Key result
Combining abdominal ultrasound with the Alvarado score yielded 96.7% sensitivity and 88.2% specificity for diagnosing acute appendicitis, compared to 67.6% and 61.5% for the Alvarado score alone.
Why the study?
Most series report a high rate of negative appendectomy operations, prompting the study of clinical scoring systems and imaging methods to lower negative appendectomy rates.
Does combining abdominal ultrasound with the Alvarado score improve diagnostic accuracy for acute appendicitis in patients with clinical suspicion?
Cross-Sectional (n=118)
Does combining abdominal ultrasound with the Alvarado score improve diagnostic accuracy for acute appendicitis in patients with clinical suspicion?
Combining the Alvarado score with abdominal ultrasound significantly improves the diagnostic accuracy for acute appendicitis compared to either modality alone.
Answers are grounded in this paper and cite their sources.
May improve diagnostic yield in suspected appendicitis; leaves open whether it reduces negative appendectomies without prospective validation.
Background: One of the most frequent reasons for urgent surgery is acute appendicitis. Although prompt diagnosis is essential, most series also report a high rate of negative appendectomy operations. Clinical scoring systems and imaging methods for diagnosing appendicitis are being studied as potential diagnostic parameters for lowering the negative appendectomy rate. Aim: to assess the efficiency of combining abdominal ultrasound with the Alvarado score in correctly identifying cases of acute appendicitis. Patients and methods: The study included 118 patients with clinical suspicion of acute appendicitis. Standardized laboratory tests, a complete medical history, and a physical examination were performed on every patient. All patients also had pelviabdominal US performed by a qualified radiologist, and their Alvarado scores were calculated. Histopathological examination of the specimen from each patient's appendectomy was used as the definitive method of diagnosis. Results: When compared to the histopathological findings, the Alvarado score had a sensitivity and specificity of 67.6% and 61.5 %, respectively, for the diagnosis of appendicitis. The ultrasound accuracy for appendicitis was 80.7%, with a sensitivity of 80.4% and a specificity of 76.9%. The combination of both parameters showed 96.7% sensitivity and 88.2% specificity in diagnosis of acute appendicitis. It also showed PPV and NPV were 89% and 83.3% respectively. Conclusion: The combined use of Alvarado score and ultrasound examination was associated with higher sensitivity and accuracy in diagnosis of acute appendicitis when compared with each modality alone.
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Helal et al. (2023) conducted a cross-sectional in acute appendicitis (n=118). Combination of abdominal ultrasound and Alvarado score vs. Alvarado score alone or ultrasound alone was evaluated on correctly identifying cases of acute appendicitis. Combining abdominal ultrasound with the Alvarado score yielded 96.7% sensitivity and 88.2% specificity for diagnosing acute appendicitis, compared to 67.6% and 61.5% for the Alvarado score alone.
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