ASSOCIATION OF ALVARADO SCORE AND THE SEVERITY OFACUTE APPENDICITIS

Background: One of the most frequent abdominal emergencies requiring emergency surgery is acute appendicitis, and appendectomy is the most common emergency procedure performed globally. There is an urgent need for a predictor of the severity of acute appendicitis since delayed identification and treatment of severe appendicitis are linked to higher risks of perforation and postoperative morbidity, mortality, and prolong hospital stay. Objectives: The aim of this study was to assess how the severity of acute appendicitis is predicted by hyperbilirubinemia. Methods: This descriptive cross-section study was carried out in the Department of Surgery at Combined Military Hospital (CMH), Cumilla, during March 2021 to Feb 2023. A total of 80 patients purposing were included in this study. Among them 30 were diagnosed as complicated appendicitis and rest 50 were simple appendicitis patients. Patients diagnosed with complicated appendicitis and simple appendicitis irrespective of age and sex were included in the study. Patients who were not given consent to participate in the study were excluded from the study. After taking consent and matching eligibility criteria, data were collected from patients on variables of interest using the predesigned structured questionnaire by interview, observation, clinical examination and hematological investigation of the patients. Statistical analyses of the results were obtained by using window based Microsoft Excel and Statistical Packages for Social Sciences (SPSS-26), where required. Results: In complicated appendicitis 40% were male and 60% were female. In simple appendicitis 40% were male and 60% were female. The mean T-Bil in complicated appendicitis was 1.187mg/dL and 1.00 mg/dL in simple appendicitis. About 46.0% patients had hyperbilirubinemia in complicated appendicitis and 32.5% in simple appendicitis. Here, 58.0% had fever >37.30C in complicated appendicitis and 33.5% in simple appendicitis. About 69.7% had positive ..........

Objective: To compare the diagnostic accuracy of the Alvarado Score and the Appendicitis Inflammatory Response (AIR) Score in patients presenting with suspected acute appendicitis, using histopathological findings as the gold standard. Study Design: Comparative cross-sectional validation study. Place and Duration of Study: The study was conducted at Surgical Unit III, Allama Iqbal Memorial Teaching Hospital, Sialkot, from November 20, 2024, to May 20, 2025. Methodology: A total of 205 patients aged 18–70 years presenting with clinical signs of acute appendicitis were included using non-probability consecutive sampling. Each patient’s Alvarado and AIR scores were calculated based on clinical, laboratory, and radiological findings. All patients underwent appendectomy, and the removed specimens were examined histopathologically. Diagnostic performance was evaluated by calculating sensitivity, specificity, positive and negative predictive value (PPV, NPV), positive and negative likelihood ratio, and overall accuracy using SPSS ver. 26.0. Results: Among patients (63.4% male, mean age 28.04 ± 4.17 years), histopathology confirmed acute appendicitis in 161 (78.5%). The Alvarado Score showed 92.55% sensitivity, 97.73% specificity, and 93.66% accuracy, while the AIR Score had 88.20% sensitivity, 97.73% specificity, and 90.24% accuracy. Conclusion: The Alvarado and AIR Scores are reliable for diagnosing acute appendicitis, with the Alvarado Score slightly outperforming in sensitivity and accuracy. The Alvarado Score may be preferred in emergency settings for efficient diagnosis and management.

