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Accuracy of Modified Alvarado Scoring System in Early Diagnosis of Acute Appendicitis
دقة تعديل نظام تسجيل Alvarado في التشخيص المبكر لالتهاب الزائدة الدودية الحاد

Authors: Star S. Hussein --- Nadya Y. Ahmed --- Tayeb S. Kareem
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2009 Volume: 13 Issue: 2 Pages: 8-13
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: Appendicitis is a common surgical emergency. The patients with equivocal signs can present a diagnostic challenge. Early diagnosis and intervention is mandatory for prevention of complications. On the other hand negative appendicectomy should be avoided as much as possible. The aim is to evaluate the role of the modified Alvarado scoring system in early diagnosis of acute appendicitis.Methods: During a period of 6 months from 1st February to 31st July 2008; 250 patients with right iliac fossa pain were admitted and observed in Emergency Hospital in Erbil. The age of the patients was ranged between 13-70 years (mean 22 years ). The male to female ratio was 3:2. They were prospectively evaluated on admission using modified Alvarado scoring system to determine whether or not they had acute appendicitis. The results were correlated with the operative and histopathological findings.Results: After first scoring; 179 (72%) patients were admitted and 71 (28%) patients were discharged. Rescoring by modified Alvarado scoring system was done after 6 hours from admission, only 162 (91%) patients were operated on , and the rest 17 (9%) patients were discharged. During operation we found that 142 cases (87.5%) had really acute appendicitis. Overall the modified Alvarado scoring system showed sensitivity of (93%) for [8-9] scores and (39%) for [1-7] scores. .Conclusions: The modified Alvarado scoring system is accurate in early diagnosis of acute appendicitis . Patients with 8-9 scores should be operated on immediately without hesitation. Patients with score 5-7 must be admitted and scored frequently. Score 1-4 can be discharged unless otherwise indicated.


Article
Clinical outcomes of acute appendicitis in children and the impact of diagnostic delay on its complications.

Author: Hassen K. Gatea*, F.I.C.M.S
Journal: KUFA MEDICAL JOURNAL مجلة الكوفة الطبية ISSN: 1993517X Year: 2009 Volume: 12 Issue: 2 Pages: 189-195
Publisher: University of Kufa جامعة الكوفة

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Background:Acute appendicitis is the most common condition in children requiring emergency abdominal surgery. The key to a successful outcome is early diagnosis followed by appendectomy before gangrene or perforation develops.:Aim of study:To analyze the time of presentation and complication s of acute appendicitisPatients and Methods:This is a retrospective study conducted in Al –Mustansiria Hospital over a period of three years from January 2005 to January 2008 .Data were collected from the patients case sheets. The patients were then divided into two groups according to the length of diagnostic period , group A including those children who presented in the first 48 hours after the onset of symptoms, and group B including those children who presented beyond the 48 hours after the onset of symptoms. Then the patients were subdivided into three age groups (<5 years,5-11 years ,and> 11 years).Results:Total number of (105) children with acute appendicitis were operated upon in Al-Mustansiria Hospital over a period extending from January 2005 to January 2008.63 (60%) were males and 42 (40%) of the patients were females; and the male to female ratio was 1.5:1. 38(36.2%) children fall into group A, while 67(63%) children fall into group B. Perforated appendicitis was observed in 25 out of the 105 patients (23.8%) when differentiated by age, perforation is more common in young children, both in group A and group B. Perforation were more frequent in group B compared to group A, 21 out of 63 (33.3%) and 4 out of 42 respectively. This was associated with higher incidence of post operative complications, 4 out of 42(9.5%) in group A and 21 out of 63 (33.3%) in group B (p>0.05). Four children from group A with non perforated appendix had wound infection .Of those cases in group A , non had perforation and non had postoperative paralytic ileus .Wound infection was observed in15 out of 63of children in group B(23.8%).Postoperative praralytic ileus was observed in 6 out of 63children in group B(9.5%).Postoperative complication in both groups.Conclusion:Appendicitis is the commonest surgical emergency in children .Diagnosis is mainly clinical .Delay in diagnosis and improper treatment increases morbidity .

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