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MODIFIED ALVARADO SCORE IN CHILDREN WITH DIAGNOSIS OF APPENDICITIS
Mehran Peyvasteh1, Shahnam Askarpour1, Hazhir Javaherizadeh2
1Department of Pediatric Surgery, Imam Khomeini Hospital.
Insights
The modified Alvarado score shows high sensitivity for diagnosing appendicitis in children, but its low specificity means many children may undergo unnecessary surgery. This score aids in identifying potential appendicitis cases but requires further diagnostic confirmation.
Area of Science:
- Pediatric Surgery
- Emergency Medicine
- Diagnostic Accuracy
Background:
- Appendicitis is a frequent surgical emergency in children.
- Predictive scoring systems aim to reduce negative appendectomy rates.
- Accurate diagnosis is crucial for effective pediatric appendicitis management.
Purpose of the Study:
- To assess the diagnostic performance of the modified Alvarado score in pediatric appendicitis.
- Evaluate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the modified Alvarado score.
- Determine the clinical utility of the modified Alvarado score in children undergoing appendectomy.
Main Methods:
- A retrospective analysis of 400 children diagnosed with appendicitis and undergoing appendectomy.
- Application of the modified Alvarado score for pre-operative evaluation.
- Histopathological confirmation of appendicitis.
Main Results:
- Key indicators like anorexia, nausea/vomiting, and rebound tenderness were more prevalent in confirmed appendicitis cases.
- The modified Alvarado score demonstrated a sensitivity of 91.3%, specificity of 38.4%, PPV of 87.7%, and NPV of 51.2% in this pediatric cohort.
- Significant differences in symptom presentation were observed between children with and without appendicitis.
Conclusions:
- The modified Alvarado score exhibits high sensitivity for diagnosing acute appendicitis in children.
- However, the score's low specificity indicates a high rate of false positives, necessitating further diagnostic steps.
- Clinical application requires careful consideration of the score's limitations in pediatric appendicitis diagnosis.
Background:
Appendicitis is one of the most common abdominal emergency. Some predictive scoring systems are recommended to decrease the rate of negative appendectomy.
Aim:
To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of modified Alvarado score in children who underwent appendectomy.
Methods:
Four hundred children with initial diagnosis of appendicitis were randomly selected from patients who underwent appendectomy. Modified Alvarado score was used for evaluation of the appendicitis, that was confirmed using histology.
Results:
Of modified Alvarado score components, anorexia; nausea and vomiting and rebound tenderness were significantly more common in children with positive appendectomy in contrast to patients with negative appendectomy. Sensitivity, specificity, positive predictive value, and negative predictive value for modified Alvarado score were: 91.3%; 38.4%; 87.7%; and 51.2% respectively.
Conclusion:
Alvarado score has high sensitivity but low specificity for diagnosis of acute appendicitis in children.
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