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Muacevic A, Adler JR, Awais M, Rafi M, Javeed S, Ahmed I, Farooq S, Ali AA. Accuracy of RIPASA and Lintula Scores in Diagnosing Acute Appendicitis Using Surgical Findings as the Gold Standard. Cureus 2022; 14:e31297. [PMID: 36514623 PMCID: PMC9733822 DOI: 10.7759/cureus.31297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Appendicitis is an inflammation of the vermiform appendix's inner lining that spreads to its other sections. Appendectomy is still the standard way to cure appendicitis. The diagnosis of acute appendicitis is still clinical and supported by a raised neutrophilic count and imaging studies; moreover, scoring systems, such as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Lintula scores, help the clinicians in the diagnosis. The main objective of this study was to establish the diagnostic accuracy of RIPASA and Lintula scores for acute appendicitis using surgical findings as the gold standard, in an Asian population. METHODS This was a retrospective cohort study conducted at the Department of Surgery, Mayo Hospital, Lahore, and Department of Surgery, Services Hospital, Lahore. This study was conducted from January 2020 to January 2022, for the duration of two years. A total of 120 patients were enrolled after meeting the inclusion criteria, and demographic data were obtained. Lintula and RIPASA scores were recorded, and patients were classified as positive or negative based on histopathological findings. IBM SPSS Statistics, version 26 (IBM Corp., Armonk, NY) was used to evaluate all of the gathered data. RESULTS The average age of the patients in this study was 37.39±14.36 years, with a male-to-female ratio of 1.14:1. Taking surgical finding as the gold standard, RIPASA scoring had a diagnosis accuracy of 91.67% while the Lintula score had a diagnostic accuracy of 79.17%. CONCLUSION While both the RIPASA and the Lintula scoring systems were accurate, the RIPASA scoring system outperformed the Lintula scoring system when surgical findings were used as the gold standard.
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BOSTANCI MT, YILMAZ İ, CİMEN S, KOŞMAZ K, GÖKCE A, AVCI MA. Are scoring systems detecting acute appendicitis reliable? a prospective clinical study. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.990183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Correlation of clinical data and the Alvarado's Score as predictors of acute appendicitis. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract
Objective To correlate the patient's clinical data and the Alvarado's Score as predictors of acute appendicitis.
Methods This is an observational, descriptive and prospective study performed at a public urgency and emergency hospital in the city of Fortaleza, Ceará, between July and December 2016, with 34 patients undergoing open appendectomy with ages between 18 and 70 years. Statistical analysis was performed using the SPSS program.
Results The following statistical correlations were performed: number of days with abdominal pain until the operative event and degree of inflammation according to a macroscopic analysis of the appendix, Alvarado's Score and number of days with abdominal pain until the operative event, Alvarado's Score and degree of inflammation according to a macroscopic analysis of the appendix, number of days with abdominal pain until the operative event, and number of days of hospitalization in the postoperative period, degree of inflammation according to amacroscopic analysis of the appendix, number of days of hospitalization in the postoperative period and Alvarado's Score, and number of days of hospitalization in the postoperative period; the first five correlations were statistically significant (p < 0.05).
Conclusion The use of this Alvarado's Score in health services emerges as a tool for the diagnosis of acute appendicitis.
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Dezfuli SAT, Yazdani R, Khorasani M, Hosseinikhah SA. Comparison between the specificity and sensitivity of the RIPASA and Alvarado Scoring systems in the diagnosis of acute appendicitis among patients with complaints of right iliac fossa. AIMS Public Health 2020; 7:1-9. [PMID: 32258184 PMCID: PMC7109537 DOI: 10.3934/publichealth.2020001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/12/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Acute appendicitis is one of the common prevalent surgical emergencies. Various techniques, such as Alvarado Score are used for diagnosis it. This study was conducted to compare the Alvarado and RIPASA scoring systems in patients referred to Hospital with complaints of right iliac fossa pain. Methodology This descriptive-analytic cross-sectional study was conducted in patients over 15 years with abdominal pain referred to emergency room of the Hospital. The data collection form was completed for each patient based on history and examinations and then examined by a surgeon. The pathological specimens were examined and the pathological outcomes of each patient were recorded in the relevant information collection form and finally analyzed. Results The results for the Alvarado system showed that 42.1%, 29.2% and 28.80% of the patients had a low probability, moderate probability and high probability of appendicitis, respectively. The findings for RIPASA system showed that 19.3% of patients definitely had appendicitis. The sensitivity and specificity of the Alvarado scoring system were 53.95% and 70.18%, respectively. Positive and negative predictive values of Alvarado were 70.69% and 53.33%, respectively. In contrast, the sensitivity, specificity, and positive and negative predictive values of the RIPASA scoring system were 93.42%, 45.61%, 69.61%, and 83.87%, respectively. Conclusion On the basis of the results, the RIPASA scoring system is a better system. Since the best cut-off point is 6 for Alvarado and 7.75 for RIPASA, it is better to use the values as a benchmark for the systems.