Background: Acute appendicitis is the most common abdominal surgical emergency, requiring rapid and accurate diagnosis to prevent serious complications. The Alvarado and RIPASA scores are widely used diagnostic tools, but they differ in characteristics and performance, particularly in Southeast Asian populations. This study sought to compare the Alvarado and RIPASA scores for diagnosing acute appendicitis at Hj. Bunda Halimah Hospital, Batam. Methods: This retrospective cross‑sectional analytic study included 125 patients with suspected acute appendicitis who underwent surgery at Hj. Bunda Halimah Hospital between 1 January 2022 and 31 December 2024. Histopathology served as the gold standard. Diagnostic metrics were calculated for an Alvarado cut‑off ≥ 7 and a RIPASA cut‑off ≥ 8 Results: The Alvarado score showed a sensitivity of 87.7%, specificity of 63.6%, PPV of 96.1%, NPV of 33.3%, and accuracy of 85.6% with an AUC of 0.797. The RIPASA score has a higher sensitivity of 91.2% but lower specificity of 54.5%, PPV of 95.4%, NPV of 37.5%, accuracy of 88%, and an AUC of 0.847. The ROC comparison shows that the AUC value of RIPASA reflects better discriminatory ability in establishing the diagnosis of acute appendicitis. Conclusion: The RIPASA score has been shown to be more sensitive and provide better discriminatory performance. Although the Alvarado score is more specific, the higher sensitivity and accuracy of RIPASA make it a superior alternative in the initial evaluation of appendicitis. Keyword : Acute appendicitis, Alvarado score, RIPASA score

Background: Acute appendicitis is the most common surgical emergency that affect about 7% of the population. Obstruction of the lumen by faecoliths is the usual cause of acute appendicitis. The histopathologic stages of appendicitis are important to regarding prognosis. Study of diagnostic accuracy and pathological correlation aiming to reduce not only late complications but also the rate of negative appendicectomies had been studied worldwide. Application of quantitative microscopic techniques for assessing the diagnosis of inflammatory condition of appendix is quite useful since it imparts objectivity and reliability to the diagnosis. This is the first study we carried out for analysis of severity of acute appendicitis by morphometric measurement of diameter of blood vessels in relation to degree of eosinophil and basophil (mast cells) infiltration. Materials and Methods: A retrospective review of archives of the department of pathology, for the period of three years from 2010 to 2012, we identified 100, clinically and histopathologically diagnosed cases of acute appendicitis. Slides and blocks were selected for the study. Blood vessel morphometric analysis was performed on H and E stained sections. Diameter of one largest measuring blood vessel in each layer (Mucosa, Muscularis propria, Submucosa and serosa) of the appendix, is measured by using ProGres Capture Pro software. Mean and SD of the diameters of the blood vessels in each layer of appendix in 100 specimens were calculated. Number of eosinophils infiltration/10 hpf on H & E stained sections and number of mast cells infiltration/10 hpf on Toluidine blue stained sections in each layer of appendix in 100 specimens were counted by using light microscopy. Results: All 100 patients, who underwent operative procedure, came with chief complaint of pain in the periumbilical region migrating to the right iliac fossa. The mean age of presentation was 25.10 years. This study found that as there is increase in the number of eosinophils (counted as number of eosinophils/10 hpf) in each layer of appendix, there is decrease in the diameter of blood vessel in corresponding layer of the same appendicectomy specimen and as there is increase in the number of mast cells (counted as number of mast cells/10 hpf) in each layer of appendix, there is also increase in the diameter of the blood vessel in corresponding layer of the same appendicectomy specimen in acute appendicitis. Conclusion: The study establishes the statistical correlation between morphometry and degree of cellular inflammatory infiltrate (eosinophils and mast cells counted by using light microscopy) which helps to assess severity of inflammation of the appendix. Keywords: Acute Appendicitis, Morphometry

