Al-Wageeh Saleh, Alyhari Qasem Abdulkarem, Ahmed Faisal, Altam Abdulfattah, Alshehari Gubran, Badheeb Mohamed
Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen.
Department of Urology, School of Medicine, Ibb University, Ibb, Yemen.
Open Access Emerg Med. 2024 Jul 6;16:159-166. doi: 10.2147/OAEM.S462013. eCollection 2024.
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.
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.
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).
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.
急性阑尾炎是一种复杂的诊断，通常需要临床和影像学评估。临床医生和医疗机构在诊断方法上存在显著差异。虽然某些指南主张根据临床特征进行风险分层，但其他指南则强调术前影像学检查的重要性。本研究旨在探讨阿尔瓦拉多评分（Alvarado Score）和腹部超声（AUS）在诊断急性阑尾炎中的准确性。
对2021年1月至2022年7月期间也门伊卜省（Ibb）索拉医院（Al-Thora Hospital）收治的疑似阑尾炎病例进行评估。收集并分析人口统计学、临床和实验室数据。本研究评估了阿尔瓦拉多评分（根据临床评估和实验室数据计算得出）和术前腹部超声检查结果，并将它们与术后及组织病理学检查结果进行关联。使用ROC曲线评估阿尔瓦拉多评分和腹部超声的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。
在1021例急腹症病例中，有171例患者疑似阑尾炎。结合腹部超声和阿尔瓦拉多评分，137例接受阑尾切除术的患者被诊断为阑尾炎。130例（94.9%）患者术中及组织病理学检查结果为阳性，7例（5.1%）为阴性。阿尔瓦拉多评分在截断值为6时，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]。腹部超声显示敏感性为98.46%，特异性为82.93%（AUC：０.907；95%CI，0.853至0.946；p<0.0001）。
阿尔瓦拉多评分和腹部超声在诊断急性阑尾炎方面表现出高敏感性和特异性。阿尔瓦拉多评分和腹部超声的高准确性和有效性支持它们在资源有限的环境中作为主要检查工具使用。这种方法有助于避免不必要的阑尾切除术，并将患者的经济负担降至最低。
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