López AY, Fernández GA, Hernández PY, Pérez SMJ

Language: Spanish
References: 32
Page: 213-224
PDF size: 107.75 Kb.

ABSTRACT

Introduction: acute appendicitis is the leading cause of emergency surgery in general surgery. Its diagnosis remains eminently clinical, and there are tools like the Alvarado´s score that allow a better assessment in the accurate diagnosis of the condition.
Objective: to evaluate the usefulness of Alvarado´s Score in the clinical diagnosis of acute appendicitis.
Material and Methods: an evaluation study of diagnostic tools was carried out, in which an assessment was performed on patients with acute abdominal pain and presumptive diagnosis of acute appendicitis. The Alvarado´s scale was used, by means of which sensitivity, specificity, predictive values, and likelihood ratios were assessed.
Results: of all patients (533), appendicitis was confirmed at laparotomy in 90,4%. Best diagnostic values of the disease for the scale values were those higher than 7 (sensitivity 55.4, specificity 96.1) score. The migration of pain was the specific component of higher value for the diagnosis (sensitivity 81.9, specificity 94.1). The test did not allow an accurate differentiation between the score and the possible anatomic-pathological status of the disease.
Conclusions: The Alvarado´s scale is a useful tool in the clinical diagnosis of inflammation of the appendix, primarily for scores higher than 7. The migration of pain was the specific item of the score with better diagnostic value. This did not allow discriminating adequately the possible anatomic-pathological status of the condition based on the value of the score.

REFERENCES

1. Fernández Gómez A, Pujol Legrá P, Fernández Cambón B, Palacios Ojeda L, Norbert Milanés A. Score de Alvarado en la apendicitis aguda. Estudio prospectivo de evaluación. MULTIMED, sept 2007; 11 (4).[Consultado 24 de noviembre de 2014]. Disponible en: http://www.multimedgrm.sld.cu/articulos/2007/V11- 4/13.html?option=com_content&view=article&id=978&Itemid=70

2. Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidencebased review of the diagnostic approach in 2014. West J Emerg Med. 2014 Nov;15(7):859-71.

3. Galloso Cueto GL, Lantigua Godoy A, Alfonso Moya O, Sánchez Maya A. Cirugía laparoscópica en la apendicitis aguda. Rev Méd Electrón. 2011; 33 (2). [Consultado: 24 de noviembre del 2014]. Disponible en: http://www.revmatanzas.sld.cu/revista%20medica/ano%202011/vol2%202011/tema 02.htm

4. Williams RA. Benign and malignant diseases of the small and large intestine. En: Wilson SE. Educational Review Manual in General Surgery. 1ra edition. New York: Castle Connolly Graduate Medical Publishing; 2000: 9-11.

5. Craig S, Incesu L, Taylor CR [editors]. Appendicitis. Medscape; 2011. [Consultado: 24 nov 2014]. Disponible en: http://emedicine.medscape.com/article/773895- overview

6. Lally KP, Cox CS, Andrassy RJ. Apéndice. En: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Tratado de Cirugía. Fundamentos biológicos de la práctica quirúrgica moderna. Madrid: Elsevier; 2005: 1381-99.

7. Ho HS. Appendectomy. En: Decker Intellectual Properties, editors. ACS Surgery: Principles and Practice. New York: Decker Publishing Group; 2011: 1-6.

8. Ferrer Robaina H, Ferrer Sánchez H, Mesa Izquierdo O, Gázquez Camejo SY. Apendicitis aguda: estudio estadístico de 214 casos operados.Rev Cubana Invest Biomed. 2007; 26 (2): 1-6.

9. Mán E, Simonka Z, Varga A, Rárosi F, Lázár G. Impact of the Alvarado score on the diagnosis of acute appendicitis: comparing clinical judgment, Alvarado score, and a new modified score in suspected appendicitis: a prospective, randomized clinical trial. Surg Endosc. 2014 Aug; 28(8):2398-405.

10. Limpawattanasiri C. Alvarado score for the acute appendicitis in a provincial hospital. J Med Assoc Thai. 2011; 94(4):441-9.

11. Rezak A, Abbas HM, Ajemian MS, Dudrick SJ, Kwasnik EM. Decreased use of computed tomography with a modified clinical scoring system in diagnosis of pediatric acute appendicitis. Arch Surg. 2011 Jan;146(1):64-7.