Background: One of the most common surgical emergencies that happens in the abdomen is the acute appendicitis. According to the research, liver function tests (LFT) may be utilized to predict the severity of appendicitis and serve as a marker for acute appendicitis. Methods: From January to June 2024, 100 cases of acute appendicitis were observed in the emergency room of “Azadi Teaching Hospital,” located in Duhok City, Kurdistan region, Iraq, as part of a single-center, observational, prospective study. The Research Ethics Committee granted ethical permission (Ref. No. 29112023-10-8). Every patient had blood testing, including liver function tests as well as abdominal ultrasonography. Reports on histopathological findings were also examined. Patients with uncomplicated and complicated appendicitis (perforated, gangrenous) were split into two groups. Microsoft Excel 2020 was used to collect and statistically evaluate the data. Results: Among the 100 patients, 54% were male, while 46% were female. Negative appendectomies were found in 2% of cases. Elevated total bilirubin levels were found in 71% of patients with an uncomplicated appendicitis and 89% of those with complicated appendicitis, yielding a significant p-value of 0.0053 and a sensitivity of 62%. Direct bilirubin was elevated in 88% of cases of uncomplicated appendicitis and 96% in complicated cases, with a significant p-value of 0.05 and a sensitivity of 69%. Both alanine transaminase (ALT)and aspartate transaminase (AST) levels were increased in both groups, especially in the complicated group, with AST elevated in 53% of cases and ALT in 35%. Alkaline phosphatase (ALP) levels were raised in 81% of uncomplicated appendicitis and 82% of complicated appendicitis cases, showing a sensitivity of 70.5%. Conclusion: In summary, liver function tests (LFT) can assist in diagnosing, evaluating the severity, and predicting complications of acute appendicitis by showing increases in total bilirubin, direct bilirubin, and alkaline phosphatase.

Background: Acute appendicitis is one of the most common abdominal emergencies requiring emergency surgery. The diagnosis based on the onset of symptoms and physical examination. Therefore, inaccuracies caused by subjective interpretation are frequent. This raises the need for tests to help diagnose acute appendicitis and predict the severity of the condition. aim of the study to investigate whether mean platelet volume, C-reactive protein, and hyperbilirubinemia can be used as inflammatory markers for the diagnosis of acute appendicitis and its correlation with histopathological examination. Methods: we prospectively analyzed 60 patients who were full fulling the inclusion criteria patients analysed for CBC, LFT and CRP and underwent for appendicectomy (Laparoscopic/open). Per-operative diagnosis was confirmed by histopathological examination from November 2020 to November 2022. Results: patients with CRP level > 6 and hyperbilirubinemia patients most likely to have acute appendicitis. Mean CRP level was 13.21±4.0 and mean bilirubin level 1.04±0.29 in case of acute appendicitis. CRP, hyperbilirubinemia levels were significantly higher in cases of acute appendicitis (p<0.01) while MPV value was not found significant. All patients was confirmed with histopathology examination. Conclusions: Serum bilirubin level and CRP estimation, which is a simple, cheap, and easily available laboratory test, can be added to the routine investigations in the diagnosis and severity of acute appendicitis and help in decreasing negative appendicectomy rates, especially in low modified Alvarado score.

Introduction:Many scoring systems have been developed to assist in diagnosis of acute appendicitis (AA). This study aimed to compare the screening performance characteristics of Alvarado, Eskelinen, Ohmann, Raja Isteri Pengiran Anak Saleha (RIPASA), and Tzanakis scores in predicting the need for appendectomy in AA patients. Methods:Our study prospectively evaluated AA patients that were treated in a tertiary hospital’s emergency department. The obtained data were used to calculate Alvarado, Tzanakis, RIPASA, Eskelinen and Ohmann scores. Patients were categorized into two groups according to their histopathological results: positive (PA) and negative appendectomy (NA). The accuracy of different scoring systems in diagnosing AA was investigated.Results:74 patients suspected to AA with the mean age of 36.68 ± 11.97 years were studied (56.8% male). The diagnosis was histopathologically confirmed in 65 cases (87.8%). Median Alvarado, Tzanakis, RIPASA, Eskelinen and Ohmann scores were significantly higher in patients with positive appendectomy. The area under the curve (AUC), sensitivity, and specificity of Tzanakis score in the cut-off value of 8 were 0.965, 84.4%, and 100%, respectively. For Ohmann and Alvarado scores, these measures were 0.941; 71.9%, 89.9% and 0.938, 60.9%, 89.9%, respectively. Tzanakis scoring system had the best screening performance in detection of cases with AA. Conclusion:Tzanakis score is more sensitive and specific than Alvarado, RIPASA, Eskelinen and Ohmann scores in identifying AA patients needing appendectomy.

