Aleem Khalid Atta Ul, Quarrell Andrew, Chandran Anupam, Javed Tasveer, Ahmad Nadeem
General Surgery, Scunthorpe General Hospital, Scunthorpe, GBR.
General Surgery, Scunthorpe general hospital, scunthorpe, GBR.
Cureus. 2024 Nov 14;16(11):e73664. doi: 10.7759/cureus.73664. eCollection 2024 Nov.
Background The Alvarado score is a diagnostic tool to stratify patients on the likelihood of acute appendicitis based on signs, symptoms, and laboratory values. The validity of this score as compared to other diagnostic measures for acute appendicitis is questionable. The current study addresses the use of a modified Alvarado score (MAS) in conjunction with the widely used acute phase reactant biomarker serum C-reactive protein (CRP) for diagnostic accuracy. Objective To determine the diagnostic accuracy in terms of specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) of the combined MAS/CRP keeping histopathological diagnosis of acute appendicitis as a gold standard. Methods This is a cross-sectional validation study carried out in the Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad. A total of 230 patients undergoing appendicectomy for appendicitis were included in the study through non-probability consecutive sampling, with positive histology undetermined. Prior to surgery, the preoperative Alvarado score was calculated and CRP was determined. The appendix removed at surgery was subjected to histopathological examination and on the basis of its report patients were postoperatively diagnosed either as positive or negative for acute appendicitis. Results The mean age of the patients was 22.66±7.48 years. There were 137 (59.6%) males and 93 (40.4%) females. One hundred eighty-three (79.6%) patients had a positive CRP and 47 (20.4%) had a negative CRP. Alvarado scores were calculated and there were 28 (12.1%) patients with a score of ≤ 6, and 202 with a score of 7-9. The appendix removed at surgery was subjected to histopathological examination. One hundred ninety-five (84.7%) patients were positive for acute appendicitis on histopathology and 35 (15.2%) had normal appendix on histopathology. Among the 195 patients with acute appendicitis 178 (91.3%) had positive CRP/MAS and 17 (87.17%) had negative CRP/MAS. Among the 182 patients with positive CRP/MAS; 178 (97.8%) had acute appendicitis and 4 (2.2%) had normal appendix. Among the 48 patients with negative CRP/MAS; 17 (35.4%) had acute appendicitis and 31 (64.3%) had normal appendix. The calculated sensitivity, specificity, PPV, and NPV were 91.2%, 88.5%. 91.8%, and 64.5%, respectively. Conclusion MAS used in combination with CRP is a highly sensitive tool for use in the diagnosis of acute appendicitis and is especially useful in resource-limited healthcare settings and for assistance in decision-making for doctors with less clinical experience.
阿尔瓦拉多评分是一种基于体征、症状和实验室值对急性阑尾炎患者可能性进行分层的诊断工具。与其他急性阑尾炎诊断措施相比，该评分的有效性存在疑问。本研究探讨改良阿尔瓦拉多评分（MAS）与广泛使用的急性期反应物生物标志物血清C反应蛋白（CRP）联合用于诊断准确性的情况。
以急性阑尾炎的组织病理学诊断为金标准，确定联合MAS/CRP在特异性、敏感性、阴性预测值（NPV）和阳性预测值（PPV）方面的诊断准确性。
这是一项在伊斯兰堡巴基斯坦医学科学研究所外科进行的横断面验证研究。通过非概率连续抽样纳入了230例因阑尾炎接受阑尾切除术的患者，组织学结果未确定。手术前，计算术前阿尔瓦拉多评分并测定CRP。手术切除的阑尾进行组织病理学检查，并根据报告术后将患者诊断为急性阑尾炎阳性或阴性。
患者的平均年龄为22.66±7.48岁。男性137例（59.6%），女性93例（40.4%）。183例（79.6%）患者CRP阳性，47例（20.4%）患者CRP阴性。计算了阿尔瓦拉多评分，28例（12.1%）患者评分≤6，202例患者评分7 - 9。手术切除的阑尾进行组织病理学检查。195例（84.7%）患者组织病理学检查显示急性阑尾炎阳性，35例（15.2%）患者组织病理学检查阑尾正常。在195例急性阑尾炎患者中，178例（91.3%）CRP/MAS阳性，17例（8.7%）CRP/MAS阴性。在182例CRP/MAS阳性的患者中，178例（97.8%）患有急性阑尾炎，4例（2.2%）阑尾正常。在48例CRP/MAS阴性的患者中，17例（35.4%）患有急性阑尾炎，31例（64.3%）阑尾正常。计算出的敏感性、特异性、PPV和NPV分别为91.2%、88.5%、91.8%和64.5%。
MAS与CRP联合使用是诊断急性阑尾炎的高敏感工具，在资源有限的医疗环境中特别有用，有助于临床经验较少的医生进行决策。