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Affiliation(s)
- Seyed Ashkan Tabibzadeh Dezfuli
- Assistant Professor, Trauma and Emergency Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Reza Yazdani
- Assistant Professor, Trauma and Emergency Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammadjavad Khorasani
- Head of Department of Emergency Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Gómez López JR, Martín Del Olmo JC, Montenegro Martín MA, Concejo Cutoli P, Martín Esteban ML, Toledano Trincado M, López Mestanza IC, Vaquero Puerta C. Laparoscopic Appendectomy in the Setting of Clinical Prediction Rules. J Laparoendosc Adv Surg Tech A 2018; 29:184-191. [PMID: 30585754 DOI: 10.1089/lap.2018.0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Acute appendicitis (AA) is the most frequent surgical entity in the emergency department, but its correct diagnosis remains challenging. To improve diagnosis, clinical prediction rules (CPRs) have been created to establish objective scores for the probability of suffering AA. In this study, we establish scores indicating whether laparoscopy would be superior to clinical observation or repeat diagnostic test. METHODS A retrospective observational study was conducted with 433 patients submitted to surgery for suspected AA using a laparoscopic approach. The Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, appendicitis inflammatory response, and adult appendicitis score scales were applied in each case to establish a high, medium, or low probability of suffering AA. RESULTS Of the 433 patients analyzed, 381 (88.0%) had AA. Twelve (2.8%) were converted to open surgery, and complications were observed in 54 (12.5%) cases. The CPRs studied showed statistically significant differences between AA and negative appendectomies. However, in patients with intermediate probability scores, the diagnostic accuracy of the CPRs evaluated was not adequate. CONCLUSIONS Laparoscopic surgery can serve as a diagnostic tool for patients with intermediate AA probability scores because of its low associated morbidity and mortality and because it affords a direct diagnosis of the problem, allowing determination of the appropriate treatment.
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do Nascimento RR, Souza JCG, Alexandre VB, Kock KDS, Kestering DDM. Association between the Alvarado score and surgical and histopathological findings in acute appendicitis. ACTA ACUST UNITED AC 2018; 45:e1901. [PMID: 30365693 DOI: 10.1590/0100-6991e-20181901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/28/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE to compare the results of the Alvarado score with the surgical findings and the results of the histopathological examination of the appendix of patients operated on for acute appendicitis. METHODS we conducted an observational study with a cross-sectional design of 101 patients aged 14 years and over undergoing emergency appendectomy. The evaluation comprised the Alvarado score, gender, age, ethnicity and time of evolution. We obtained data regarding the surgical aspect of the appendix, postoperative complications and the result of the histopathological examination. The pre-established confidence interval was 95%. We calculated sensitivity, specificity, positive and negative predictive values of the score, and performed an analysis through the ROC curve. RESULTS we found a statistically significant (p=0.002) association between the Alvarado score and the diagnostic confirmation using a cutoff score of six or greater, with a sensitivity of 72% and a specificity of 87.5%. A score greater than or equal to six showed a greater tendency to present more advanced stages of acute appendicitis in both surgical and histopathological findings when compared with a score lower than six. Males presented greater chances of complications when compared with females (p=0.003). CONCLUSION the Alvarado score proved to be a good method for diagnostic screening in acute appendicitis, since scores greater than or equal to six are associated with a higher probability of diagnostic confirmation and more advanced stages of the acute disease.