Introduction The neutrophil-to-lymphocyte ratio (NLR) has emerged in recent years as a predictor of inflammation in various infectious pathologies. Among them, its value in predicting severity or complications in acute appendicitis has been studied and validated in adults and children. Although these studies are clear about its usefulness, it’s still unclear what value is optimal as a cut-off point. However, there is a knowledge gap in whether this evidence can be extrapolated to pregnant women with acute appendicitis. Gestation is a physiological situation that causes an intrinsic alteration of the immune system, altering white blood cell counts, and making the pregnant woman vulnerable to infection. Among these, acute appendicitis is the most frequent cause of acute abdomen in pregnancy. The aim of this study is to analyse whether NLR can play a predictive role in the severity of acute appendicitis in pregnant women. Methods We reviewed medical records for all consecutive pregnant patients admitted for acute appendicitis from 2018 to 2023 in our tertiary care university hospital. Results Fourteen patients were analysed, mean age was 29 years. Five (35.7%) were in the first trimester, 4 in the second trimester and 5 in the third trimester. The mean evolution time from the onset of symptoms to diagnosis was 2.4 days. The most used diagnostic technique was abdominal ultrasound (13 cases) and only in one patient MRI was performed for diagnosis. Four appendectomies had an open approach, and the others were laparoscopic. During surgery, peritonitis was observed in 9 cases (64%), and in 4 of them there was generalized peritonitis. In 2 cases acute appendicitis triggered birth, both in the third trimester, and both presented peritonitis. The mean hospital stay was 4 days, and 11 patients (78.5%) received empirical antibiotic therapy after surgery. Of the 14 cases, 6 presented complicated acute appendicitis in the pathological study, which did not correlate with intraoperative findings. CPR was significantly elevated in cases with peritonitis (mean 163 mg/l in cases with peritonitis versus 52 mg/l in non-peritonitis). We found the same correlation between NLR and peritonitis, significantly higher with a mean of 15.84% in the peritonitis group versus 7.31% in cases without peritonitis, However, we did not find a correlation between the anatomopathological diagnosis and the NLR. Conclusions In 5 years, only 14 pregnant women presented acute appendicitis in our tertiary hospital, despite being the most common cause of acute abdomen during pregnancy. Due to the small sample we cannot draw conclusions, but we can observe trends. It seems that the NLR behaves similarly as a predictor of complication or severity, especially if there is peritonitis. In published literature, it seems that the average NLR in pregnant women is higher than that of the non-pregnant population. We also observed that more than half of appendicitis in pregnant women presented peritonitis, whether localized or generalized, which is higher than in the general population. It seems that the NLR may behave similarly in pregnant women with peritonitis as in the non-pregnant population, so it could help predict the presence of peritonitis to provide early care in this vulnerable population.

BackgroundAcute appendicitis is one of the most common abdominal emergencies worldwide. Both environmental and genetic factors contribute to the disease. C-reactive protein (CRP) is an important biomarker in the diagnosis of acute appendicitis. CRP concentrations are significantly affected by genetic variation. However, whether such genetic variation is causally related to appendicitis risk remains unclear. In this study, the causal relationship between single-nucleotide polymorphisms (SNPs) associated with circulating CRP concentrations and the risk and severity of acute appendicitis was investigated.MethodsCRP concentrations in serum of appendicitis patients (n = 325) were measured. Appendicitis was categorized as complicated/uncomplicated and gangrenous/non-gangrenous. Imputed SNP data (n = 287) were generated. A genome-wide association study (GWAS) on CRP concentrations and appendicitis severity was performed. Intersection and colocalization of the GWAS results were performed with appendicitis and CRP-associated loci from the Pan-UKBB cohort. A functional-genomics approach to prioritize genes was employed.ResultsThirteen percent of significant CRP quantitative trait loci (QTLs) that were previously identified in a large cohort of healthy individuals were replicated in our small patient cohort. Significant enrichment of CRP-QTLs in association with appendicitis was observed. Among these shared loci, the two top loci at chromosomes 1q41 and 8p23.1 were characterized. The top SNP at chromosome 1q41 is located within the promoter of H2.0 Like Homeobox (HLX) gene, which is involved in blood cell differentiation, and liver and gut organogeneses. The expression of HLX is increased in the appendix of appendicitis patients compared to controls. The locus at 8p23.1 contains multiple genes, including cathepsin B (CTSB), which is overexpressed in appendix tissue from appendicitis patients. The risk allele of the top SNP in this locus also increases CTSB expression in the sigmoid colon of healthy individuals. CTSB is involved in collagen degradation, MHC class II antigen presentation, and neutrophil degranulation.ConclusionsThe results of this study prioritize HLX and CTSB as potential causal genes for appendicitis and suggest a shared genetic mechanism between appendicitis and CRP concentrations.

