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Article
IS PEDIATRIC APPENDICITIS SCORE SUFFICIENT TO MAKE THE DIAGNOSIS OF ACUTE APPENDICITIS AMONG CHILDREN?

Authors: Ali F Abdullah علي فاروق عبد الله --- Firas M Katoof فراس مجيد --- Basim Sh Ahmed باسم شهاب احمد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 2 Pages: 195-199
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Children with acute abdominal pain represent most of the admitted cases to the pediatric surgical department, one third of these cases are acute appendicitis. Early diagnosis of “no appendicitis” or “appendicitis” on the basis of pediatric appendicitis score could potentially save emergency department's time and resource use and could avoid time cost and risks for further evaluation.Objective:Evaluation of Samuel scoring system in diagnosing children with acute appendicitis and their need for surgery.Methods:One hundred and twelve patients aged between 5 to 15 years who presented with abdominal pain suggestive of acute appendicitis were studied. A complete data from patients were analyzed by using Samuel score. The clinical findings used by previously mentioned scoring system were analyzed to determine reliability of pediatric appendicitis score (PAS). The Final diagnosis was determined by histopathological report for patients' undergone appendicectomy.Results:The mean (median, SD) score for children with acute appendicitis and non-acute appendicitis were 4.9 (5, 1.8) and 4.6 (5, 1.7) respectively. No variable (of the known signs and symptoms regarded as pathognomonic for acute appendicitis) shows a significant value in the diagnosis of acute appendicitis. A PAS of ≥ 4 had a sensitivity, specificity, Positive predictive value (PPV), and Negative predictive value (NPV) of 0.78, 0.27, 0.87, and 0.16 respectively.Conclusion:The diagnosis of acute appendicitis and the need for surgery is still a matter of clinical judgment which can be built with practice, and although the PAS could provide useful diagnostic information in children with suspected acute appendicitis, it cannot be used as sole method for determining the need for surgery.Key words:Pediatric Appendicitis Score (PAS), acute appendicitis, appendicectomy.


Article
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
The significance of preoperative white blood cells count and ultrasonography for diagnosis of acute appendicitis

Author: Majeed H. H.AL-amiri مجيد حمود العامري
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2011 Volume: 7 Issue: 12 Pages: 247-253
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background:Appendicectomy is still the most common surgical procedure; but diagnostic failure may still occur & leads to delay in treatment or negative appendicectomy.Objectives of this study:to evaluate value of preoperative white blood cells count &ultrasonography in diagnosis of acute appendicitisPatients and methods:This study had been carried on 588 cases of acute appendicitis. Appendicectomy done for all cases. Over period of 4 years from January 2006-january 2010. the range of age was between 7-76 years.With mean age of (41.5 years).and median age 25 years old. 366 males (62.244%) and 222 females (37.755). ultrasonography done for all patients by our radiologists. white blood cells count performed in our lab.Results:Negative appendicectomy rate was 102 patients (17.346%) this rate was 42 patients (11.475%) for male and 60 patients (27.027%) for female patients. positive appendicitis in 486Increase white blood cells count for acute appendicitis (histological positive result) in 388 patients (79.835%) from the 486 patients.And increase white blood cells count for non-acute appendicitis (i.e. negative histological result) in 52 patients (50.980) from the 102 patients.Conclusion:In spite of the improvement tests for acute appendicitis we could not sufficiently reduce the negative appendicectomy rate. If there is doubt about the diagnosis although leukocyte levels and altrasonographic result are normal, especially for female patients performing further radiologic examination such as CT can be favorable.

تمت الدراسة على 588 مريض مصاب باعراض التهاب الزائدة الدودية،جميعهم تم لهم استئصال الزائدية الدودية بعملية جراحية ،خلال اربعة سنوات من كانون الثاني 2006- الى كانون الثاني 2010 . 366 مريض ذكر و222 مريضة انثى، اعمارهم تتراوح بين 7-76 سنة. جميعهم يشكون من اعراض التهاب الزائدة الدودية مثلا الم حول السرة او الم اسفل الجهة اليمنى من البطن مع تقيء وعدم الشهية للاكل الخ. وتم اجراء فحص سونار البطن لجميعهم, واجراء فحص عدد كريات الدم البيضاء لهم في شعبة الاشعة وشعبة المختبر التابعين للمستشفى .الهدف من هذة الدراسة لمعرفة اهمية اجراء فحص سونار البطن واجراء الفحص المختبري لعدد كريات الدم البيضاء لغرض تشخيص التهاب الزائدة الدودية.وتم استئصال الزائدة الدودية لكل المرضى وارسلت الزائدة للفحص النسيجي للتاكد من حقيقة التهابها من عدمة. وكان هناك 102 مريض ,كانت نتيجة الفحص النسيجي سالبة اي بنسبة%346. 17. وكانوا 42 مريض ذكر و60 مريضة انثى. وتبين ان نسبة اجراء عملية سالبة تقل كلما كان هناك ارتفاع في عدد كريات الدم البيضاء وهناك دلائل على التهاب الزائدة الدودية بواسطة السونار. وتبين وجود نتيجة للفحص النسيجي موجبة في 486 مريض اي بنسبة%653. 82 . زيادة عدد كريات الدم البيضاء في الدم للحالات الموجبة للزائدة الدودية كانت في 388 مريض اي بنسبة%835 .79. وكانت عدد كريات الدم البيضاء في الدم للحالات السالبة في 52 مريض اي بنسبة%980. 50.في 198 مريض اي بنسبة%673. 33 كان فحص السونار سالب. ومن 198 مريض كان 89 مريض اي بنسبة%949. 44 كانت نتيجة الفحص النسيجي موجبة.و390 مريض اي بنسبة%326. 66 كان فحص السونار موجب والفحص النسيجي ل 45 مريض منهم اي بنسبة%538. 11 سالب .


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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Abstract

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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