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Affiliation(s)
| | | | | | - Kelser de Souza Kock
- UNISUL - Universidade do Sul de Santa Catarina, Faculdade de Medicina, Tubarão, SC, Brasil
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Jung JY, Na JU, Han SK, Choi PC, Lee JH, Shin DH. Differential diagnoses of magnetic resonance imaging for suspected acute appendicitis in pregnant patients. World J Emerg Med 2018; 9:26-32. [PMID: 29290892 DOI: 10.5847/wjem.j.1920-8642.2018.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Accurate and timely diagnosis of acute surgical disease in pregnant patient is challenging. Although magnetic resonance imaging (MRI) is the most accurate modality to diagnose acute appendicitis in pregnant patients, it is often used as a last resort because of high cost and long scan time. We performed this study to analyze differential diagnoses of appendix MRI and to investigate if there are any blood tests that can predict surgical condition in pregnant patients. METHODS A retrospective, cross-sectional study was conducted on 46 pregnant patients who underwent non-enhanced appendix MRI in suspicion of acute appendicitis from 2010 to 2016. Differential diagnoses of appendix MRI were analyzed and blood tests were compared between those who had surgical and non-surgical disease. RESULTS Appendix MRI differentiated two surgical disease; acute appendicitis and ovarian torsion; and various non-surgical conditions such as uterine myoma, hydronephrosis, ureterolithiasis and diverticulitis among clinically suspected acute appendicitis in pregnancy. The diagnostic accuracy of MRI for acute appendicitis in this study was 93.5%. Patients who had surgical disease showed significantly higher WBC count (≥11,000/mm3), proportion of neutrophils in the WBC (≥79.9%), neutrophil-to-lymphocyte ratio (NLR≥6.4), levels of C-reactive protein (CRP≥1.82 mg/dL) and bilirubin (≥0.66 mg/dL) than those who had non-surgical disease. CONCLUSION MRI can reliably differentiate surgical conditions and several blood tests (WBC, proportion of neutrophils in the WBC, NLR, CRP, bilirubin) can help anticipate acute surgical condition among pregnant patients suspected to have acute appendicitis.
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Affiliation(s)
- Ji Yong Jung
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Ung Na
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Kuk Han
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil Cho Choi
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jang Hee Lee
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyuk Shin
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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How much Reliable Is Alvarado Scoring System in Reducing Negative Appendectomy? Indian J Surg 2017; 79:106-110. [PMID: 28442835 DOI: 10.1007/s12262-015-1433-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/23/2015] [Indexed: 12/29/2022] Open
Abstract
There is still an ongoing debate, especially regarding early diagnosis of acute appendicitis. Early surgery leads to inadequate evaluation of acute abdominal pain and negative appendectomy, whereas delayed surgery leads to appendicitis perforation complications. The diagnosis of this condition is considerably difficult, especially due to subtle early symptoms and clinical condition. The aim of the present study was to identify whether the Alvarado scoring system could reduce the incidence of negative appendectomy in patients who will undergo surgery for acute appendicitis. Patients who underwent surgery with acute appendicitis prediagnosis were retrospectively classified as negative appendectomies (group A) and positive appendectomies (group B) according to histological diagnosis. All groups were evaluated for age, gender, Alvarado scores, and parameters. Two hundred eighty-one patients were included in the study. Group A contained 71 (25.3 %) patients, and group B contained 210 (74.7 %) patients. There was a significant difference in WBC, left shift, rebound, and change of pain localization between the groups (p = 0.002, p < 0.001, p < 0.001, and p = 0.023, respectively). Alvarado scores were significantly different between the groups (p < 0.001). In logistic model examination, the major factor was the Alvarado score (7 or above) and the minor factor was spreading pain. The Alvarado scoring system can be used to reduce negative appendectomy in patients who will undergo surgery with acute appendicitis.
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Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 2016; 11:34. [PMID: 27437029 PMCID: PMC4949879 DOI: 10.1186/s13017-016-0090-5] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023] Open
Abstract
Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.
