PDF(Pubmed)
Abstract：
UNASSIGNED: Acute appendicitis is a complex diagnosis that often requires both clinical and radiological evaluation. Significant variations in diagnostic approaches are evident among clinicians and healthcare institutions. While certain guidelines advocate for risk stratification based on clinical characteristics, others emphasize the importance of pre-operative imaging. This study seeks to explore the accuracy of the Alvarado Score and abdominal ultrasound (AUS) in diagnosing acute appendicitis.
UNASSIGNED: Suspected cases of appendicitis admitted to Al-Thora Hospital in Ibb, Yemen, from Jan 2021 to July 2022 were evaluated. The demographics, clinical, and laboratory data were collected and analyzed. This study assessed Alvarado scores (calculated based on clinical evaluation and laboratory data) and pre-operative AUS findings, correlating them with post-operative and histopathology findings. The Alvarado scores and AUS sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were assessed using the ROC curve.
UNASSIGNED: Out of 1021 cases of acute abdomen, 171 patients were suspected of appendicitis. Using AUS along with the Alvarado score, appendicitis was presumed in 137 patients who underwent appendectomy. 130 (94.9%) patients had positive intraoperative and histopathology findings while 7 (5.1%) had negative findings. The Alvarado Score had a sensitivity and specificity of 94.62% and 87.80% at cutoffs of 6, respectively [Area under the curve (AUC): 0.985; 95% confidence interval (CI), 0.954 to 0.998; p < 0.0001]. Abdominal US showed a sensitivity of 98.46% and specificity of 82.93% (AUC:0.907; 95% CI, 0.853 to 0.946; p < 0.0001).
UNASSIGNED: Alvarado\'s score and AUS exhibited high sensitivity and specificity in diagnosing acute appendicitis. The substantial accuracy and efficacy of both the Alvarado score and AUS support their utilization as primary investigative tools in resource-limited settings. This approach can help avoid unnecessary appendectomies and minimize the financial burden on patients.
Acute appendicitis poses a diagnostic challenge, with a high rate of false-positive cases identified post-operatively. Computed tomography has been recommended by several surgical societies; however, it is limited by unaffordability and unavailability. Herein, we utilized the Alvarado score along with abdominal ultrasound as an alternative accurate, and cost-effective diagnostic approach. In this study, the negative appendectomy rate was 5.1%. The sensitivity of abdominal ultrasound in detecting appendicitis was 98.5%, with a specificity of 82.9%. The positive predictive value, negative predictive value, and accuracy were determined to be 94.8%, 94.4%, and 94.7%, respectively. The mean Alvarado score was 6.9±2.4, with a sensitivity and specificity of 97.81% and 97.06% at cutoffs of 6, respectively. The area under the curve values of the ROC curve for Alvarado’s and abdominal ultrasound were 0.985 (95% CI, 0.954 to 0.998) and (AUC:0.907; 95% CI, 0.853 to 0.946), which was statistically significant (p < 0.0001).
UNASSIGNED: Suspected cases of appendicitis admitted to Al-Thora Hospital in Ibb, Yemen, from Jan 2021 to July 2022 were evaluated. The demographics, clinical, and laboratory data were collected and analyzed. This study assessed Alvarado scores (calculated based on clinical evaluation and laboratory data) and pre-operative AUS findings, correlating them with post-operative and histopathology findings. The Alvarado scores and AUS sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were assessed using the ROC curve.
UNASSIGNED: Out of 1021 cases of acute abdomen, 171 patients were suspected of appendicitis. Using AUS along with the Alvarado score, appendicitis was presumed in 137 patients who underwent appendectomy. 130 (94.9%) patients had positive intraoperative and histopathology findings while 7 (5.1%) had negative findings. The Alvarado Score had a sensitivity and specificity of 94.62% and 87.80% at cutoffs of 6, respectively [Area under the curve (AUC): 0.985; 95% confidence interval (CI), 0.954 to 0.998; p < 0.0001]. Abdominal US showed a sensitivity of 98.46% and specificity of 82.93% (AUC:0.907; 95% CI, 0.853 to 0.946; p < 0.0001).
UNASSIGNED: Alvarado\'s score and AUS exhibited high sensitivity and specificity in diagnosing acute appendicitis. The substantial accuracy and efficacy of both the Alvarado score and AUS support their utilization as primary investigative tools in resource-limited settings. This approach can help avoid unnecessary appendectomies and minimize the financial burden on patients.
Acute appendicitis poses a diagnostic challenge, with a high rate of false-positive cases identified post-operatively. Computed tomography has been recommended by several surgical societies; however, it is limited by unaffordability and unavailability. Herein, we utilized the Alvarado score along with abdominal ultrasound as an alternative accurate, and cost-effective diagnostic approach. In this study, the negative appendectomy rate was 5.1%. The sensitivity of abdominal ultrasound in detecting appendicitis was 98.5%, with a specificity of 82.9%. The positive predictive value, negative predictive value, and accuracy were determined to be 94.8%, 94.4%, and 94.7%, respectively. The mean Alvarado score was 6.9±2.4, with a sensitivity and specificity of 97.81% and 97.06% at cutoffs of 6, respectively. The area under the curve values of the ROC curve for Alvarado’s and abdominal ultrasound were 0.985 (95% CI, 0.954 to 0.998) and (AUC:0.907; 95% CI, 0.853 to 0.946), which was statistically significant (p < 0.0001).