ABSTRACTBACKGROUND:The novel coronavirus disease 2019 (COVID-19) has resulted in major changes in health-care systems and emergency surgical interventions. Here, we examined patients with acute appendicitis who presented to emergency departments and compared diagnosis, treatment, and post-treatment processes before and during the pandemic period and investigated how the pandemic affected management of acute appendicitis.METHODS:A national, multicenter, and cohort study model was designed that included patients older than 18 years of age diagnosed with acute appendicitis clinically and/or radiologically, with patients compared before (pre-pandemic period: January 1–April 30, 2019) and after (pandemic period: January 1–April 30, 2020) the pandemic. Our investigation included comparisons of pre-operative imaging methods, presence of plastron appendicitis/abscess, conservative/surgical approach, type of anesthesia given, laparoscopic/open surgical approach, bowel resection rates, drain insertion rates, and presence of post-operative complicationsRESULTS:For the two study groups, 8972 patients from 69 centers were examined, with 4582 patients operated in the pre-pandemic period and 4234 patients operated in the pandemic period. During the pandemic period, 63.6% of patients underwent open surgery, whereas 34.4% had laparoscopic surgery. Although 60 patients (1.3%) requested non-operative follow-up in the pre-pandemic period, 94 patients (2.2%) requested this in the pandemic period. When conditions of patients were evaluated regardless of their own wishes, 114 patients (2.4%) before and 163 patients (3.8%) during the pandemic received non-operative follow-up.CONCLUSION:Our study did not show the direct correlation between the application of COVID-19-related restrictions and the severity of acute appendicitis. Although non-operative management rates have been increased during the COVID-19 period, the incidences of both complicated and the uncomplicated appendicitis were similar during the COVID-19 crisis period. Given this information non-operative management can be employed for patients diagnosed with appendicitis.

Background: Multiple scoring systems have been addressed to identify those patients who need emergency appendicectomy as the risk of delay could be avoided. Of these, the consideration of both sore related to the Alvarado and Tzanakis is essential for the study to understand the effective diagnose of acute appendicitis.Aim: The study aims to compare and evaluate Alvarado and Tzanakis score for diagnosing the acute appendicitis.Materials snad Methods: This study was conducted in the department of General Surgery associated with the M.K.C.G, Medical College and Hospital, Berhampur from August, 2018 to July, 2020. A total of 96 patients were being considered for carrying out a systematic study after carefully verifying a variety of the inclusion and exclusion criteria. To conduct the study in a systematic manner, the doctor has analyzed and given the score of Alvarado and Tzanakis. On the basis of score of these two approaches, the medical team has provided the treatment to these patients. The proper identification of score has helped to select the method of operation and surgery. In addition to this, the comparison of score focusing on the NPV and PPV has also allowed for identifying the sensitivity.Results: The Alvarado and Tzanakis score was found to have sensitivity along with the specificity of 94.44% and 83.33% respectively. However, the PPV and NPV was found to be 98.84% and 50.00% respectively as compared to Alvarado score where sensitivity, specificity, PPV and NPV was found out to be 77.77%, 66.66%, 97.22% and 16.66% respectively.Conclusion: From the study, it has carried out that the Tzanakis scoring system has been addressed a more reliable for analyzing the condition of patients and offering the treatment. Diagnostic. Alvarado score, with the former achieving higher sensitivity and PPV.

