The predictive value of Alvarado score, inflammatory parameters and ultrasound imaging in the diagnosis of acute appendicitis
Ceren Şen Tanrıkulu1, Mehmet Akif Karamercan2, Yusuf Tanrıkulu3, Miraç Öztürk4, Yücel Yüzbaşıoğlu4, Figen Coşkun4
1Department of Emergency Medicine, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
2Department of Emergency Medicine, Gazi University School of Medicine, Ankara, Turkey
3Clinic of General Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey
4Clinic of Emergency Medicine, Ankara Training and Research Hospital, Ankara, Turkey
Objective: Acute appendicitis (AA) is one of the most common surgical emergencies. Despite extraordinary advances in modern investigations, the accurate diagnosis of AA remains an enigmatic challenge. The aim of this study was to compare and evaluate the diagnostic accuracy of inflammatory parameters [C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], ultrasound (US) and Alvarado score (AS) in reducing the rate of negative appendectomies.
Material and Methods: Two hundred seventy-eight patients were included in this study. Patients were separated into two main groups as the surgery group (n=184) and non-operative group (n=94). Complete blood count, ESR and PCT levels were assessed, abdominal US was performed and AS was calculated for all patients.
Results: In the surgery group, clinical predictive factors for histopathologic results such as AS ≥7, AA signs on US, neutrophilia and leukocytosis were significant. Neutrophilia and leukocytosis had the highest accuracy rate among these factors. Inflammatory parameters were not predictive for histopathologic results, although higher CRP and PCT levels were significant in perforated and necrotizing appendicitis. Multifactorial regression analyses showed that AS was not of significant predictive value in the non-operative group.
Conclusion: There was no superiority of AS and/or US in the diagnosis of AA. Recent findings have shown the most reliable parameters in the diagnosis of AA to be primarily ‘neutrophilia’ and secondarily ‘leukocytosis’. Other results of this study indicated that inflammatory parameters (CRP, PCT, ESR) were not superior to other parameters but CRP and PCT levels were significantly high in complicated cases.
Keywords: Alvarado score, acute appendicitis, C-reactive protein, ultrasound
Ethical approval was obtained from the Regional Ethics Review Committee before the commencement of the study.
Written informed consent was obtained from patients who participated in this study.
Concept - C.Ş.T., Y.T.; Design - C.Ş.T., Y.T., M.A.K.; Supervision - C.Ş.T., Y.T., M.A.K.; Resources - C.Ş.T., Y.T., M.A.K.; Materials - C.Ş.T., Y.T., M.A.K.; Data Collection and/or Processing - C.Ş.T., M.A.K., Y.T., M.Ö., Y.Y., F.C.; Analysis and/or Interpretation - Y.T., M.A.K., C.Ş.T., Y.T.; Literature Search - C.Ş.T., Y.T.; Writing Manuscript - C.Ş.T., Y.T.; Critical Review - C.Ş.T., Y.T., M.A.K.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.