The Alvarado Score and Computed Tomography for Predicting Acute Appendicitis in Elderly Patients

Objective: The aim of this study was to modify the Alvarado scoring system to increase its sensitivity and specificity in predicting acute appendicitis in elderly patients. Methods: The data of 81 patients older than 70 years of age who were admitted for acute abdominal pain between January 2015 and December 2017 were randomized into 2 groups and evaluated retrospectively. In Group 1 patients, acute appendicitis was not histopathologically established postoperatively, while Group 2 patients had pathological results consistent with acute appendicitis. The sensitivity and specificity of computed tomography (CT) scans and Alvarado scores were evaluated in the 2 groups. Results: The specificity and sensitivity of the modified Alvarado score was 86% and 81%, respectively, whereas the specificity and sensitivity of a CT scan was 93% and 92.1%, respectively, in diagnosing acute appendicitis. Conclusion: There are a limited number of studies related to acute appendicitis in elderly patients and the current strategy for treatment is not clear. Due to the decreased sensitivity of the Alvarado score in the diagnosis of acute appendicitis in elderly patients, the goal of this research was to adjust the scoring system. Scores >7 are more reliable in predicting appendicitis. We believe that patients can be more accurately diagnosed in a short period of time using this modified Alvarado scoring system. In combination with a CT scan evaluation, the success rate of diagnosis may be improved and delayed diagnosis prevented.

Yaşlı Hastalarda Akut Apandisit Tahmini İçin Alvarado Skoru ve Bilgisayarlı Tomograf

Amaç: Yaşlı hastalarda akut apandisitin tahmininde Alvarado skorlama sistemini modifiye ederek, skorlamanın sensivite ve spesifitesini arttırmayı amaçladık. Gereç ve Yöntem: Ocak 2015–Aralık 2017 tarihleri arasında kliniğimizde akut karın ağrısı ile başvuran yetmiş yaş üstü 81 hastanın dahil edildiği geriye dönük bir çalışma yürüttük. Tıbbi takiple taburcu edilen ve ameliyat sonrası patolojik tanısı apandisit ile uyumlu olmayan hastalar Grup 1, ameliyat sonrası histopatolojik olarak apandisit olduğu gösterilmiş hastalar Grup 2 olarak tanımlandı. Bilgisayarlı tomografi (BT) ve Alvarado skorunun yetmiş yaş üstü hastalarda sensivitesi ve spesifitesi değerlendirildi. Bulgular: Çalışmamızda, modifiye Alvarado skorunun akut apandisit tanısını koymada spesifitesi %81, sensitivitesi %86 iken BT’nin spesifitesi %93, sensitivitesi %92.1 olarak bulunmuştur. Sonuç: Yaşlılarda akut apandisite yönelik stratejisi hala belirsizdir ve bu konuda az sayıda çalışma vardır. Alvarado skorlama sisteminin yaşlı hastalarda tanıda duyarlılığının düşük olduğundan dolayı, Alvarado skorlama sistemini modifiye ederek 7 ve üzerinde skor alan yaşlı hastalarda akut apandisit tanısının daha yüksek doğrululuk oranıyla, zamanında teşhis edilebileceğini düşünmekteyiz. Akut apandisit tanısında Alvarado skorlama sistemi ile BT kombine edildiğinde tanıdaki başarının artıp teşhisteki gecikmenin azalacağı kanaatindeyiz. Anahtar Sözcükler: Alvarado skoru; bilgisayarlı tomografi; yaşlılarda apandisit.

Kaynakça

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Kaynak Göster

Southern Clinics of Istanbul Eurasia
  • ISSN: 2587-0998
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2017

1b368

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