Alvarado score and computerized tomography scan as impact indicator in intervening negative appendectomy rate

Authors

  • Braja Mohan Mishra Department of General Surgery, Veer Surendra Sai Institute of Medical Science and Research, Burla, Odisha, India
  • Pramit Ballav Panigrahi Department of General Surgery, Veer Surendra Sai Institute of Medical Science and Research, Burla, Odisha
  • Sandeep Mishra Department of General Surgery, Veer Surendra Sai Institute of Medical Science and Research, Burla, Odisha, India
  • Abinasha Mohapatra Department of General Surgery, Veer Surendra Sai Institute of Medical Science and Research, Burla, Odisha, India

DOI:

https://doi.org/10.18203/2349-2902.isj20201401

Keywords:

Alvarado score, Computerized tomography scan, Impact indicator, Negative appendectomy rate, Ultrasound sonography

Abstract

Background: The objective of this study is to study the impact of combined use of Alvarado score and computed tomography (CT) scan on negative appendectomy rate.

Methods: This prospective observational study comprising of patients presenting with clinical features of appendicitis admitted to department of general surgery, VIMSAR, Burla from November 2017 to October 2019, where Alvarado score and ultrasonography (USG) findings are mismatching each other. Alvarado scores calculated and categorized in 2 groups as negative (score <4) and positive (score ≥4). These patients were also subjected to USG and categorized as negative (USG -ve) and positive (USG +ve). Those patients having discrepancy in both the findings were subjected to CT scan. On histopathological examination, inflamed appendix in 63 (97%) patients and non-inflamed in 2 (3%). Rest patients were either discharged (both -ve) or operated (both +ve).

Results: Total 84 patients showed discrepancy between Alvarado score and USG findings and are subjected to CT scan abdomen and pelvis. CT scan was positive for appendicitis in 65 cases (where appendectomy done) and negative for appendicitis in 19 cases (where the diagnosis is different). patient. Thus, negative appendectomy (NAR) is 3% in this study.

Conclusions: Alvarado score and ultrasonography could not be used as absolute tool in doubtful and equivocal cases, where combined use of CT scan with Alvarado score and USG has definitely has an edge by diagnosing the differentials and reducing NAR followed by reduction in cost and length of hospital stay.

References

Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiol. 2000;215:337e348.

Colson M, Skinner KA, Dunnington G. High negative appendectomy rates are no longer acceptable. Am J Surg. 1997;174(6):723e726.

Lewis FR, Holcroft JW, Boey J, Dunphy E. Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg. (Chicago, Ill: 1960). 1975;110(5):677-84.

Velanovich V, Satava R. Balancing the normal appendectomy rate with the perforated appendicitis rate: implications for quality assurance. Am Surg. 1992;58(4):264-9.

Raja AS, Wright C, Sodickson AD. Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology 2010;256:460-5.

Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiol. 2006;241(1):83-94.

Kim K, Rhee JE, Lee CC, Kim KS, Shin JH, Kwak MJ, et al. Impact of helical computed tomography in clinically evident appendicitis. Emerg Med J. 2008;25(8):477-81.

Tsao KJ, Peter SDS, Valusek PA, Spilde TL, Keckler SJ, Nair A, et al. Management of pediatric acute appendicitis in the computed tomographic era. J Surg Res. 2008;147(2):221-4.

Lewis FR, Holcroft JW, Boey J, Dunphy E. Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg. 1975;110(5):677-84.

Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey RB. Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiol. 2002;225(1):131-6.

Balthazar EJ, Rofsky NM, Zucker R. Appendicitis: the impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol. 1998;93(5):768-71.

Tan WJ, Acharyya S, Goh YC, Chan WH, Wong WK, Ooi LL, et al. Prospective comparison of the Alvarado score and CT scan in the evaluation of suspected appendicitis: a proposed algorithm to guide CT use. J Am College Surg. 2015;220(2):218-24.

Mariadason JG, Wang WN, Wallack MK, Belmonte A, Matari H. Negative appendicectomy rate as a quality metric in the management of appendicitis: impact of computed tomography, Alvarado score and the definition of negative appendicectomy. The Ann Royal College Surg Eng. 2012;94(6):395-401.

Mohebbi HA, Mehrvarz S, Kashani MT, Kabir A, Moharamzad Y. Predicting negative appendectomy by using demographic, clinical, and laboratory parameters: a cross-sectional study. Inter J Surg. 2008;6(2):115-8.

Das MK, Gautam D, Roy H, Mukherjee A, Gaurav R, Sen S. Unnecessary appendicectomy in suspected cases of acute appendicitis. J Indian Med Associat. 2009;107(6):354-6.

Subotić AM, Šijački AD, Dugalić VD, Antić AA, Vuković GM, Vukojević VS, et al. Evaluation of the Alvarado score in the diagnosis of acute appendicitis. Acta Chirurgica Iugoslavica. 2008;55(1):55-61.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.

Petrosyan M, Estrada J, Chan S, Somers S, Yacoub WN, Kelso RL, et al. CT scan in patients with suspected appendicitis: clinical implications for the acute care surgeon. Eur Surg Res. 2008;40(2):211-9.

Antevil JL, Rivera L, Langenberg BJ, Hahm G, Favata MA, Brown CV. Computed tomography-based clinical diagnostic pathway for acute appendicitis: prospective validation. J Am College Surg. 2006;203(6):849-56.

Tseng J, Cohen T, Melo N, Alban RF. Imaging utilization affects negative appendectomy rates in appendicitis: an ACS-NSQIP study. The Am J Surg. 2019;217(6):1094-8.

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Published

2020-03-26

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Original Research Articles