12. N N, Mohammed A, Shanbhag V, Ashfaque K, SAP. A Comparative Study of RIPASA Score and ALVARADO Score in the Diagnosis of Acute Appendicitis. J ClinDiagn Res. 2014 Nov;8(11):44-60.

13. Sigdel GS, Lakhey PJ, Mishra PR. Tzanakis score vs. Alvarado score in acute appendicitis. JNMA J Nepal Med Assoc. 2010 Apr-Jun; 49(178):96-9.

14. Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg. 1995; 161(4): 273-81.

15. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 158(5): 557-64.

16. Crawford JM. El tracto gastrointestinal. Apéndice. En: Robbins. Patología estructural y funcional. 5ta edición. Madrid: McGraw-Hill-Interamericana; 1995, p.911.

17. Liu W, Wei Qiang J, Xun Sun R. Comparison of multislice computed tomography and clinical scores for diagnosing acute appendicitis. J Int Med Res. 2015 Jun;43(3):341-9.

18. Toprak H, Kilincaslan H, Ahmad IC, Yildiz S, Bilgin M, Sharifov R, et al. Integration of ultrasound findings with Alvarado score in children with suspected appendicitis. Pediatr Int. 2014 Feb; 56(1): 95-9.

19. Tan WJ, Pek W, Kabir T, Goh YC, Chan WH, Wong WK, et al. Alvarado score: a guide to computed tomography utilization in appendicitis. ANZ J Surg. 2013 Oct; 83(10): 748-52.

20. Ozkan S, Duman A, Durukan P, Yildirim A, Ozbakan O. The accuracy rate of Alvarado score, ultrasonography, and computerized tomography scan in the diagnosis of acute appendicitis in our center. Niger J Clin Pract. 2014; 17(4):413-8.

21. Kariman H, Shojaee M, Sabzghabaei A, Khatamian R, Derakhshanfar H, Hatamabadi H. Evaluation of the Alvarado score in acute abdominal pain. UlusTravma Acil Cerrahi Derg. 2014 Mar; 20(2):86-90.

22. Meltzer AC, Baumann BM, Chen EH, Shofer FS, Mills AM. Poor sensitivity of a modified Alvarado score in adults with suspected appendicitis. Ann Emerg Med. 2013; 62(2):126-31.

23. Yüksel Y, Dinç B, Yüksel D, Dinç SE, Mesci A. How reliable is the Alvarado score in acute appendicitis? UlusTravma Acil Cerrahi Derg. 2014 Jan; 20(1):12-8.

24. Pouget-Baudry Y, Mucci S, Eyssartier E, Guesdon-Portes A, Lada P, Casa C, et al. The use of the Alvarado score in the management of right lower quadrant abdominal pain in the adult. J Visc Surg. 2010; 147(2): 13-7.

25. Memon ZA, Irfan S, Fatima K, Iqbal MS, Sami W. Acute appendicitis: diagnostic accuracy of Alvarado scoring system. Asian J Surg. 2013 Oct; 36(4):144-9.

26. Teo AT, Lefter LP, Zarrouk AJ, Merrett ND. Institutional review of patients presenting with suspected appendicitis. ANZ J Surg. 2015 Jun; 85(6):420-4.

27. Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Ann Emerg Med. 2007; 49(6):778-84.

28. Pouget-Baudry Y, Mucci S, Eyssartier E, Guesdon-Portes A, Lada P, Casa C, et al. The use of the Alvarado score in the management of right lower quadrant abdominal pain in the adult. J Visc Surg. 2010; 147: 40-4.

29. Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004; 91(1):28–37.

30. Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008; 32(8):1843-9.

31. Cedillo Alemán EJ, Santana Vela IA, González Cano R, Onofre Castillo J, Gartz- Tondorf GR. Sensibilidad y especificidad de la Escala de Alvarado en el diagnóstico de apendicitis aguda comparada con TAC o ultrasonido en las primeras 24 horas de evolución. Ciruj Gen. 2012; 34(2): 107-10.

32. Sousa-Rodrigues CF, Rocha AC, Rodrigues AK, Barbosa FT, Ramos FW, Valões SH. Correlation between the Alvarado Scale and the macroscopic aspect of the appendix in patients with appendicitis. Rev Col Bras Cir. 2014 Sep-Oct; 41(5):336-9.