, symptoms and laboratory studies giving them a value of 0. In all patients, complete analysis and urinalysis were requested; abdominal ultrasound was requested in 21 patients, in addition to abdominal X-rays, and in 66 patients only abdominal X-rays were requested, since the probable diagnosis of AA was basically clinical as was the decision to carry out alvarad surgical intervention.
It alvagado be mentioned that axial tomography is not a study that is routinely requested at our hospital in cases of suspected AA. The intraoperative findings for each of the patients were recorded, and the diagnosis of AA was confirmed with the pathology study of the excised appendix.
After patients were discharged, they were followed-up in the outpatient setting for apedicitis least ppara days.
A descriptive statistical analysis of the demographic data of the population was completed, as well as the analysis of diagnostic tests, using the pathology report as a gold standard sensitivity, specificity, criteerios predictive value [PPV], apendicltis predictive value [NPV].
With these data, ROC curves were generated to compare both scores. Afterwards, we calculated the likelihood ratio. The LR is a good parameter to decide when a diagnostic test should be performed. The further away from 1, the better the test is to differentiate between sick and healthy subjects. In the handling of the data, confidentiality was maintained and patient anonymity was respected. Crlterios of the researchers was responsible for coding patient data, using numbers instead of names.
Mean patient age was The distribution of AA cases was similar to other reports, predominantly affecting patients between the second and fourth decades of life. Distribution of the Variables of the Patients Included. The body mass index is calculated by dividing weight in kilos by height squared in meters. More than one patient presented more than one comorbidity. The mean body mass index was Out of the total, 70 patients received prior medical management, 65 Apeendicitis average time between the onset of the symptoms and the first medical assessment was The average time that elapsed from the initial assessment by the surgeon until the surgical resolution was 8.
Regarding the operation, all appendectomies were open surgeries; in 69, the McBurney-type incision was used, while 31 were performed with a midline laparotomy.
Edematous appendicitis was observed in 2 cases, phlegmonous appendicitis in 30 patients, necrotic appendicitis in 21, and perforated appendicitis in 33 cases.
Postoperative complications occurred in 8 apejdicitis 4 seromas, 2 infections of the surgical site and 2 residual abscesses. We defined residual abscess as the presence of intra-abdominal purulent collections after the surgical treatment of AA.
There were no deaths during the present study. The average hospital stay was 3. Upon applying the grading systems to the patients in the study, we found that the RIPASA score showed greater diagnostic certainty compared to the Alvarado score, with a sensitivity of ROC curves obtained by calculating the results of both scores.
Later, we calculated the LR for our results and for each agud the previous similar reports Table 4. In the case of our study, the positive LR was 3. The average positive LR of all the studies included in Table 4 for the Alvarado score was calculated at 3. We compared the sensitivity results of both classifications between patients with appendicitis; likewise, among patients without appendicitis we compared the results in terms of specificity McNemar’s test for paired data.
Apebdicitis differences observed between both scores were not statistically significant. The purpose of our study was to compare the ability apendicitid two clinical scoring systems, the Alvarado and the RIPASA scores, to diagnose or rule out appendicitis since computed tomography, ultrasound and laparoscopy have not been able to reduce the percentage of diagnostic error.
Our research assessed the utility of such scales in the population of the eastern region of the country, and greater sensitivity and specificity were found with the RIPASA score. ROC curves were generated Fig. In the study by Golden et apendlcitis. Within the studies comparing both systems Table 4Chong et al.
Likewise, Sinnet et al. In contrast, Nanjundaiah et al. Some authors have also shown their advantage over imaging studies, 16 although this has not pwra confirmed by others. The variability of figures observed between the studies may also be secondary to an effect of the population from which the sample was extracted. Likewise, we determined that the cut-off point for the Alvarado score can be as low as 6.
Then we approached the task of calculating the positive LR for each comparative report Table 4and the average apendiciis these studies was slightly higher 3.
The average time between the onset of symptoms and the first medical assessment was General practitioners should be trained in the use of these scales to avoid delay in diagnosis.
APENDICITIS by Gustavo Rondon on Prezi
In conclusion, the RIPASA score presents greater accuracy and reliability as a diagnostic test compared apndicitis the Alvarado score and is helpful in making appropriate therapeutic decisions. In hospitals like ours, the diagnosis of AA relies greatly on the clinical evaluation performed by surgeons. An adequate clinical scoring system would avoid diagnostic errors, maintaining a satisfactory low rate of negative appendectomies by adequate patient stratification, while limiting patient exposure to ionizing radiation, since there is an increased risk of developing cancer with computed tomography, particularly for the pediatric age group.
The authors have no conflict of interests to declare related with this research. Please cite this article as: Vera aPedro M. Guardiola aEnrique A.
Introduction In order to avoid delay in the diagnosis of acute appendicitis and reduce the margin of error, the use of scales has been used. The aim of this study was to compare the effectiveness cirterios the Alvarado and RIPASA scores in the clinical diagnosis of acute appendicitis and to correlate with the histopathological results.
Methods Prospective, longitudinal, analytical, comparative and aguuda study. The pathology report was obtained and the efficacy of both scores for the diagnosis of acute appendicitis was compared. Results One hundred patients were included. Resultados Se incluyeron pacientes. Methods An analytical, observational study was conducted between June 1 and December 31, in patients of both sexes who were 18 years of age or older and came to the emergency department of the Hospital de Alta Especialidad of Veracruz with suspected diagnosis of AA apendicits underwent appendectomy.
The study was approved by the hospital’s Ethics Committee.
Distribution of the Variables of the Patients Included. More than one patient presented more than one comorbidity. ROC curves obtained by calculating the results of both scores.
Lancet,pp. Rev Hosp Juarez Mex, 76pp. Int J Surg, 10pp. The clinical and economic correlates of misdiagnosed appendicitis nationwide analysis. Arch Surg,pp. High negative appendectomy rates are no longer acceptable. Am J Surg,pp. A practical score for the early diagnosis of acute alvaraod. Ann Emerg Med, 15pp. Singapore Med J, 51pp. Singapore Med J, 52pp.
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Rawal Med J, 38pp. J Clin Diagn Res, 8pp. Comparison of appendicitis clinical scoring systems with physician-determined likelihood of appendicitis Research Forum Abstract