Akut apandisit tanısında Alvarado skoru ve ultrasonografinin etkinliğinin karşılaştırılması

Amaç: Bu çalışmanın amacı Alvarado skoru ile ultrasonografinin akut apandisit tanısındaki etkinliğini karşılaştırmaktır.Gereç ve Yöntem: Ocak 2013-Şubat 2015 tarihleri arasında sağ alt kadran ağrısı ile acil servise başvuran 211 hasta geriye dönük olarak incelendi. Apandisit dışında patolojiler tesbit edilen ve ultrasonografi yapılamayan 22 hasta çalışma dışı bırakıldı. Hastaların Alvarado skorları hesaplandı ve kaydedildi. Alvarado skoruna göre <7 ve ≥7 olarak 2 gruba ayrıldı. Tüm hastaların preoperatif ultrasonografi ve postoperatif histopatolojik sonuçları kaydedildi.Bulgular: Çalışmaya dahil edilen 189 hastadan 157(%83) hastada akut appandisit ve 32(%17) hastada normal appendiks mevcuttu. Alvarado skoru <7 olan 68 (%35.9) ve ≥7 olan 121(%64.1) hasta mevcuttu. Alvarado skorunun spesifitesi %90.6, sensivitesi %75.1, pozitif prediktif değeri %97.5,negatif prediktif değeri %18.4 ve doğruluk oranı %77.7 olarak hesaplandı. Preoperatif 129 (%68.2) hastada ultrasonografi akut appandisit olarak rapor edildi. Bu hastaların, 117 (%61.9) tanesinde patoloji sonucu akut apandisit, 12 (%6.3) tanesinin ise patolojisi normaldi. Ultrasonografinin spesifitesi %62.5, sensivitesi %74.5, pozitif prediktif değeri %90.6, negatif prediktif değeri %12.7 ve doğruluk oranı %72.4 olarak hesaplandı.Sonuç: Alvarado skorlama sistemi ve ultrasonografi akut apandisitin tanısında kullanılabilecek etkili araçlardır. Ancak Alvarado skorlama sistemi, daha duyarlı bir yöntem olarak ön plana çıkmaktadır. Alvarado skorunun ≥7 olduğu ve ultrasonografik olarak apandisitin tesbit edildiği hastalarda bu iki yöntemin birlikte kullanılması daha değerli bulunmuştur.

Anahtar Kelimeler:

Akut apandisit, Alvarado skoru, ultrasonografi

Comparison of efficiency of Alvarado score and ultrasonography in acute appendicitis diagnosis

Purpose: The aim of this study is to compare the efficiencies of Alvarado score and ultrasonography in diagnosis of acute appendicitisMaterial and Methods: Two hundred and eleven patients who applied to emergency service with complaint of right lower quadrant pain between January 2013 and February 2015, were retrospectively examined. Twenty two patients, where the pathologies other than appendicitis were determined and no ultrasonography was applied, were excluded from the study. The Alvarado scores of the patients were calculated and recorded. They were divided into 2 groups by the Alvarado score; the scores <7 and those ≥7. Results: Of 189 patients involved in this study, 157 patients (83%) had acute appendicitis and 32 (17%) had normal appendix. There were 68 patients (35.9%) having Alvarado score <7 and 121 patients (64.1%) having Alvarado score ≥7. Specificity of Alvarado score was calculated to be 90.6%, sensitivity to be 75.1%, positive predictive value to be 97.5%, negative predictive value to be 18.4%, and accuracy rate to be 77.7%. The specificity of ultrasonography was calculated to be 62.5%, sensitivity to be 74.5%, positive predictive value to be 90.6%, negative predictive value to be 12.7%, and accuracy rate to be 72.4%.Conclusion: Alvarado scoring system and ultrasonography are the effective tools that can be used in diagnosis of acute appendicitis. But, however, Alvarado system come to the forefront as a more sensitive system. Among the patients having Alvarado score ≥ 7 and ultrasonographically diagnosed to have appendicitis, it would be better to use these methods together.