The diagnosis and severity of acute appendicitis (AA) are still challenging despite all the improvements in diagnosis and treatment. This study aimed to evaluate the efficacy of complete blood count (CBC) parameters in diagnosing AA and measuring severity. Data of 521 patients were reviewed retrospectively. Fifty-three patients with CBC results influenced by various reasons were excluded from the study. Age, gender, length of stay, CBC parameters, and histopathological results were examined. The study included 468 patients: 90 patients with a preliminary diagnosis of AA, not undergoing surgery but receiving medical treatment (Group I), 227 patients with uncomplicated appendicitis (Group II), and 151 patients with complicated appendicitis (Group III). Of the patients, 279 were male (59.6%) and 189 were female (40.4%). The mean age was 33.37±13.05 years. Groups I and III had the lowest and highest white blood cell (WBC), neutrophil, and neutrophil-to-lymphocyte ratio (NLR), respectively. There was a statistically significant difference between the groups (p<0.05). The highest and lowest mean platelet volume (MPV) values were in Groups II and III, respectively. There was no statistically significant difference between the groups (p>0.05). AA is the most common cause of abdominal surgery. The CBC is a cost-effective and easily-accessible test with acceptable diagnostic accuracy. It provides fast results and can be used in the diagnosis of appendicitis. Neutrophil, WBC, and NLR are helpful and useful parameters for physical examination and other diagnostic methods in diagnosing AA and measuring severity. However, the use of MPV is not recommended as it has a low diagnostic rate and contradictory results.

The Alvarado scoring system in acute appendicitis: A 6-month cross-sectional study to evaluate its reliability in reducing the rate of negative appendicectomy at Queen’s Hospital, Burton

In this study, we aimed to investigate the correlation of Alvarado scoring with C-reactive protein and leukocytes and the reliability of Alvarado scoring, and to guide clinicians for patient management. This study was planned as a prospective study. Data of the patients who presented to the emergency department with abdominal pain and diagnosed with acute appendicitis, and the control group were examined by the researchers. After a detailed physical examination, patientsÂ’ Alvarado scoring parameters and laboratory outcomes were recorded. Pathologic outcomes of the patients who were considered to have acute appendicitis and operated were studied. A different pathology other than appendicitis was found in 13 (15.1%) of 86 patients who were considered to have acute appendicitis and operated (negative appendectomy). According to the pathologic outcomes of the patient group, the most common cause of acute appendicitis was found to be fecalloids by 84.9%. Whereas simple appendicitis was observed in 85% of the patients, perforation was found in 8.2%. The most common finding of physical examination was right iliac fossa (95.8%), while the most common symptom was nausea / vomiting (67.1%) the in the cases of acute appendicitis. Among the Alvarado scoring parameters, fever was the least common symptom by 12.4%. In our study, we found a significant correlation between Alvarado scoring and leukocytes both in patients and control groups. Whereas there was no correlation between Alvarado scoring and C-reactive protein in the patient group, there was a correlation between these two parameters in the control group. There was a weak negative correlation between Alvarado scoring and acute appendicitis. Although Alvarado scoring has been reported to be a guiding scoring system in management of patients considered to have acute appendicitis, in our study this scoring was found to be statistically insignificant. Alvarado scoring alone is not sufficient in establishing a diagnosis, and the diagnosis should be supported by laboratory tests or imaging methods.

Background: Acute appendicitis despite being a common problem, remains a difficult diagnosis to establish. A delay to diagnose this condition as well as negative appendicectomies should be prevented. The above problems can be avoided by using scoring systems. This study aims to compare the efficacy of Alvarado score and RIPASA score in the diagnosis of acute appendicitis.Methods: In this study, 100 cases of appendicitis were admitted. Alvarado and RIPASA scores were applied to all patients. The scores were compared with post-operative histopathology findings.Results: Alvarado score was positive in 75% cases and RIPASA score was present in 90% cases. Histologically, appendicitis was present in 99% cases.Conclusions: RIPASA score is more efficient in diagnosing acute appendicitis compared to Alvarado score.