Document Type : Original Articles

Authors

1 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

2 Cancer Research center, Gerash University of Medical Sciences, Gerash, Iran

3 Department of Surgical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Introduction: Acute appendicitis is the major cause of abdominal pain which indicates urgent surgery. Commonly, it is diagnosed through clinical signs and symptoms and blood test. This study aimed to assess the  accuracy of acute appendicitis diagnosis through signs and symptoms, Alvarado score system, and ultrasonography method.
Methods: This was a cross-sectional study. Medical profiles of 696 patients with abdominal pain suspected of acute appendicitis referred to Shahid Faghihi hospital were reviewed from June to October 2016. A checklist was used for data collection. The gold standard for diagnosis of acute appendicitis was patient’s pathology report. For signs and symptoms, Alvarado score system and ultrasonography method sensitivity, specificity, positive and negative predictive value, and the Youden’s index were calculated based on true positive and true negative values.
Results: Among 696 patients suspected of acute appendicitis, 371 (53.3%) were men and 325 (46.7%) women. The mean age for women and men was 30.14+11.49  and 30.53+11.61 years, respectively. Sensitivity and specificity for ultrasonography and Alvarado score system were 68.1% and 78.9%, 76.1%, and 59.9%, respectively. The areas under roc curve and the Youden’s index for ultrasonography and Alvarado score system were 0.73, 0.47, and 0.71, 0.55, respectively.
 Conclusion: The results showed that ultrasonography and Alvarado score system were effective pre-surgical diagnostic tests for patients suspected of acute appendicitis.

