Using modified Alvarado score in conservative treatment of acute appendicitis

Baderkhan Saeed  Ahmed

doi:10.56056/amj.2017.29

Authors

Baderkhan Saeed Ahmed C.A.B.M.S (surgery). Lecturer: Hawler Medical University-Collage of Medicine-Department of Surgery

DOI:

https://doi.org/10.56056/amj.2017.29

Keywords:

Alvarado Score, Appendicitis

Abstract

Background and objectives: Acute appendicitis is the most common and challenging surgical emergencies. The diagnosis is still based on the clinical examination. The modified alvarado score system isa safe diagnostic modality without extra expense and complications. Efficacy ofantibiotic treatment was often considered as a bridge to surgery inselectedpatients with acute appendicitis aided by using of Modified Alvarado scoring system.

Methods: A prospective clinical trial comparing antibiotics with appendectomy, a total of 424 consecutive patients were enrolled, according to Modified Alvarado Scoring Systemwere divided into three groups: Group A: score between 8-10 (emergency surgery group),Group B: score between 5-7 (conservative group): these patients were subjected to repeated clinical examinations for 24 hours. Group C: scorebetween 1-4, the choice of antibiotic regimen was made by using an intravenous injection of (ceftriaxon 1g x2 and metronidazo l500mg x 3).

Results: out of 424 patients, 206(48.6%) female and 218(51.4%) male. 156(36.8%) patients group A,148 (34.9%) group B, histopathology confirmed appendicitis in 128(82%). patients nine (5.8%) patient in group A revisiting hospital due to complications. Mean hospital stay in group A was lesser than group B. The antibiotic response rate was 91.3%, In group A 12(7.7%) patients had wound infection,while in group B and C seven (4.7%) had complications. Out Of 13 patients in the antibiotic group, nine (6%) underwent appendectomy during the initial hospitalization.

Conclusions: Modified Alvaro Scoring System as a diagnostic tool,can be usedsafely for conservative treatment of patients with acute uncomplicated appendicitis by giving antibiotics only.

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References

Binnebösel M, Otto J, Stumpf M, Mahnken AH, Gassler N, Schumpelick V, Truong S.Acuteappendicitis,Moderndiagnostics–surgical ultrasound.Chirurg;2009, 80(7):579–87.

Hamdi JT. Is There a Place for Conservative Treatmentof AcuteAppendicitis?, JKAU: Med. Sci.,2010;17(1):11-7. 3.O`Connel PR. The vermiform appendix. In: Williams NS, Bulstrode CJ, O`Connel PR, editors. Bailey and Love`s Short practice of surgery. 25th ed. London: Edward Arnold; 2008.1204-18.

PhophromJ,Trivej T. The Modified Alvarado Score versus the Alvarado Score for the Diagnosis of Acute Appendicitis; the THAI Jour of surg, 2005; 26:69-72.

Stephens PL, Mazzucco JJ. Comparison of ultrasound and the Alvarado score for the diagnosis of acute appendicitis. Conn Med, 1999;63:137-40.

Nasiri S, MohebbiF,SodagariN,Hedayat A. Diagnostic values of ultrasound and the ModifiedAlvarado Scoring System in acute appendicitis. International Journal of Emergency Medicine ;2012, 5:26

Alvarado A: A practical score for the early diagnosis of acuteappendicitis. Ann Emerg Med 1986, 15:557–64.

Flum DR, Koepsell T: The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 2002, 137:799–804.

Van Randen A, Bipat S, Zwinderman AH, Ubbink DT, Stoker J, Boermeester MA. Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 2008; 249:97-106.

Mason RJ. Surgery for appendicitis: Is it necessary? SurgInfect(Larchmt) 2008;9:481-8.

Owen A, Moore O, Marven S, RobertsJ. Interval laparoscopic appendicectomy in children. J LaparoendoscAdvSurg Tech A 2006; 16:308-11.

Gillick J, Mohanan N, Das L,Puri P. Laparoscopic appendicectomyafter conservative management of appendix mass.PediatrSurgInt

; 24:299-301

Gillick J, Velayudham M, Puri P. Conservative management ofappendix mass in children. Br J Surg 2001; 88:1539-42.

Andersson R, Hugander A, Thulin A, Nyström PO, Olaison G. Indications for operation in suspected appendicitis and incidence of perforation. BMJ 1994; 8; 308(6921):107-10.

Jones PF. Suspected acute appendicitis: trends in management over 30 years. Br J Surg 2001; 88(12):1570-7.

Andersson R. The natural history and traditional management of appendicitis revisited: spontaneous resolution and predominance of prehospital perforations imply that a correct diagnosis is more important than an early diagnosis. World J Surg 2007; 31(1):86-92.

D`Souza N. Appendicitis. ClinEvid 7 Jan 2011(http://clinicalevidence.bmj.com)

Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2010; 6 ;( 10):CD001546.

VaradhanKK , Neal KR, LoboDN.Safety and efficacy of antibiotics compared withappendicectomy for treatment of uncomplicated acuteappendicitis: meta-analysis of randomizedcontrolledtrials,BMJ2012; 344:e2156

Styrud J, Eriksson S, Nilsson I. Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg; 2006; 30(6): 1033-37.

Marudanayagam R, Williams G, Rees B. Review of the pathological results of 2660 appendicectomy specimens. J Gastroenterol 2006; 41(8): 745-49.

- MemonZA ,Irfan S , Fatima K ,Iqbal MS ,SamiW. Acute appendicitis: Diagnostic accuracy of Alvarado scoring system; Asian Journal of Surgery (2013) 36, 144-49.

- Jalil A, Shah SA, Saaiq M, Zubair M, Riaz U, Habib Y.Alvarado Scoring System in Prediction of Acute Appendicitis;Journal of the College of Physicians and Surgeons Pakistan 2011, Vol. 21 (12): 7.

- Yildirim E, Karagülle E, Kirba? I, Türk E, Hasdo?an B, Tek?am M, Co?kun M. Alvarado scores and pain onset in relation to multislice CT findings in acute appendicitis;DiagnIntervRadiol 2008; 14:14-18.

- Murali U, Anu S. Application of Alvarado Score in Diagnosis of Acute Appendicitis in Patients; Journal of Dental and Medical Sciences, Volume 14, Issue 4 Ver.VI (Apr. 2015),71-73.

- Mui LM, Ng CS, Wong SK, Lam YH, Fung TM, FokKL,et al. Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis. ANZ J Surg. 2005; 75:425-8