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Affiliation(s)
| | - Arianna Birindelli
- S. Orsola Malpighi University Hospital - University of Bologna, Bologna, Italy
| | - Micheal D Kelly
- Locum Surgeon, Acute Surgical Unit, Canberra Hospital, Canberra, ACT Australia
| | - Fausto Catena
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Dieter G Weber
- Trauma and General Surgeon Royal Perth Hospital & The University of Western Australia, Perth, Australia
| | | | | | - Mark De Moya
- Harvard Medical School - Massachusetts General Hospital, Boston, USA
| | - Carlos Augusto Gomes
- Department of Surgery Hospital Universitario, Universidade General de Juiz de Fora, Juiz de Fora, Brazil
| | - Aneel Bhangu
- Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgabaston, Birmingham, UK
| | | | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Ewen Griffiths
- University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital, Birmingham, UK
| | | | - Jeffry Kashuk
- Department of Surgery, University of Jerusalem, Jerusalem, Israel
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari Leppaniemi
- Abdominal Center, University of Helsinki, Helsinki, Finland
| | - Luca Ansaloni
- General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Manne Andersson
- Department of Surgery, Linkoping University, Linkoping, Sweden
| | | | - Raul Coimbra
- UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego, CA USA
| | | | | | - Walter Biffl
- Queen's Medical Center, University of Hawaii, Honolulu, HI USA
| | | | | | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gustavo P Fraga
- Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP Brazil
| | | | - Ronald V Maier
- Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA USA
| | | | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Cino Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Roberto Cirocchi
- Department of Surgery, Terni Hospital, University of Perugia, Terni, Italy
| | - Valeria Tonini
- S. Orsola Malpighi University Hospital - University of Bologna, Bologna, Italy
| | - Alice Piccinini
- Trauma Surgery Unit - Maggiore Hospital AUSL, Bologna, Italy
| | | | - Elio Jovine
- Department of Surgery, Maggiore Hospital AUSL, Bologna, Italy
| | - Roberto Persiani
- Catholic University, A. Gemelli University Hospital, Rome, Italy
| | - Antonio Biondi
- Department of Surgery, University of Catania, Catania, Italy
| | | | - Philip Stahel
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Rao Ivatury
- Professor Emeritus Virginia Commonwealth University, Richmond, VA USA
| | - George Velmahos
- Harvard Medical School - Chief of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, USA
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Chawla LS, Toma I, Davison D, Vaziri K, Lee J, Lucas R, Seneff MG, Nyhan A, McCaffrey TA. Acute appendicitis: transcript profiling of blood identifies promising biomarkers and potential underlying processes. BMC Med Genomics 2016; 9:40. [PMID: 27417541 PMCID: PMC4946184 DOI: 10.1186/s12920-016-0200-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/09/2016] [Indexed: 12/31/2022] Open
Abstract
Background The diagnosis of acute appendicitis can be surprisingly difficult without computed tomography, which carries significant radiation exposure. Circulating blood cells may carry informative changes in their RNA expression profile that would signal internal infection or inflammation of the appendix. Methods Genome-wide expression profiling was applied to whole blood RNA of acute appendicitis patients versus patients with other abdominal disorders, in order to identify biomarkers of appendicitis. From a large cohort of emergency patients, a discovery set of patients with surgically confirmed appendicitis, or abdominal pain from other causes, was identified. RNA from whole blood was profiled by microarrays, and RNA levels were filtered by a combined fold-change (>2) and p value (<0.05). A separate set of patients, including patients with respiratory infections, was used to validate a partial least squares discriminant (PLSD) prediction model. Results Transcript profiling identified 37 differentially expressed genes (DEG) in appendicitis versus abdominal pain patients. The DEG list contained 3 major ontologies: infection-related, inflammation-related, and ribosomal processing. Appendicitis patients had lower level of neutrophil defensin mRNA (DEFA1,3), but higher levels of alkaline phosphatase (ALPL) and interleukin-8 receptor-ß (CXCR2/IL8RB), which was confirmed in a larger cohort of 60 patients using droplet digital PCR (ddPCR). Conclusions Patients with acute appendicitis have detectable changes in the mRNA expression levels of factors related to neutrophil innate defense systems. The low defensin mRNA levels suggest that appendicitis patient’s immune cells are not directly activated by pathogens, but are primed by diffusible factors in the microenvironment of the infection. The detected biomarkers are consistent with prior evidence that biofilm-forming bacteria in the appendix may be an important factor in appendicitis. Electronic supplementary material The online version of this article (doi:10.1186/s12920-016-0200-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lakhmir S Chawla
- Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA.,The Department of Medicine, Veterans Affairs Medical Center, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Ian Toma
- Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Danielle Davison
- Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Khashayar Vaziri
- Department of Surgery, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Juliet Lee
- Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA.,Department of Surgery, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Raymond Lucas
- Department of Emergency Medicine, The George Washington University Medical School and GW Medical Faculty Associates, Washington, DC, USA
| | - Michael G Seneff
- Department of Emergency Medicine, The George Washington University Medical School and GW Medical Faculty Associates, Washington, DC, USA
| | - Aoibhinn Nyhan
- Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA
| | - Timothy A McCaffrey
- Department of Medicine, Division of Genomic Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA. .,Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University Medical Center, 2300 I Street, NW Ross 443, Washington, DC, 20037, USA.