Keywords

1.         Emil S, Laberge JM, Mikhail P, Baican L, Flageole H, Nguyen L, Shaw K. Appendicitis in children: a ten-year update of therapeutic recommendations. J Pediatr Surg.2003;38(2):236-42.
2.         Korner H, Soreide JA, Sondenaa K. Diagnostic accuracy of inflammatory markers in patients operated on for suspected acute appendicitis: a receiver operating characteristic curve analysis. Eur J Surg.1999;165(7):679-85.
3.         Denizbasi A, Unluer EE. The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident. Eur J Emerg Med.2003;10(4):296-301.
4.         Abou-Nukta F, Bakhos C, Arroyo K, Koo Y, Martin J, Reinhold R, Ciardiello K. Effects of delaying appendectomy for acute appendicitis for 12 to 24 hours. Arch Surg.2006;141(5):504-6; discussioin 506-7.
5.         Ahmai Nejad M, Saki M. Study of sonography sensitivity and specificity to the diagnosis of acute appendicitis in suspected patients referred to Khorramabad Ashayer hospital. scientific magazine yafte.2012;13(4):23-7.[Persian]
6.         Khorasani B, Gholizadeh Pasha A . Chronic appendicitis in a patient with 15 years abdominal pain. scientific magazine yafte.2007;9(1):71-4.[Persion]
7.         Amanollahi O, Rezaei M, Golpazir A. The role of abdominal sonography compare to clinical Alvarado criteria in diagnosis of appendicitis. J Kermanshah Univ Med Sci.2012;16(1):23-7.[Persian]
8.         Raman SS, Lu DS, Kadell BM, Vodopich DJ, Sayre J, Cryer H. Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. AJR Am J Roentgenol.2002;178(6):1319-25.
9.         Wong SK, Chan LP, Yeo A. Helical CT imaging of clinically suspected appendicitis: correlation of CT and histological findings. Clin Radiol.2002;57(8):741-45.
10.       Fuchs JR, Schlamberg JS, Shortsleeve MJ, Schuler JG. Impact of abdominal CT imaging on the management of appendicitis: an update. J Surg Res.2002,106(1):131-36.
11.       Rosengren D, Brown AF, Chu K. Radiological imaging to improve the emergency department diagnosis of acute appendicitis. Emerg Med Australas.2004;16(5-6):410-16.
12.       Delshad S, Yousefi S. The relation between clinical manifestation and pathological reports of acute appendicitis in children admitted in Hazrat Ali Asghar hospital. IJFM.2007;13(1):11-4.[Persian]
13.       Eskandarlou M, Hashemi SH, Rezaie AA, Basiri Z, Dehghan A. A Case Report of Acute Appendicitis with Complicated Clinical Course. Sci J Hamadan Univ.2006;13(1):66-70.[Persian]
14.       Motie M, Mousavi M, Behnampour N, Mortazavy B, Kalany M. Accuracy of ultrasonography in diagnosis of acute appendicitis. J Gorgan Uni Med Sci.2010;11(4):70-5.[Persian]
15.       Laal M, Granpaye L, Khodadi F, Salavatipour A, Sadeghi AR. Sonography versus the Alvarado Scoring System for the diagnosis of acute appendicitis. Tehran Univ Med J.2008;66(6):408-12.
16.       Chong CF, Adi MI, Thien A, Suyoi A, Mackie AJ, Tin AS, Tripathi S, Jaman NH, Tan KK, Kok KY, Mathew VV, Paw O, Chua HB, Yapp SK . Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J.2010;51(3):220-25.
17.       Panagiotopoulou IG, Parashar D, Lin R, Antonowicz S, Wells AD, Bajwa FM, Krijgsman B.The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications. Ann R Coll Surg Engl.2013;95(3):215-21.
18.       Kessler N, Cyteval C, Gallix B, Lesnik A, Blayac PM, Pujol J, Bruel JM, Taourel P. Appendicitis: evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings. Radiology.2004;230(2):472-78.
19.       Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl.1994;76(6):418-19.
20.       Nasiri S, Mohebbi F, Sodagari N, Hedayat A. Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis. Int J Emerg Med.2012;5(1):26.
21.       Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med.2011; 9:139.
22.       Paajanen H, Gronroos JM, Rautio T, Nordstrom P, Aarnio M, Rantanen T, Hurme S, Dean K, Jartti A, Mecklin JP, Sand J, Salminen P. A prospective randomized controlled multicenter trial comparing antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis (APPAC trial). BMC surg.2013;13:3.
23.       Atema JJ, van Rossem CC, Leeuwenburgh MM, Stoker J, Boermeester MA. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg.2015;102(8):979-90.
24.Varadhan KK, Neal KR, Lobo DN. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ.2012;344:e2156.
25.       Sevinc MM, Kinaci E, Cakar E, Bayrak S, Ozakay A, Aren A, Sarı S. Diagnostic value of basic laboratory parameters for simple and perforated acute appendicitis: an analysis of 3392 cases. Ulus Travma Acil Cerrahi Derg.2016;22(2):155-62.
26.       Rafiq MS, Khan MM, Khan A, Ahmad B. Total leukocyte and neutrophil count as preventive tools in reducing negative appendectomies. Ulus Travma Acil Cerrahi Derg.2015;21(2):102-6.
27.       West WM, Brady-West DC, McDonald AH, Hanchard B, Fearon-Boothe D. Ultrasound and white blood cell counts in suspected acute appendicitis. West Indian Med J.2006;55(2):100-2.
28.       Khanal BR, Ansari MA, Pradhan S. Accuracy of ultrasonography in the diagnosis of acute appendicitis. Kathmandu University medical journal (KUMJ).2008;6(1):70-4.
29        Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, Babyn PS, Dick PT.US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology.2006;241(1):83-94.
30.       Sahbaz NA, Bat O, Kaya B, Ulukent SC, Ilkgul O, Ozgun MY, Akça Ö. The clinical value of leucocyte count and neutrophil percentage in diagnosing uncomplicated (simple) appendicitis and predicting complicated appendicitis. Ulus Travma Acil Cerrahi Derg.2014;20(6):423-6.
31.       Saaiq M, Niaz Ud D, Jalil A, Zubair M, Shah SA. Diagnostic accuracy of leukocytosis in prediction of acute appendicitis. J Coll Physicians Surg Pak.2014;24(1):67-9.
32.       Anwar MW, Abid I. Validity Of Total Leucocytes Count And Neutrophil Count (Differential Leucocytes Count) In Diagnosing Suspected Acute Appendicitis. Pakistan Armed Forces Journal.2012;62(3):344-48.
33.       Tanrikulu CS, Karamercan MA, Tanrikulu Y, Ozturk M, Yuzbasioglu Y, Coskun F. The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis. Ulus Cerrahi Derg.2016;32(2):115-21.
34.Kwan KY, Nager AL. Diagnosing pediatric appendicitis: usefulness of laboratory markers. Am J Emerg Med .2010,28(9):1009-15.
35.       Peixoto Rde O, Nunes TA, Gomes CA . Indices of diagnostic abdominal ultrasonography in acute appendicitis: influence of gender and physical constitution, time evolution of the disease and experience of radiologist. Rev Col Bras Cir.2011;38(2):105-11.
36.       Tauro L, Premanand T, Aithala P, George C, Suresh H, Acharya D, et al. Ultrasonography is still a useful diagnostic tool in acute appendicitis. Journal of clinical and diagnostic research. 2009;3:1731-6.
37.       Erfani Fam T, Izadi S, Niksirat A. Factors Increasing the Likelihood of Positive Pathology among One Hundred Appendectomy Cases in Ayatollah Mousavi Hospital of Zanjan. ZUMS Journal.2013;21(88):56-62.
38.       Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology.2000;215(2):337-
39.       Hanafi M G,Shiri A. Diagnostic Accuracy of Acute Appendicitis by Ultrasound in Hospital Emergency. International Journal of Pediatrics. 2019;7(1): 8787-8793.
40.Tatli F, Ekici U, Kanlioz M, Gozeneli O, Uzunkoy A, Yucel Y, Dirican A. Ultrasonography in diagnosis of acute appendicitis. Ann Ital Chir. 2016;87:152-4.
41. Pedram A, Asadian F, Roshan N. Diagnostic Accuracy of Abdominal Ultrasonography in Pediatric Acute Appendicitis. Bull Emerg Trauma. 2019 Jul;7(3):278-283.
42.       Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, Macarini L, Giganti M . Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Critical ultrasound journal. 2013;5 Suppl 1:S2.
43.       Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology. 2000;215(2):337-48.
44.       Hooshmand B, Shokouh-Saremi A, Noferesti A, Yaghoubi MA, Elahifar A. Diagnostic accuracy of Alvarado score in the diagnosis of acute appendicitis. Zahedan Journal of Research in Medical Sciences.2012;13(8):18-21.[persian]
45.       Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg.2004;91(1):28-37.
46.       Borhani M, Mohammad K, Holakooei Naeini K, Majd zadeh SR, Kaviyani A .accuracy assessment of diagnostic tests in patients suspected of acute appendicitis using the roc curve analysis. Quarterly monitoring.2005;5(4):255-62.[persian]