medigraphic.com
ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2010, Number 1

<< Back Next >>

Cir Gen 2010; 32 (1)

Prospective evaluation of the Alvarado Scale in the diagnosis of acute appendicitis

Velázquez MJD, Godínez RC, Vázquez GMÁ

Language: Spanish
References: 25
Page: 17-23
PDF size: 147.16 Kb.


ABSTRACT

Objective: To determine the usefulness and efficacy of the Alvarado Scale for the diagnosis of acute appendicitis, using clinical and laboratory tests.
Setting: Regional Hospital Salamanca PEMEX. Second level health care hospital.
Design: Transversal, prospective, analytical study.
Statistical analysis: Sensitivity, specificity, positive and negative predictive values of the diagnostic test.
Material and methods: The study was performed from July 2007 to December 2008. Patients of any age and gender with a diagnosis of acute appendicitis were included, patients were captured sequentially during the study period. We obtained the scores according to the variables of the Alvarado Scale, appendicectomy was performed in all patients, and the result from the histopathological report was obtained. The studied variables were age, gender, time of evolution, migration of pain to the right inferior quadrant, anorexia, nausea and vomiting, pain in the inferior right quadrant, rebound, increased temperature, leukocytosis and neutrophilia.
Results: We studied 113 patients subjected to appendicectomy, there were 63 men (55.8%) and 50 women (44.2%), mean age was of 28 (± 12.6) years. The Alvarado Scale was applied to the 113 patients with the presumptive diagnosis of acute appendicitis. Less than 4 points were obtained in 12 patients, from 5 to 6 in 25 patients, from 7 to 10 in 76 patients. The histopathological report was positive for acute appendicitis in 92 patients (81.4%), and histologically normal appendices were found in 21 patients (18.6%). A 99% sensitivity, 62% specificity, 92% positive predictive value, 93% negative predictive value, and an accuracy of 92% were obtained for the diagnosis of acute appendicitis using the Alvarado Scale.
Conclusion: The Alvarado Scale is useful as a diagnostic tool for acute appendicitis, it presents high sensitivity, high positive and negative predictive values, it is applicable to all patients with acute abdominal pain suggestive of appendicitis.


REFERENCES

  1. Andersson REB. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 2004; 91: 28-37.

  2. Kearney D, Cahill R, O’Brien E, Kirwan W, Redmond H. Influence of delays on perforation risk in adults with acute appendicitis. Dis Colon Rectum 2008; 51: 1823-1827.

  3. Florence M, Flum DR, Jurkovich GJ, Lin P, Steele SR, Symons RG, et al. Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg 2008; 248: 557-563.

  4. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosis appendicitis. Nationwide analysis. Arch Surg 2002; 137: 799-804.

  5. Sengupta A, Bax G, Paterson-Brown S. White cell count and C-reactive protein measurement in patients with possible appendicitis. Ann R Coll Surg Engl 2009; 91: 113-115.

  6. Padierna-Luna JL, Ruiz-Valenzuela KL, Morales-Arellano AC. Proteína C reactiva en el diagnóstico de apendicitis aguda. Rev Mex Patol Clin 2005; 52: 163-167.

  7. Beltrán MA, Almonacid FJ, Vicencio A, Gutiérrez J, Danilova T, Cruces KS. Rol del recuento de leucocitos y de la proteína C reactiva en niños con apendicitis. Rev Chil Cir 2007; 59: 38-45.

  8. Poortman P, Oostvogel H, Lohle P, Cuesta M, de Lange-de Klerk E, Hamming J. Ultrasonography and clinical observation in women with suspected acute appendicitis: A prospective cohort study. Dig Surg 2009; 26: 163-168.

  9. Andre JB, Sebastian VA, Ruchman RM, Saad SA. CT and appendicitis: evaluation of correlation between CT diagnosis and pathological diagnosis. Postgrad Med J 2008; 84: 321-324.

  10. McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med 2007; 25: 489-493.

  11. Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis. Implications for pathophysiology and management. Ann Surg 2007; 245: 886-892.

  12. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15: 557-564.

  13. Ohmann C, Franke C, Yang Q. Clinical benefit of a diagnostic score for appendicitis: Results of a prospective interventional study. Arch Surg 1999; 134: 993-996.

  14. Otero-Cruz H, Rodríguez D. Certeza diagnóstica en apendicitis: Aplicación del protocolo de Alvarado. Rev Med Dom 2001; 62: 18-23.

  15. Beltrán SM, Villar MR, Tapia TF. Score diagnóstico de apendicitis: Estudio prospectivo, doble ciego, no aleatorio. Rev Chil Cir 2004; 56: 550-557.

  16. Guzmán-Valdivia GG. Una clasificación útil en apendicitis aguda. Rev Gastroenterol Mex 2003; 68: 261-265.

  17. Blomqvist PG, Andersson REB, Granath F, Lambe MP, Ekbom AR. Mortality after appendectomy in Sweden, 1987-1996. Ann Surg 2001; 233: 455-460.

  18. Ahmed AM, Vohra LM, Khaliq T, Lehri AA. Diagnostic accuracy of Alvarado Score in the diagnosis of acute appendicitis. Pak J Med Sci 2009; 25: 118-121.

  19. Subotić AM, Sijacki AD, Dugalić VD, Antić AA, Vuković GM, Vukojević VS, et al. Evaluation of the Alvarado Score in the diagnosis of acute appendicitis. Acta Chir Iugosl 2008; 55: 55-61.

  20. Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl 1994; 76: 418-419.

  21. Sanei B, Mahmoodieh M, Hosseinpour M. Evaluation of validity of Alvarado scoring system for diagnosis of acute appendicitis. Pak J Med Sci 2009; 25: 298-301.

  22. Donlan SM, Mycyk MB. Is female sex associated with ED delays to diagnosis of appendicitis in the computed tomography era? Brief Report. Am J Emerg Med 2009; 27: 856-858.

  23. Mittal VK, Goliath J, Sabir M, Patel R, Richards BF, AlkalayI, et al. Advantages of focused helical computed tomographic scanning with rectal contrast only vs triple contrast in the diagnosis of clinically uncertain acute appendicitis. A prospective randomized study. Arch Surg 2004; 139: 495-500.

  24. Bhatt M, Lawrence J, Ducharme F, Dougherty G, McGillivray D. Prospective validation of the Pediatric Appendicitis Score in a Canadian Pediatric Emergency Department. Acad Emerg Med 2009;16: 591-596.

  25. Goldman RD, Carter S, Stephens D, Antoon R, Mounstephen W, Langer JC. Prospective validation of the Pediatric Appendicitis Score. J Pediatr 2008; 153: 278-282.




2020     |     www.medigraphic.com