Evaluation of the Appendicitis Inflammatory Response Score for Patients with Acute Appendicitis

Background

Acute appendicitis is still a difficult diagnosis. Scoring systems are designed to aid in the clinical assessment of patients with acute appendicitis. The Alvarado score is the most well known and best performing in validation studies. The purpose of the present study was to externally validate a recently developed appendicitis inflammatory response (AIR) score and compare it to the Alvarado score.

Methods

The present study selected consecutive patients who presented with suspicion of acute appendicitis between 2006 and 2009. Variables necessary to evaluate the scoring systems were registered. The diagnostic performance of the two scores was compared.

Results

The present study included 941 consecutive patients with suspicion of acute appendicitis. There were 410 male patients (44%) and 531 female patients (56%). The area under the receiver operating characteristic curve of the AIR score was 0.96 and significantly better than the area under the curve of 0.82 of the Alvarado score (p?Conclusions This study externally validates the AIR Score for patients with acute appendicitis. The scoring system has a high discriminating power and outperforms the Alvarado score.     

The Appendicitis Inflammatory Response Score: A Tool for the Diagnosis of Acute Appendicitis that Outperforms the Alvarado Score

BACKGROUND: The clinical diagnosis of appendicitis is a subjective synthesis of information from variables with ill-defined diagnostic value. This process could be improved by using a scoring system that includes objective variables that reflect the inflammatory response. This study describes the construction and evaluation of a new clinical appendicitis score. METHODS: Data were collected prospectively from 545 patients admitted for suspected appendicitis at four hospitals. The score was constructed from eight variables with independent diagnostic value (right-lower-quadrant pain, rebound tenderness, muscular defense, WBC count, proportion neutrophils, CRP, body temperature, and vomiting) in 316 randomly selected patients and evaluated on the remaining 229 patients. Ordered logistic regression was used to obtain a high discriminating power with focus on advanced appendicitis. Diagnostic performance was compared with the Alvarado score. RESULTS: The ROC area of the new score was 0.97 for advanced appendicitis and 0.93 for all appendicitis compared with 0.92 (p = 0.0027) and 0.88 (p = 0.0007), respectively, for the Alvarado score. Sixty-three percent of the patients were classified into the low- or high-probability group with an accuracy of 97.2%, leaving 37% for further investigation. Seventy-three percent of the nonappendicitis patients, 67% of the advanced appendicitis, and 37% of all appendicitis patients were correctly classified into the low- and high-probability zone, respectively. CONCLUSION: This simple clinical score can correctly classify the majority of patients with suspected appendicitis, leaving the need for diagnostic imaging or diagnostic laparoscopy to the smaller group of patients with an indeterminate scoring result.     

Diagnosing Appendicitis at Different Time Points in Children with Right Lower Quadrant Pain: Comparison Between Pediatric Appendicitis Score and the Alvarado Score

Background  

Acute appendicitis is the most common abdominal emergency in clinical surgery. This study was designed to compare the diagnostic value of the Pediatric Appendicitis Score (PAS) with that of the Alvarado score based on different time points in children with right lower quadrant (RLQ) abdominal pain.     

改良Alvarado评分系统在成人急性阑尾炎分型诊断中的应用价值

目的探讨改良Alvarado评分系统在急性阑尾炎分型诊断中的应用价值。方法回顾性收集2004年1月至2014年1月期间于榆林市第一医院行手术且术后病理学检查确诊为急性阑尾炎的成人住院患者1 930例,采用改良Alvarado评分系统进行评分,分析改良Alvarado评分系统得分与急性阑尾炎病理学分型的关系,并绘制受试者工作特征（ROC）曲线,以探讨改良Alvarado评分系统对急性阑尾炎分型诊断的最佳诊断截点。结果1930例急性阑尾炎患者中,包括单纯型344例,进展型1586例。单纯型组患者的改良Alvarado评分系统得分为1-9分、（3.6±0.7）分;进展型组为1-10分、（7.5±1.3）分,进展型组的得分较高（P〈0.001）。改良Alvarado评分系统判断急性阑尾炎分型的价值较高,ROC曲线下面积（AUC）为0.943（95%CI：0.929-0.958,P〈0.001）;最佳诊断截点为6分,此时灵敏度为92.9%,特异度为86.3%,阳性预测值为96.9%,阴性预测值为72.6%,阳性似然比为6.8,阴性似然比为0.1,约登指数为91.7%。结论改良Alvarado评分系统对于急性阑尾炎的分型诊断具有一定的价值。     

