Ceyhan Şahin, Seher Erdoğan, Ahmet Sami Yazar, Şirin Güven

Reliability of ultrasonography and the Alvarado scoring system in acute appendicitis

In this study, we aimed to evaluate the diagnostic performance ofultrasonography, the Alvarado score, mean platelet volume and C-reactiveprotein in the diagnosis of acute appendicitis.Patients admitted to the pediatric emergency department with abdominal painwho were operated on with a preliminary diagnosis of acute appendicitiswere evaluated. The patients who had acute appendicitis diagnosis in thehistopathological assessment were considered as the Appendicitis (App)Group, while patients who did not have acute appendicitis according tohistopathology were considered as the Non-app Group.Of 200 patients assessed in the study, 137 (68.5%) were male and 63 (31.5%)were female. Of the patients operated on; 170 (85%) had acute appendicitis,while the pathological results of 30 (15%) were not consistent with acuteappendicitis. The Alvarado score of the patients in App Group was significantlyhigher than those in Non-app Group (p=0.001). The sensitivity and specificityof the Alvarado score and ultrasonography were 60%, 81.18% and respectively,for the diagnosis of appendicitis. There were no significant differences (p>0.05) in terms of average white blood cell, absolute neutrophil count, plateletcount, mean platelet volume and C-reactive protein between the two groups.According to our study the use of Alvarado Scoring System with ultrasonographyis more effective and accurative than ultrasonography performing alone. Werecommend performing ultrasonography on patients with right lower quadrantpain and suspected appendicitis admitted to the emergency department and tooperate on patients with a ultrasonography-supported appendicitis diagnosisand an Alvarado score of 7 and above. Patients with an appendicitis diagnosisnot supported by ultrasonography and an Alvarado score lower than 7 shouldbe closely monitored.

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1. Ergul E. Importance of family history and genetics for the prediction of acute appendicitis. Internet J Surg 2007; 10: 2.
2. Nance ML, Adamson WT, Hedrick HL. Appendicitis in the young child: a continuing diagnostic challenge. Pediatr Emerg Care 2000; 16: 160-162
3. Richard G. Bachur, Kara Hennelly, Michael J. Diagnostic imaging and negative appendectomy rates in children: effects of age and gender. Pediatrics 2012; 129: 5
4. Paajanen H, Mansikka A, Laato M, Ristamäki R, Pulkki K, Kostiainen S. Novel serum inflammatory markers in acute appendicitis. Scand J Clin Lab Invest 2002; 62: 579-584.
5. Madan S. Pediatric appendicitis score. Journal of Pediatric Surg 2002; 37: 877-881.
6. Goldman RD, Carter S, Stephens D, Antoon R, Mounstephen W, Langer JC. Prospective Validation of the Pediatric Appendicitis Score. J Pediatr 2008; 153: 278-282
7. Erkasap S, Ates E, Ustuner Z, Sahin A, Yılmaz S, Yasar B. Diagnostic value of interleukin-6 and C-reaktive protein in acute appendicitis. Swiss Surg 2000; 6: 169-172.
8. Ilkhanizadeh B, Owji AA, Tavangar SM, Vasei M, Tabei SM. Spot urine 5-hydroxy indole acetic acid and acute appendicitis. Hepatogastroenterology 2001; 48: 609-613.
9. Pipal DK, Kothari S, Shrivastava H, Soni A, Pipal V. To evaluate the diagnostic accuracy of alvarado score, C-reactive protein, ultrasonography and computed tomography in acute appendicitis and to correlate them with operative and histological findings. Int Surg J 2017; 4: 361-367
10. Alvarado AA. Practical score for early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15: 557-564.
11. Almaramhy HH. Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr 2017; 43: 15
12. Becker T, Kharbanda A, Bachur R. Atypical clinical features of pediatric appendicitis. Acad Emerg Med Off J Soc Acad Emerg Med 2007; 14: 124-129.
13. Omundsen M, Dennett E. Delay to appendicectomy and associated morbidity: a retrospective review. ANZ J Surg 2006; 76: 153-155
14. Bergeron E. Clinical judgement remains of great value in the diagnosis of acute appendicitis. J Can Chir 2006; 49: 96-100.
15. Anderson RE, Hugander A, Thulin AJ. Diagnostic accuracy and perforation rate in appendicitis: Association with age and sex of the patient and with appendectomy rate. Eur J Surg 1992; 158: 37-41.
16. Ohle R, O’Reilly F, O’Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute apandicitis: a systematic review. BMC medicine 2011; 9: 139.
17. McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med 2007; 25: 489-493.
18. Mostbeck G, Adam EJ, Nielsen MB, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging. 2016; 7: 255-263.
19. Al-Khayal KA, Al-Omran MA. Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicites. A meta-analysis. Saudi Med J 2007; 28: 173-180.
20. Doria AS, Moineddin R, Kellenberger CJ, et al. US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology 2006; 241: 83-94.
21. Rosai J. Rosai and Ackerman’s surgical pathology. (9th ed). Gastrointestinal tract-appendix. Newyork: Elsevier, 2004: 757-758.
22. Kafetzis DA, Velissariou IM, Nikolaides P, et al. Procalcitonon as a predictor of severe appendicitis in children. Eur J Clin Microbiol 2005; 24: 484-487.
23. Wu JY, Chen HC, Lee SH, Chan RC, Lee CC, Chang SS. Diagnostic role of procalcitonin in patients with suspected appendicitis. World J Surg 2012; 11: 1744- 1749.
24. Al-Gaithy ZK. Clinical value of total blood cells and neutrophil counts in patients with suspected appendicitis: retrospective study. WJES 2012; 7: 32.
25. Yang HR, Wang YC, Chung PK, et al. Role of leukocyte count, neutrophil percentage, and C-reactive protein in the diagnosis of acute appendicitis in the elderly. Am Surg 2005; 71: 344-347.
26. Albayrak Y, Albayrak A, Albayrak F, et al. Mean platelet volume: a new predictor in confirming acute appendicitis diagnosis. Clin Appl Thromb Hemost 2011; 17: 362-366.
27. Tanrıkulu CS, Tanrıkulu Y, Sabuncuoğlu MZ, Karamercan MA, Akkapulu N, Coşkun F. Mean platelet volume and red cell distribution width as a diagnostic marker in acute appendicitis. Iran Red Crescent Med J 2014; 16: e10211.
28. Erdem H, Aktimur R, Çetinkunar S, et al. Evaluation of mean platelet volume as a diagnostic biomarker in acute appendicitis. Int Clin Exp Med 2015; 15: 1291- 1295.
29. Narcı H, Turk E, Karagülle E, Togan T, Karabulut K. The role of mean platelet volume in the diagnosis of acute appendicitis: a retrospective case-controlled study. Iran Red Crescent Med J 2013; 15: e11934.