摘要：
■急性阑尾炎是一种复杂的诊断，通常需要进行临床和放射学评估。在临床医生和医疗机构中，诊断方法的显着差异是显而易见的。虽然某些指南提倡根据临床特征进行风险分层，其他人强调术前成像的重要性。本研究旨在探讨Alvarado评分和腹部超声（AUS）诊断急性阑尾炎的准确性。
■IbbAl-Thora医院收治的阑尾炎疑似病例，也门,从2021年1月到2022年7月进行了评估。人口统计，临床,和实验室数据进行了收集和分析。这项研究评估了Alvarado评分（根据临床评估和实验室数据计算）和术前AUS结果，将它们与术后和组织病理学发现相关联。阿尔瓦拉多得分和AUS敏感度，特异性，准确度,阳性预测值(PPV)，使用ROC曲线评估阴性预测值（NPV）。
■在1021例急腹症中，171例患者被怀疑为阑尾炎。使用AUS和Alvarado得分，在137例接受阑尾切除术的患者中推测为阑尾炎.130例（94.9％）患者的术中和组织病理学检查结果为阳性，而7例（5.1％）的结果为阴性。Alvarado评分在截止时间为6时的敏感性和特异性分别为94.62％和87.80％[曲线下面积（AUC）：0.985；95％置信区间（CI），0.954至0.998；p<0.0001]。腹部US的敏感性为98.46％，特异性为82.93％（AUC：0.907；95％CI，0.853至0.946；p<0.0001）。
■Alvarado's评分和AUS在诊断急性阑尾炎方面表现出很高的敏感性和特异性。Alvarado评分和AUS的实质性准确性和有效性支持在资源有限的环境中将其用作主要调查工具。这种方法可以帮助避免不必要的阑尾切除术，并最大限度地减少患者的经济负担。
急性阑尾炎提出了诊断挑战，术后发现的假阳性病例率高。一些外科学会建议使用计算机断层扫描；但是，它受到不可负担性和不可用性的限制。在这里，我们利用Alvarado评分和腹部超声作为另一种准确的方法，和具有成本效益的诊断方法。在这项研究中,阴性阑尾切除术率为5.1%.腹部超声检测阑尾炎的敏感性为98.5%,特异性为82.9%。阳性预测值，负预测值，准确度确定为94.8%，94.4%,和94.7%，分别。平均Alvarado评分为6.9±2.4，截止时间为6时的敏感性和特异性分别为97.81％和97.06％。Alvarado's和腹部超声的ROC曲线的曲线下面积为0.985（95％CI，0.954至0.998）和（AUC：0.907；95％CI，0.853至0.946），具有统计学意义（p<0.0001）。
■IbbAl-Thora医院收治的阑尾炎疑似病例，也门,从2021年1月到2022年7月进行了评估。人口统计，临床,和实验室数据进行了收集和分析。这项研究评估了Alvarado评分（根据临床评估和实验室数据计算）和术前AUS结果，将它们与术后和组织病理学发现相关联。阿尔瓦拉多得分和AUS敏感度，特异性，准确度,阳性预测值(PPV)，使用ROC曲线评估阴性预测值（NPV）。
■在1021例急腹症中，171例患者被怀疑为阑尾炎。使用AUS和Alvarado得分，在137例接受阑尾切除术的患者中推测为阑尾炎.130例（94.9％）患者的术中和组织病理学检查结果为阳性，而7例（5.1％）的结果为阴性。Alvarado评分在截止时间为6时的敏感性和特异性分别为94.62％和87.80％[曲线下面积（AUC）：0.985；95％置信区间（CI），0.954至0.998；p<0.0001]。腹部US的敏感性为98.46％，特异性为82.93％（AUC：0.907；95％CI，0.853至0.946；p<0.0001）。
■Alvarado's评分和AUS在诊断急性阑尾炎方面表现出很高的敏感性和特异性。Alvarado评分和AUS的实质性准确性和有效性支持在资源有限的环境中将其用作主要调查工具。这种方法可以帮助避免不必要的阑尾切除术，并最大限度地减少患者的经济负担。
急性阑尾炎提出了诊断挑战，术后发现的假阳性病例率高。一些外科学会建议使用计算机断层扫描；但是，它受到不可负担性和不可用性的限制。在这里，我们利用Alvarado评分和腹部超声作为另一种准确的方法，和具有成本效益的诊断方法。在这项研究中,阴性阑尾切除术率为5.1%.腹部超声检测阑尾炎的敏感性为98.5%,特异性为82.9%。阳性预测值，负预测值，准确度确定为94.8%，94.4%,和94.7%，分别。平均Alvarado评分为6.9±2.4，截止时间为6时的敏感性和特异性分别为97.81％和97.06％。Alvarado's和腹部超声的ROC曲线的曲线下面积为0.985（95％CI，0.954至0.998）和（AUC：0.907；95％CI，0.853至0.946），具有统计学意义（p<0.0001）。