Keywords:

Acute appendicitis, Alvarado score, ultrasonography,

PDF

___

1. Ergul E. Importance of family history and genetics for the prediction of acute appendicitis. Internet J Surg. 2007;10:2.
2. Peterson MC, Holbrook JH, Hales D, Smith, NL, Staker, LV. Contributions of history, physical examination and laboratory investigations in making medical diagnosis. West J Med. 1992;156:163-5.
3. Colson M, Skinner KA, Dunnignton G. High negative appendectomy rates are no longer acceptable. Am J Surg. 1997;174:723-6.
4. Fingerhut A, Yahchouchy-Chouillard E, Etrenne JC. Appendicitis or nonspesific pain in the right iliac fossa. Rev Prot. 2001;51:1654-6.
5. Dado G, Anania G, Baccarani U, Marcotti E, Donini A, Risaliti A. Application of a clinical score for the diagnosis of acute appendicitis in childhood. J Pediatr Surg. 2000;35:1320-2.
6. Sezer TO, Gulece B, Zalluhoglu N, Gorgun M, Dogan S: Diagnostic value of ultrasonography in appendicitis. Adv Clin Exp Med. 2012,21:633-6.
7. Alvarado A. A practical score for early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15.557-64.
8. Horzic M, Salamon A, Koplijar M, Skupnjak M, Cupurdija K, Vanjak D. Analysis of scores in diagnosis of acute appendicitis in women. Coll Anropol. 2005;29:133.
9. Hale DA, Molloy M, Richard HP, Pearl R, Schutt DC, Jaques DP. Appendectomy A contemporary appraisal. Ann Surg. 1997;225:252-61.
10. Bergeron E. Clinical judgement remains of great value in the diagnosis of acute appendicitis. J Can Chir. 2006;49:96-100.
11. Leite PN, Pereira JM, Cunha R, Pinto P,Sirlin C. Computed tomography evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. Am J Roentgenology. 2005;185:406-17.
12. Puylaert JB, Rutgers PH, Lalisang RI, de veries BC, Van der Werf SD, Dörr JP et al. A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med. 1987;317:666-9.
13. Tatlı F, Ekici U, Kanlioz M, Gozeneli O, Uzunkoy A, Yucel Y et al. Ultrasonograpy in diagnosis of acute appendicitis. Ann Ital Chir. 2016;87:152-4.
14. Sitter H, Hoffmann S, Hassan I, Zielke A. Diagnostic score in appendicitis. Validation of a diagnostic score (Eskelinen score) in patients in whom acute appendicitis is suspected. Langenbecks Arch Surg. 2004;389:213-8.
15. Turan A, Kapan S, Kütükçü E, Yiğitbaş E, Hatipoğlu S, Aygün E. Comparison of operative and non operative managment of acut appendicitis. Ulusal Travma Acil Cerrahi Derg. 2009;15.459-62.
16. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: Computed tomographyand ultrasonography to detectacute appendicitis in adults and adolescents. Intern Ann Med. 2004;141:537-46.
17. Coşkun T, Kaya Y: Akut Apandisit. In Temel Cerrahi.4th ed (Ed. İ Sayek):1342-43. Ankara, Güneş Tıp Kitapevi, 2013.
18. Ozkan S, Duman A, Durukan P, Yildirim A, Ozbakan O. The accuracy rate of Alvarado score, ultrasonography, and computerized tomography scan in the diagnosis of acute appendicitis in our center. Niger J Clin Pract. 2014;17:413-8.
19. Limpawattanasiri C. Alvarado score for the acute appendicitis in a provincial hospital. J Med Assoc Thai. 2011;94:441-9.
20. İnan M, Tulay SH, Besim H, Karakaya J. The value of ultrasonography and its’ comparison with Alvarado scoring system in acute appendicitis. Ulusal Cerrahi Dergisi. 2011;27:149-53.