Appendicitis

Appendicitis is a common condition, occurring in 250,000 patients every year in the United States and accounting for an estimated 1 million hospital days per year. Acute appendicitis is the most common cause of an acute abdomen that requires surgical treatment. A diagnosis can be made on clinical grounds in most patients, but imaging studies are useful in patients with equivocal findings. Prompt diagnosis and surgical treatment are the cornerstones of therapy to preempt progression of the disease to perforation that is associated with increased morbidity. Both laparoscopic and open appendectomy are viable surgical options, with most recent studies suggesting more favorable outcomes with a laparoscopic approach. In practice, the choice for either is usually based on the expertise of the surgeon along with the availability of hospital resources.The precise etiology of appendicitis is unclear. Accordingly, surgeons will continue to evaluate and treat patients with appendicitis for the foreseeable future. The liberal use of imaging modalities to improve the accuracy of preoperative diagnosis and minimize the negative appendectomy rate is a trend that is likely to continue. Operating on a patient without an imaging examination may often be appropriate, but will be the exception, not the rule. Finally, the trend toward laparoscopy is relatively slow compared with its adoption for the surgical treatment of other diseases, but inexorable. It would not be surprising if laparoscopic appendectomy becomes the most popular treatment for appendicitis in the future.     

Developing and validating of Ramathibodi Appendicitis Score (RAMA-AS) for diagnosis of appendicitis in suspected appendicitis patients

Background

Diagnosis of appendicitis is still clinically challenging where resources are limited. The purpose of this study was to develop and externally validate Ramathibodi Appendicitis Score (RAMA-AS) in aiding diagnosis of appendicitis.

Methods

A two-phase cross-sectional study (i.e., derivation and validation) was conducted at Ramathibodi Hospital (for derivation) and at Thammasat University Hospital and Chaiyaphum Hospital (for validation). Patients with abdominal pain and suspected of having appendicitis were enrolled. Multiple logistic regression was applied to develop a parsimonious model. Calibration and discrimination performances were assessed. In addition, our RAMA-AS was compared with Alvarado’s score performances using ROC curve analysis.

Results

The RAMA-AS consisted of three domains with seven predictors including symptoms (i.e., progression of pain, aggravation of pain, and migration of pain), signs (i.e., fever and rebound tenderness), and laboratory tests (i.e., white blood cell count (WBC) and neutrophil). The model fitted well with data, and it performed better discrimination than the Alvarado score with C-statistics of 0.842 (95% CI 0.804, 0.881) versus 0.760 (0.710, 0.810). Internal validation by bootstrap yielded Sommer’s D of 0.686 (0.608, 0.763) and C-statistics of 0.848 (0.846, 0.849). The C-statistics of two external validations were 0.853 (0.791, 0.915) and 0.813 (0.736, 0.892) with fair calibrations.

Conclusion

RAMA-AS should be a useful tool for aiding diagnosis of appendicitis with good calibration and discrimination performances.

     

Vacation Appendicitis

Objective:

When someone plans a vacation, one of the last things taken into consideration is the possibility of contracting an illness while away. Unfortunately, if people develop abdominal pain while planning for a vacation, they usually proceed with the vacation and do not consider getting medical attention for their pain. The purpose of this study was to examine the effect of being on vacation and its association with ruptured appendicitis.

Methods:

From January 1, 2007 to December 31, 2008, the incidence of ruptured appendicitis cases at Florida Hospital–Celebration Health, located 5 miles from Walt Disney World, was compared with that of Florida Hospital–Orlando, approximately 30 miles away from Walt Disney World. We evaluated whether patients “on vacation” versus residents of Orlando have an increased incidence of ruptured appendicitis.

Results:

Of patients treated for presumed appendicitis, 60.59% at Florida Hospital–Celebration Health had ruptured appendicitis during this time versus 20.42% at Florida Hospital–Orlando. Of those 266 patients seen at Florida Hospital–Celebration Health, 155 were on vacation versus only 21 at Florida Hospital–Orlando.

Conclusion:

Although there is not a direct cause and effect, it is clear that there is a higher incidence of ruptured appendicitis in patients on vacation versus in the regular community in the Orlando, Florida area.     

Xanthogranulomatous Appendicitis

A 78-years-old man presented with right lower quadrant pain for 2 months. Computed tomography revealed an irregular and multicystic mass near the cecum like as appedeceal mucocle. The lesion was diagnosed xanthogranulomatous appendicitis by histopathological findings of surgical specimen. Xanthogranuloma is uncommon disease, especially in the appendix. We report an interesting case of xanthogranulomatous appendicitis mimicking appendiceal mucocele in radiological images.