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Kaewlai R, Lertlumsakulsub W, Srichareon P. Body mass index, pain score and Alvarado score are useful predictors of appendix visualization at ultrasound in adults. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1605-1611. [PMID: 25771443 DOI: 10.1016/j.ultrasmedbio.2015.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/29/2014] [Accepted: 01/21/2015] [Indexed: 06/04/2023]
Abstract
The study objective was to find factors predictive of ultrasound visualization of the appendix in patients with suspected appendicitis. A total of 238 consecutive adult patients (178 women, mean age 38.9 y, weight 58.2 kg, body mass index 22.7) who underwent appendiceal ultrasound from January to December 2011 were included. Appendicitis was confirmed in 171 patients (171/238, 71.9%). Ultrasound sensitivity, specificity and accuracy were 64%, 90% and 71%, respectively. The appendix was visualized at ultrasound in 126 patients (group 1) and not visualized in 112 patients (group 2). Group 1 had a lower body mass index, higher pain score and higher Alvarado score. The chances of visualizing the appendix in patients with body mass indexes ≤22, pain scores ≥6, and Alvarado scores ≥6 were 2.3, 2.9, and 3.8 times higher than those of their counterparts, respectively. Therefore, in patients with these factors, the use of ultrasound may be beneficial in the diagnosis of acute appendicitis.
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Affiliation(s)
- Rathachai Kaewlai
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand.
| | - Waraporn Lertlumsakulsub
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
| | - Pungkava Srichareon
- Department of Emergency Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok, Thailand
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Sousa-Rodrigues CFD, Rocha ACD, Rodrigues AKB, Barbosa FT, Ramos FWDS, Valões SHC. Correlation between the Alvarado Scale and the macroscopic aspect of the appendix in patients with appendicitis. Rev Col Bras Cir 2014; 41:336-9. [DOI: 10.1590/0100-69912014005007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/30/2014] [Indexed: 12/14/2022] Open
Abstract
Objective: To evaluate the possible association between the scale of Alvarado (EA) and macroscopic appearance (MA) of the appendix in patients with acute appendicitis.Methods: after receiving the diagnosis of acute appendicitis, EA data were collected. During appendectomy, MA data were collected. Data from patients without appendicitis were excluded. The Spearman correlation test was used to compare EA with Appendix MA (p < 0.05). Other variables were represented by simple frequency. The confidence interval (CI) of 95% was calculated for the correlation test.Results: Data were collected from 67 consecutive patients. The mean age was 37.1 ± 12.5 years and 77.6% of patients were male. The Spearman correlation test used for EA and MA was + 0.77 (95% CI 0.65-0.85, p < 0.0001).Conclusion: although correlation was not perfect, our data indicate that a high score on the scale of Alvarado in patients with appendicitis is correlated with advanced stages of the inflammatory process of acute appendicitis.
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Erdem H, Çetinkünar S, Daş K, Reyhan E, Değer C, Aziret M, Bozkurt H, Uzun S, Sözen S, İrkörücü O. Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis scores for diagnosis of acute appendicitis. World J Gastroenterol 2013; 19:9057-9062. [PMID: 24379631 PMCID: PMC3870559 DOI: 10.3748/wjg.v19.i47.9057] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/09/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the reliability and practical applicability of the widely used Alvarado, Eskelinen, Ohhmann and Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring systems in patients with suspected acute appendicitis.
METHODS: Patients admitted to our tertiary center due to suspected acute appendicitis constituted the study group. Patients were divided into two groups. appendicitis group (Group A) consisted of patients who underwent appendectomy and were histopathologically diagnosed with acute appendicitis, and non-appendicitis group (Group N-A) consisted of patients who underwent negative appendectomy and were diagnosed with pathologies other than appendicitis and patients that were followed non-operatively. The operative findings for the patients, the additional analyses from follow up of the patients and the results of those analyses were recorded using the follow-up forms.
RESULTS: One hundred and thirteen patients with suspected acute appendicitis were included in the study. Of the 113 patients (62 males, 51 females), the mean age was 30.2 ± 10.1 (range 18-67) years. Of the 113 patients, 94 patients underwent surgery, while the rest were followed non-operatively. Of the 94 patients, 77 patients were histopathologically diagnosed with acute appendicitis. Our study showed a sensitivity level of 81% for the Alvarado system when a cut-off value of 6.5 was used, a sensitivity level of 83.1% for the Ohmann system when a cut-off value of 13.75 was used, a sensitivity level of 80.5% for the Eskelinen system when a cut-off value of 63.72 was used, and a sensitivity level of 83.1% for the RIPASA system when a cut-off value of 10.25 was used.
CONCLUSION: The Ohmann and RIPASA scoring systems had the highest specificity for the diagnosis of acute appendicitis.
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